Preparing for your first appointment
at ArthritisCARE

Before we can make an appointment for you, we need to have a copy of a referral from your GP or referring specialist
Then once you have your appointment date, please complete our New Patient Information Form
It is also really helpful for your Rheumatologist if you bring the following to your first appointment:

before visit

Any previous lab and/or radiographic x-ray/ultrasound/MRI tests results for your Rheumatologist to review. (Medical records are typically sent electronically to us by your referring GP or specialist, but occasionally, despite best intentions, they do not arrive in time for your appointment).

An up-to-date medication list with the specific dosages you are taking.

before visit

A list of allergies to medications.

It also helps to have a list of medications you have already tried to reduce duplication of prior treatments.

Your family medical history, including any known relatives with rheumatologic/autoimmune disease.

Emergency Care

Before we can make an appointment for you, we need to have a copy of a referral from your GP or referring specialist. Then once you have your appointment date, please complete our New Patient Information Form

It is also really helpful for your Rheumatologist if you bring the following to your first appointment:

  • Any previous lab and/or radiographic x-ray/ultrasound/MRI tests results for your Rheumatologist to review. (Medical records are typically sent electronically to us by your referring GP or specialist, but occasionally, despite best intentions, they do not arrive in time for your appointment.)
  • An up-to-date medication list with the specific dosages you are taking
  • It also helps to have a list of medications you have already tried to reduce duplication of prior treatments
  • A list of allergies to medications
  • Your family medical history, including any known relatives with rheumatologic/autoimmune disease

Frequently Asked Questions

A Rheumatologist is a specialist physician who has expertise in diagnosing and treating diseases of the joints, muscles and bones. Sometimes the term rheumatic disease or ‘rheumatism’ is used to describe this group of diseases.

There are also a number of rarer rheumatic conditions that can affect other parts of the body including the skin, hair and internal organs. These include “lupus”, myositis, vasculitis and scleroderma.

The more common rheumatic diseases include:

  • Rheumatoid Arthritis
  • Psoriatic Arthritis
  • Ankylosing Spondylitis
  • Gout
  • Back and neck pain
  • Osteoarthritis
  • Muscle and tendon injury/tear
  • Tendonitis
  • Fibromyalgia
  • Polymyalgia Rheumatica
  • Bone Disease
  • Osteoporosis
  • Paget’s disease

The following fees will apply for consultations with one of the ArthritisCARE Rheumatologists.

Initial Consultation Fees

  • Our full private rate for an initial appointment is $520 (which comes down to $260.60 after your Medicare Rebate of $259.40 is refunded to you)
  • We offer a reduced consultation fee for our patients on full pensions such as the Aged Pension or a Disability Pension. Please note this reduced fee does not apply to holders of Health Care Cards or Commonwealth Seniors Cards – it’s a special support extended to those on full pensions only.

Follow-up/Review Appointment Fees

  • Our full private rate for a review appointment is $195 (which comes down to $120.75 after your Medicare Rebate of $74.25 is refunded to you)
  • As with our initial appointment consultation fees, we also offer a reduced review appointment fee for our patients on full pensions such as the Aged Pension or a Disability Pension. As above, this reduced fee does not apply to holders of Health Care Cards or Commonwealth Seniors Cards – it’s a special support extended to those on full pensions only.

Telehealth Appointment Fees

  • Charges for our Telehealth appointments vary dependent on the complexity of the condition being discussed with your rheumatologist and the length of time that will be needed to ensure your issues are fully reviewed. We will advise you ahead of your appointment of the fees which will apply.259.40

We don’t bulk bill for appointments with our Rheumatologists. However, we do offer a once-a-week option for you to be seen by a rheumatology Registrar (a doctor who is close to completing his/her advanced training to become a Rheumatologist). You can be seen by the Registrar, and Dr Peter Landsberg will also meet with you for part of that appointment in his role of supervising the Registrar and to check in on your management plan.

We definitely do offer Telehealth or online video consultation appointments. Especially in these times of COVID-19 disrupting our ability to set up face-to-face meetings for our immune-suppressed patients. But, we do very much prefer to see you in person for your first appointment.

We believe that this is critical to ensure that we are able to most accurately diagnose and map out the best management plan for your condition. Some things just can’t be done well online and we pride ourselves on looking after you as best as we can.

After that initial appointment, once we have met with you and we understand you and your condition, we then feel confident that we can move to Telehealth appointments and offer optimal quality for your ongoing personal care plan.

COVID-19 Advice

With COVID-19 now declared a global pandemic, ArthritisCARE will continue to monitor and implement all necessary government recommendations and will do our best to provide a high standard of care to our patients and their families, while at the same time, maintaining a safe workplace for our staff and their families.

