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Rheumatology

Our Department specialises in the diagnosis, treatment and ongoing management of a wide range of conditions which affect the joints and surrounding tissues. 'Conditions treated include arthritis, osteoporosis, connective tissues and other systemic autoimmune diseases'.

We work as a multidisciplinary team of clinical staff, Consultants, GPs with Specialist Interests, Specialist Rheumatology Nurses and Therapists. We are supported by Medical Secretaries and the Booking Team. We all work together to get the best outcomes for our patients. To access the rheumatology service patients need to be referred via electronic referral by their GP or a hospital consultant.

What is Rheumatology?

The rheumatology department offers procedures such as ultrasound scans for diagnosing and monitoring inflammatory arthritis and for guiding intra-articular injections and when appropriate long-term management of:

Rheumatoid arthritis
Is a condition that causes pain and swelling in the joints. Hands, feet and wrists are commonly affected, but it can also damage other parts of the body. Rheumatoid arthritis can make your joints feel stiff and can leave you feeling generally unwell and tired.


Psoriatic arthritis
Causes painful inflammation in and around your joints. It usually affects people who already have psoriasis, a skin condition that causes a red, scaly rash, especially on your elbows, knees, back, buttocks and scalp. However, some people develop the arthritic symptoms before the psoriasis, while others will never develop the skin condition.


Ankylosing spondylitis
Ankylosing spondylitis (AS) is a type of chronic (long-term) arthritis that affects parts of the spine, including the bones, muscles and ligaments.
The symptoms of ankylosing spondylitis can vary, but most people experience back pain and stiffness. The spinal joints and ligaments and the sacroiliac joints (the joints at the base of the spine) become inflamed. Inflammation in the spine can cause pain and stiffness in the neck and back. Sacroiliitis (inflammation of the sacroiliac joints) causes pain in the lower back and buttocks.

Other 'spondyloarthritides 
including 'reactive arthritis' and 'enteropathic arthritis'​​​​​​​


Gout and pseudogout
Gout is the most common type of inflammatory arthritis, and it’s often said to be the most painful. Attacks of gout usually come on very quickly, often during the night. The symptoms of gout are caused by certain chemical processes that take place within your body. In Gout a substance called urate and in pseudo-gout a substance called calcium-pyrophosphate dihydrate, builds up and forms crystals in your joints, which can lead to painful inflammation. Typical symptoms may include intensely painful, red, hot and swollen joints with the skin over the joint appearing shiny and peeling.
 

Systemic Lupus Erythematosis (SLE)
Often known just as lupus, is an autoimmune disease where your immune system produces antibodies that attack your body’s own tissues, causing inflammation. Lupus can affect many different parts of your body. If your heart, brain or kidneys are affected, it can be much more serious, but most people will only have a few symptoms. Many people will find that the symptoms come and go.


Scleroderma
Is a long-term condition that causes your skin to thicken and harden, but it can also affect your internal organs. It’s an autoimmune disease, which means your immune system attacks your body’s own tissues. It’s one of a number of conditions called connective tissue diseases.


Dermatomyositis & Polymyositis
Myositis means inflammation of the muscles (myo = muscle, itis = inflammation). It causes pain and weakness. Polymyositis affects many areas (poly = many), mainly the larger muscles like those around your shoulders, hips and thighs. When polymyositis develops alongside a skin rash, the condition is called dermatomyositis (derm = skin).


Sjogren's syndrome
Sjögren’s (pronounced Shurgren’s) syndrome is a condition that mainly causes a dry mouth and eyes, though it can also cause a range of other symptoms including joint pain and fatigue. There are 2 types of Sjögren’s syndrome:
Primary – when it occurs on its own
Secondary – when it also occur in association with another rheumatic disease such as rheumatoid arthritis, lupus or scleroderma
 

Vasculitis
Vasculitis means inflammation of the blood vessels. It can affect any of the body’s blood vessels, causing a variety of symptoms and potential complications. Inflammation causes swelling of the blood vessel walls, reducing or even blocking the flow of blood to tissues and organs. The main symptom of vasculitis is inflammation, and this can be painful. With many forms of the condition the inflammation is internal and you can’t see it. Because vasculitis takes different forms, the symptoms vary from person to person. Many people with vasculitis feel unwell with fever, sweats, fatigue and weight loss.


Polymyalgia rheumatica
Polymyalgia rheumatica (usually shortened to PMR) is an inflammatory condition that causes many (poly) painful muscles (myalgia), mainly in your shoulder and thigh. If you have PMR you’ll have severe and painful stiffness in the morning, especially in your shoulders and thighs. PMR often strikes suddenly, appearing over a week or 2 and sometimes just after a flu-like illness.


