Head of Division & Senior Consultant
Senior Consultants
Consultants
Associate Consultant
Visiting Consultants
Senior Residents
Clinical Fellows
Rheumatology Nurses
Allergy Nurses
Honorary Nurse Clinician
Pharmacists
Rheumatology Specialist Outpatient Clinics
Our Rheumatology specialist outpatient clinics operate daily at the Medicine Clinic at Medical Centre (Level 13). Patients receive support from our experienced nurse educators, clinic nurses and allied health staff. Joint aspiration and injection procedures may be performed if required. We provide comprehensive care for a wide range of conditions including:
• Inflammatory arthritis such as rheumatoid arthritis, spondyloarthritis (e.g. ankylosing spondylitis, psoriatic arthritis, reactive arthritis and enteropathic spondyloarthritis), adult patients with juvenile idiopathic arthritis
• Connective tissue disease including systemic lupus erythematous, sjögren’s syndrome, systemic sclerosis, inflammatory myositis, mixed connective tissue disease, overlap connective tissue disease
• Antiphospholipid syndrome
• Systemic vasculitis including takayasu’s arteritis, giant cell arteritis and polymyalgia rheumatica, polyarteritis nodosa, ANCA-associated vasculitis (granulomatous polyangiitis, microscopic polyangiitis and eosinophilic granulomatous polyangiitis), Behcet’s disease, cryoglobulinemic vasculitis
• Crystal arthropathies including gout and pseudogout
• Osteoporosis
• Osteoarthritis
• Soft tissue rheumatism
• IgG4-related disease
• Sarcoidosis
• Relapsing polychondritis
• Still’s disease
• Autoinflammatory syndromes e.g. VEXAS syndrome
In addition to our general Rheumatology clinics, we offer subspecialty, multidisciplinary clinics and allied health-led clinics to provide holistic care.
Subsepecialty Clinics
Early Access Inflammatory Arthritis Clinic
Patients with suspected inflammatory arthritis are given expedited access to this clinic for early diagnosis and treatment. Point of care ultrasound and joint aspiration / injection procedures may be performed as appropriate.
Lupus Clinic
Patients with severe systemic lupus erythematosus (SLE) may have multisystem disease requiring frequent follow-up and multidisciplinary care. This clinic provides fast-track and comprehensive care for these patients with the support of our allied health professionals. Patients are also given early-access to cutting-edge treatment including involvement in clinical trials.
High Risk Pregnancy Clinic
Our patients with rheumatic disease are at higher risk of foetal and maternal complications during pregnancy. This clinic specialises in managing patients with rheumatic diseases who are pregnant, planning to conceive or are undergoing assisted reproductive treatments. Close partnership with Obstetrics is maintained throughout pregnancy and peri-partum to optimise care. Many of our patients have gone on to have successful pregnancies – click here to find out about one such patient who was featured on The Straits Times.
Combined Connective Tissue Disease - Interstitial Lung Disease (CTD-ILD) Clinic
This clinic specialises in care for patients with interstitial lung disease (ILD) associated with various connective tissue diseases (CTD). ILD consists of a diverse group of lung conditions caused by inflammation and scarring. If not treated early, patients with CTD-ILD may develop worsening symptoms (such as cough, shortness of breath and activity limitation) which can progress to respiratory failure. Patients receive coordinated care by our rheumatologist and respiratory physician in this combined clinic. Additionally, nailfold capillaroscopy may be performed.
Combined Eye-Rheumatology Clinic
This is a monthly subspecialty clinic where our rheumatologists and ophthalmologists concurrently review patients with complex autoimmune eye conditions. Holistic care is provided to prevent irreversible vision loss and manage associated co-morbidities.
Allied-Health Led Clinics
1. Immunotherapeutics Clinic
A pharmacist-led clinic monitoring patients on medications for inflammatory and autoimmune diseases. Medications include conventional antirheumatic drugs like methotrexate and azathioprine, as well as newer biologic therapies such as monoclonal antibodies and targeted synthetic antirheumatic drugs. Our trained pharmacists closely monitor potential side effects and perform dose adjustment to optimise treatment efficacy for every patient.