For patients that have an upcoming appointment, if you have a fever, cough, sore throat or flu-like symptoms OR have travelled overseas in the last 14 days OR have had close contact with someone diagnosed with, or suspected of having, Coronavirus in the last 14 days, please contact us directly. On phone (07) 3255 1066 or email admin@arthritiscare.com.au for advice.

Likewise, all of our staff will follow the same guidelines to ensure our patients and work colleagues are as safe as possible.

Safety is our number one priority.

Wherever possible we would prefer to review patients via Telehealth consultation. However, if this is not an option for you at this stage, we are still open for regular consultations also. If you are coming onsite for your review or initial consult, please ensure you are not experiencing one of the following symptoms or you may be asked to postpone your appointment on arrival.

  • High temperature
  • Coughing
  • Sore throat
  • Shortness of breath

As advocates of the Australian Medical Association (AMA) our Rheumatologists take the safety of our patients, our staff and their families very seriously. We follow AMA Guidelines for Infection Control, which includes minimising the risk of transmitting viruses including the Novel Coronavirus (COVID-19).

Social distancing

If you are coming onsite for your initial consult or review, we have implemented the following guidelines.

All patients should maintain a 1.5 metre distance from each other and their treating Rheumatologist as well as our administrative staff at all times. We have allocated areas for waiting and have spaced out our onsite reviews where possible to limit thoroughfare onsite.

We recommend all our patients practice social distancing wherever possible, particularly over the next few weeks.

Should patients who become infected with the virus cease their medication?

If patients develop symptoms of any infection, established practice should be followed and immunosuppressive therapy paused for the duration of the infection until they feel well, in consultation with their rheumatology team. For patients on glucocorticoids (steroids, prednisolone) where treatment should not be stopped abruptly, advice should be sought from their treating team.

What precautions should you take?

Patients concerned about the risk of infection are advised to take precautions. In addition, patients should ensure that their vaccinations, such as flu and pneumococcal, are up to date to reduce the risk of secondary infections. However, if you have any queries or concerns please contact ArthritisCARE direct to arrange a telehealth consultation with your treating Rheumatologist.

If you are intending to travel overseas, should you change your plans?

It is strongly advised that immunosuppressed patients, as well the elderly and those with chronic illnesses, limit their travel wherever possible for the foreseeable future. Patients should be directed to the country-specific advice, which can be accessed from the following website.

https://www.smartraveller.gov.au/news-and-updates/coronavirus-covid-19

Australian rheumatology Association

This helpful COVID-19 Information for people with Rheumatoid and other Inflammatory Arthritis, Systemic Lupus Erythematosus (SLE) and other Autoimmune Diseases information is now available and regularly updated by the Australian rheumatology Association.

Coronavirus from the Australian rheumatology Association.

Download a PDF version of this page here.

From the Australian rheumatology Association
As of 7th April 2021

Why is it important for me to have the vaccine?

Some diseases (including rheumatoid arthritis) are caused by the body’s immune system, which usually protects us from infection. When the immune system is affected by arthritis or drugs to treat the condition, the risk from COVID-19 may be increased.

If you get vaccinated, you will be less likely to get COVID-19. Even if you are infected, it is more likely to be a milder illness.

People who catch COVID-19 can become very unwell. Many people will need hospital treatment even if they do not have a health condition.

What vaccination will be available?

Two COVID-19 vaccines are currently available in Australia – the AstraZeneca (Oxford) vaccine and the Pfizer (Comirnaty) vaccine. Both are suitable for rheumatology patients whose immune system may not be strong. The AstraZeneca vaccine is a viral vector vaccine. The Pfizer vaccine uses messenger RNA (mRNA).

Other vaccines are likely to be available in Australia later in 2021. The COVID-19 vaccines which will be available in Australia are safe for people with arthritis and people taking drugs that suppress the immune system, even if the condition is active. This is because none of these is a “live” vaccine.

Australians will not get to choose which vaccine they receive because both are effective and safe.

Protection from COVID-19

Both the AstraZeneca and Pfizer COVID-19 vaccines are very good at stopping serious illness caused by COVID-19.

This is what the trials found:

  • AstraZeneca (Oxford) vaccine: Prevented COVID-19 in about 7 in every 10 people (70%), and with no severe cases from 14 days after the first injection.
  • Pfizer (Comirnaty) vaccine: Prevented COVID-19 in over 9 in every 10 patients (95%) and starts to work around 10 days after the first dose.