Giant cell arteritis
Giant cell arteritis causes inflammation of the lining of the body’s medium and large arteries (vasculitis). The scalp's arteries (like temporal arteries) can be particularly affected. Symptoms of giant cell arteritis include severe headache, jaw muscle pain while chewing, double vision, scalp-tenderness and vision loss.
It can lead to blindness; hence, it is very important that once suspected it is treated as soon as possible to reduce the risk of blindness. However, in practical terms, this can be difficult because the initial symptoms of giant cell arteritis can often be vague and non-specific


Granulomatosis with polyangitis
Granulomatosis with polyangitis is a kind of vasculitis which can affect various parts of body. It occurs as a result of inflammation of small vessels and may affect any part of body, more commonly upper and lower respiratory tract and the kidneys.


Churg-strauss
Churg-Strauss Syndrome is a rare kind of vasculitis affecting arteries supplying heart, lung, brain, kidney and gut. It is commonly associated with asthma.
 

Osteoporosis
The word osteoporosis literally means porous (spongy) bone. It causes your bones to become fragile, so they break more easily. These fractures most commonly occur in the spine, wrist and hips but can affect other bones such as the arm or pelvis.


Paget's disease
Paget’s disease of bone affects the way that your bone develops and renews itself, causing it to become weaker than normal. InPaget’s disease, the process of renewal and repair is disrupted where bone cells become larger, more active and increase in number causing chaotic bone repair and thus the new bone formed is weaker than
usual as its abnormal in shape and structure. Most commonly affected bones are thigh, shin, pelvis, spine and skull.
 

Meet the team

Marwan Bukhari

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Marwan Bukhari is a consultant rheumatologist at University Hospitals of Morecambe Bay NHS Trust and an honorary senior lecturer at the University of Manchester. His clinical base is at the Royal Lancaster Infirmary. Dr Bukhari trained in rheumatology and epidemiology in Manchester. His research interests include inflammatory arthritis and quality of life in patients with arthritis and osteoporosis. Dr Bukhari is educational lead for medicine for students at Lancaster University and associate director for medical education at the Royal Lancaster infirmary, He is also the co-editor of the journal Rheumatology. He is the northern regional advisor for NRAS.

 

 

Lesley Ottewell

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Dr Lesley Ottewell is a Consultant Rheumatologist at University Hospitals of Morecambe Bay NHS Trust.  She joined the trust in 2011 after completing undergraduate training at Dundee University and specialist training in Newcastle.  During her specialist training she developed an interest in connective tissue disease, in particular scleroderma and she spent some time in research into this condition.  She currently works at both Furness General and Lancaster Royal Infirmary.  Her current interests are the rheumatic causes of interstitial lung disease and connective tissue disease. Dr Ottewell is the Lead Clinician for Rheumatology. 

 

 

 

 

Syed Bilgrami 

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Dr Syed Bilgrami MBBS, MRCGP [International], MRCP, MRCPE has moved from Chester to Lancaster and joined the team in 2017.

He has worked nationally as well as internationally in delivering efficient and effective care to the patients. Dr Syed Bilgrami is a Consultant Rheumatologist who is passionate about delivering evidence based care in a timely manner. He is working across all three sites across Morecambe Bay. He also has another role as an educational & clinical supervisors for junior doctors.  Dr Bilgrami has a clinical and research interest in systemic vasculitis, connective tissue diseases and rheumatoid arthritis. 

 

 

 

Gill Roketzky RGN, MSc, BSc(HONS)

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Gill qualified as a registered nurse at The West Cumberland Hospital in 1982, she also worked in York, before moving back to her home town of Barrow. Gill has spent the last 21yrs working in Rheumatology, mainly at FGH but also Ulverston OPD. She completed her BSc(HONS) nursing degree at The University Of Central Lancashire and her MSc Rheumatology nursing degree at Keele University. Gill has seen the face of Rheumatology change and expand during her time at UHMB, particularly with the newer treatment options available. The majority of her work is within nurse-led clinics, both face to face and telephone clinics. She works mainly with patients diagnosed with inflammatory arthritis and aims to provide patient-centred care, dealing with the physical, emotional and social needs of our patients. This includes educating, monitoring and assessing disease-modifying and biologic drugs. 

Arthritis Research UK
www.arthritisresearchuk.org

Arthritis Research UK list of Condition Information for Patients
www.arthritisresearchuk.org/arthritis-information/conditions.aspx

 Arthritis UK list of Drugs Information for Patients
www.arthritisresearchuk.org/arthritis-information/drugs.aspx

National Rheumatoid Arthritis Society
www.nras.org.uk

South Lakeland and District NRAS Group
https://www.nras.org.uk/groups

National Ankylosing Spondylitis Society
www.nass.co.uk

Lupus UK
www.lupusuk.org.uk

North West Lupus Group
www.northwestlupus.org,uk/support.php

Hypermobility Syndromes Society
www.hypermobility.org

Patient UK
www.patient.co.uk

For more information about rheumatology please visit the NHS website.