Need for a second dose

The AstraZeneca vaccine will require a second dose, usually 12 weeks after the first dose. The Pfizer vaccine will require a second dose, usually 21 days after the first dose.

The first dose does provide some protection. The second dose gives more long-term protection from COVID-19.

Will the drugs that I take for my condition affect the way the vaccine works?

Some people who are taking drugs that suppress the immune system may be given advice to continue avoiding exposure to COVID-19 after they have had the vaccination. This is because their medications could mean their immune system doesn’t respond as strongly to the vaccine as people who don’t take these drugs. This does not mean you should stop your treatment, because this can result in a flare of your condition which puts you at greater risk from COVID-19. Everyone in Australia will need to follow Government advice on reducing the spread of COVID-19, even after they have had the vaccine.

Can I have the influenza vaccination at the same time as the COVID-19 vaccination?

The administration of an influenza vaccine on the same day as the COVID-19 vaccine is not recommended. The preferred minimal interval between an influenza vaccine and the COVID-19 vaccine is 14 days. You do not need to delay your influenza vaccine until you complete the course of two COVID-19 vaccines.

Should I delay my rituximab treatment so that I can have the vaccine?

To ensure the best response to the COVID-19 vaccination, it is recommended that vaccination occurs as far away from a rituximab infusion as possible. Please discuss the timing with your Rheumatologist.

What about other disease-modifying antirheumatic drugs (DMARDs) for e.g. methotrexate? 

Currently, there is no evidence that other DMARDs reduce protection from the vaccine. Continuing DMARDs will often be the safest option to prevent disease flares. Information is being reviewed constantly to inform such recommendations.

Can I have surgery after having the COVID-19 vaccine?

Surgery guidelines recommend people do not have major surgery and vaccines within one week of each other. This is because both surgery and the vaccine can cause a fever.

Can I have the COVID-19 vaccine if I am pregnant or breastfeeding?

These vaccines haven’t been tested during pregnancy. These vaccines are not thought to be a risk to the breastfeeding infant. More information can be found here; https://ranzcog.edu.au/statements- guidelines/covid-19-statement/covid-19-vaccination-information.You can talk to your midwife and/or rheumatology healthcare team if you are not sure what to do.

Can children have the COVID-19 vaccine?

Trials for the vaccine in children have only just begun, so it’s generally not recommended for children under 16. It’s also known that children and young people are at a very low risk of COVID-19 generally. It’s possible these recommendations may change once more adults have had the vaccination.

Are there any side effects?

Some people will get mild side effects. These can include pain where the injection goes in, tiredness, headache and aching of muscles. Serious reactions like allergic reactions are extremely rare. People with a history of severe allergic reactions can be vaccinated but should be monitored for 30 minutes after receiving the AstraZeneca vaccine. If you have any concerns about the vaccine, ask your doctor, nurse or pharmacist.

What about reports of blood clots with the AstraZeneca vaccine?

Experts are examining a small number of reports of people with unusual clots after COVID-19 vaccination with the AstraZeneca vaccine. Almost all reported cases have been in the United Kingdom and Europe. One probable case was reported in Australia on 2 April 2021. This case is being investigated by the Therapeutic Goods Administration (TGA).

Australian authorities and specialists are keeping a close eye on this situation. Please note that at this point in time the recommendations have not changed and that the benefits of the AstraZeneca vaccine continue to outweigh the risk of side effects. For more information go to; https://www.health.gov.au/news/atagi-statement-consumers-specific-clotting-condition-after-covid-19- vaccination

When will people with rheumatology conditions receive the vaccine?

In Australia, we are currently in Phase 1B which includes people with rheumatic diseases (except osteoarthritis and fibromyalgia). General practices and Aboriginal Community Controlled Health Services have appointments available, with numbers increasing over a 4-week period. Phase 1B includes more than 6 million Australians, so please be patient. You can check your eligibility using this Australian government website: https://covid-vaccine.healthdirect.gov.au/eligibility

 Do you still need to have the vaccine if you have had COVID-19?

It is possible for people who have already had COVID-19 to have the vaccine for it. It is not known yet how long the antibodies made by your body in response to COVID-19 last, so a vaccine could offer more protection or boost any antibodies your body has already made.

An Australian Government COVID vaccine fact checker is available at; https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/is-it-true

As more information becomes available, this document will be updated by the Australian rheumatology Association.

Download a PDF version of this advice from the Australian rheumatology Association here.

Other valuable sources of information about the COVID-19 vaccine for Australians with autoimmune conditions include:

Blog Post by Dr Peter Landsberg, Rheumatologist at ArthritisCARE|
Is the COVID-19 Vaccine safe for immunocompromised patients?

Updates on the CreakyJoints Australia website
COVID-19 Vaccine Information for Australians With Autoimmune Conditions – Updated 11 January 2021

From the Australian rheumatology Association
As at 25th March 2020

This is GENERAL advice. If you have specific questions, please contact your specialist.

We understand that many of you are feeling particularly vulnerable and anxious because you have chronic illnesses and take medications that may affect the immune system, so we hope that this information will help.

So far, studies of the outbreak in Wuhan have NOT found that immunosuppressive treatments prescribed for rheumatology patients are a risk factor for higher mortality. However up-to-date information is being continuously monitored.

Risks to date have been identified as people with the following:

  • Over 70 years of age
  • Chronic heart or lung disease
  • Diabetes
  • High blood pressure

What should I do if I am well?

Do NOT stop your medications. There is no evidence to suggest that WELL patients, without fever or signs of infection should change or stop any of their regular prescribed medications including:

  • DMARDs: methotrexate (including Trexject injections), hydroxychloroquine (Plaquenil), leflunomide (Arava), sulfasalazine (Salazopyrin), azathioprine (Imuran), mycophenolate (CellCept, Myfortic)
  • Biologics (bDMARDs): adalimumab (Humira), etanercept (Enbrel, Brenzys), golimumab (Simponi), abatacept (Orencia), certolizumab (Cimzia), tocilizumab (Actemra), infliximab (Remicade, Inflectra) or targeted DMARDs (tsDMARDs) e.g. baricitinib (Olumiant), tofacitinib (Xeljanz)
  • Anti-inflammatories: celecoxib (Celebrex), ibuprofen (Brufen), meloxicam (Mobic), naproxen (Naprosyn)
  • Steroids: prednisone or prednisolone

The COVID-19 pandemic may last months, so if you stop your medicine you may have a flare and need to restart or have to take more intensive treatment with steroids. We do not recommend stopping your rheumatology medication. Do not stop steroids suddenly or you may become very unwell.

If you are on these medicines and have risk factors for COVID-19 noted above, or have had a history of recurrent infections while on these medicines, it is especially important to take actions to reduce your risk of exposure and you should socially isolate to protect yourself.

If you are on a biological medication and someone close to you has a confirmed COVID-19 infection, talk to your GP or Rheumatologist about delaying your next dose.

What should I do if I get sick?

If you think you have been exposed or have developed symptoms, seek medical advice from your general practitioner. If you have fever, sore throat, shortness of breath or cough, CALL FIRST and tell them you are on immunosuppressive medications. You can also call the National Coronavirus Health Information Line 1800 020 080 or your state or territory public health agency and they will be able to advise you.

If you are acutely unwell, please call an ambulance as you would do normally in an emergency situation.

If you develop symptoms of any significant infection, established practice is to pause immunosuppressive medicines for the duration of the infection in consultation with your rheumatology team. It you are on steroids (prednisone) do not stop abruptly. Seek advice from your treating team.

If you have questions about your immune suppressing medications, contact your Rheumatologist/Immunologist or other prescribing specialist for advice.

What if I am a health professional but also have a rheumatic condition?

You should ensure your line manager/clinical lead, occupational health and treating Rheumatologist are all aware of your medication and scope of practice.

What can I do to help prevent the spread of coronavirus?

IT IS VITAL THAT EVERYONE IN AUSTRALIA FOLLOWS THE GENERAL PUBLIC HEALTH ADVICE

Avoidance of all non-essential contact with people is recommended. This includes:

  • exercise personal responsibility for social distancing
  • working from home if possible
  • avoiding public spaces
  • avoiding unnecessary travel
  • using telehealth/phone to communicate with doctors where possible (see below)

Excellent personal hygiene is needed including the following:

  • Wash your hands frequently with soap and water, before and after eating, after going to the toilet, after being out in general community areas (schools, shops, after touching lifts, escalators, shopping trolleys etc)
  • 20 seconds with soap and water is needed; use hand sanitiser if water is not available
  • wash the backs of your hands, tips of your fingers, thumbs and wrists
  • sneeze/cough into a disposable tissue or your elbow and then wash your hands, please dispose of tissues and use alcohol-based hand sanitiser
  • limit touching your face
  • sanitise your phone, computer and work surfaces regularly.

There is no evidence to suggest that you should wear a mask unless you are advised by a health care professional to do so. Gloves do not replace the need to wash your hands as above.

What about vaccinations?

  • It is really important your vaccines are kept up to date.
  • Flu vaccination when available and appropriate (early April 2020)
  • Consider pneumococcal vaccination– please discuss this with your GP

What about supply of medications?

Australian medications are sourced widely. There have been reports of supply issues with some medications such as hydroxychloroquine (Plaquenil) and sulfasalazine (Salazopyrin). There are now measures in place to ensure adequate provision for those needing the medications for approved indications. Some pharmacies may ask for a letter to confirm you are taking the medication for an approved indication. Your Rheumatologist can supply that if needed. Please do not stockpile.

What about appointments and blood tests?

If you are on a b/tsDMARD, due to the exceptional circumstances, you do not have to see your Rheumatologist face to face for a repeat prescription. Seek a review via the phone or telehealth. COVID-19 bulk billed Medicare items numbers have been created; please contact your Rheumatologist as soon as possible if you are under financial stress.

If you need blood tests, there are now Medicare rebates which may allow you to have these collected at home.

As your health care providers all members of the Australian rheumatology Association, (Rheumatologists, nurses, physiotherapists, exercise physiologists and other allied health providers), are keen to provide you with information about the COVID-19 (Coronavirus) situation. As more information becomes available, this document will be updated.

For the latest advice, information and resources, please refer to Department of Health.
https://www.health.gov.au/resources/collections/novel-coronavirus-2019-ncov-resources

There are resources available for both health professionals and public. There are also resources available in Farsi, Italian, Arabic, Vietnamese, Korean, Simplified and Traditional Chinese.

National Coronavirus Health Information Line 1800 020 080 – operates 24 hours, seven days a week. If translation or interpreting services needed, call 131 450.

The phone number of your state or territory public health agency is available at
https://www.health.gov.au/about-us/contact-us/local-state-and-territory-health-departments

Download a PDF version of this advice from the Australian rheumatology Association here.
Version 3, 25th March 2020

IF YOU ARE WELL

There is no evidence to suggest that WELL patients, without fever or signs of infection should change or stop any of their regular prescribed medications including:

  • Usual DMARDs (methotrexate, hydroxychloroquine, leflunomide, mycophenolate, azathioprine, sulfasalazine)
  • Biologics (bDMARDS) eg. etanercept, adalimumab etc or targeted DMARDS
  • (tDMARDS) eg. tofacitinib, baricitinib
  • Anti-inflammatories (ibuprofen, meloxicam, celecoxib etc)
  • Steroids (prednisone or prednisolone)

If you are on a biologic medication and someone close to you is proven to have COVID infection, talk to your GP or Rheumatologist about delaying your next dose.

We encourage our patients to get the annual Flu vaccination when available.

We would also recommend following general public health advice including:

  • Frequent handwashing
    • before eating and after being out in general community areas (schools, shops, after touching lifts, escalators, shopping trolleys etc)
    • 20 seconds with soap and water (hand sanitiser if this is not available)
  • Sneeze/cough into a disposable tissue or your elbow and then wash your hands
  • Limit touching your face
  • Sanitise your phone, computer and work surfaces regularly
  • Avoid crowds and sick people (e.g. concerts, church services, sporting events, etc)

IF YOU GET SICK

We recommend patients seek medical advice from either their usual general practitioner or hospital emergency department.

If you have fever or cough, we suggest you CALL FIRST and tell them you are on immunosuppressive medications.

If you are an older adult with a chronic illness or you are taking medications that affect your immune system you may be at a higher risk of more serious COVID-19 disease. If you are at increased risk, it is especially important to take actions to reduce your risk of exposure. If you think you have been exposed or have developed symptoms, you should also contact your doctor early in the course of your illness, even if it is mild, and let them know if you are taking immune-suppressing drugs.

MEDICATIONS

Currently, there is no need to stockpile medications as Australian medications are sourced widely.

This is GENERAL advice. If patients have specific questions about their situation, they should discuss this with their specialist.

For the latest advice, information and resources, please refer to Department of Health.

https://www.health.gov.au/resources/collections/novel-coronavirus-2019-ncov-resources

National Coronavirus Health Information Line 1800 020 080 – operates 24 hours, seven days a week.

Published by the Australian rheumatology Association
As at 17th March 2020

Medication Information

The Australian rheumatology Association (ARA) and Arthritis Australia are pleased to provide the following patient information, for your easy access and downloading.

The development of the Medicine Information Sheets has been a collaborative effort between many members of the ARA in consultation with Arthritis Australia and Communicating for Health, Victoria.  Major credits must go to the past and present members of the ARA Therapeutics Committee for their efforts in delivering these most useful sheets to us.  They have recently been extensively revised using feedback from patients focus groups and new information. We would welcome any feedback on the sheets and where they could be improved for future updates.  Comments can be forwarded to the ARA Secretariat: admin@rheumatology.org.au

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