2. Gout Telemedicine Virtual Monitoring Clinic (VMC)
A pharmacist-led clinic providing virtual care for patients with gout, enabling remote monitoring and medication delivery. Blood tests may be arranged at the hospital or at the patient’s nearest polyclinic, with medication delivered to the patient’s doorstep after consultation.
3. Rheumatology Nurse Education Clinic
Our passionate specialty nurses provide counselling and support for our Rheumatology patients to improve their disease understanding. They empower patients to better manage and cope with their condition. For selected conditions, our nurses provide additional support through a helpline service.
Specialised Services: Joint Aspiration / Injection, Musculoskeletal Ultrasound and Nailfold Capillaroscopy
Joint Aspiration / Injection Service
Our rheumatologists are skilled in performing aspiration (removing fluid) and injection procedures for various joints. Removing fluid from a swollen joint allows us to determine the cause of the swelling and aids in relieving pain. Steroid / local anaesthetic medications may be injected into the joint or surrounding soft tissue to reduce pain and inflammation. These procedures may be performed on the same day as the Rheumatology consultation as part of the diagnostic evaluation and treatment. Ultrasound-guided procedures may be performed in select situations (see below). Additionally, we provide training for our Internal Medicine residents and non-rheumatologists to gain proficiency in these procedures.
1. Ultrasound Clinic
This weekly service offers musculoskeletal ultrasonography by our rheumatologists, aiding in the diagnosis of various inflammatory arthritis types such as rheumatoid arthritis, spondyloarthritis, crystal arthritis, and osteoarthritis.
2. Point of Care Ultrasound
We provide bedside ultrasound service in the inpatient and outpatient settings.
3. Ultrasound-Guided Joint Aspiration and Injection
Our trained specialists provide ultrasound-guided joint aspiration / injection services, which may be employed in joints that are less easily accessed through the general joint aspiration / injection procedure.
Nailfold Capillaroscopy Service
This is a fortnightly clinic where our rheumatologists perform nailfold capillaroscopy to look at the small blood vessels (capillaries) around the fingernails. This aids in evaluation of Raynaud’s phenomenon and various connective tissue diseases such as systemic sclerosis and dermatomyositis.
Immune-related Toxicity Team and CAR-T Steering Committee
Immune-related Toxicity (IrTox) Team
Immunotherapies are increasingly used in the treatment of cancers and have led to improved outcomes. However, these treatments may be complicated by immune-related adverse events (irAE) which may affect multiple organ systems and require urgent treatment. Managing these irAEs requires specialised, multidisciplinary expertise to ensure timely diagnosis and appropriate intervention. This led to the formation of the immune-related toxicity (IrTox) Team, a multidisciplinary team of physicians who provide real-time collaborative care for these patients. The team is helmed by Rheumatology and supported by Oncology (National University Cancer Institute, Singapore).
CAR-T Steering Committee
Chimeric antigen receptor (CAR) T-cell therapy is a novel advanced treatment used in the treatment of certain cancers. It works by re-programming the body’s T cells (a type of white blood cell) to recognise and destroy cancer cells. CAR-T cell therapy has also been used to treat various autoimmune diseases by reprogramming T cells to destroy immune cells that produce autoantibodies which cause autoimmune disease. The CAR-T Steering committee is led by Rheumatology and Haematology (National University Cancer Institute, Singapore), and is dedicated to prioritising clinical trials and investigator-initiated studies of CAR-T cell therapy for the treatment of autoimmune diseases and cancer.
Allergy Clinic
There is a trend for an increase in allergic diseases worldwide. This can range from mild allergies to severe allergies, which can be life threatening is not recognised and treated.
Patients may suffer from allergies to environmental agents such as dust mite and pollen, medications, and food. The workup of allergies relies heavily on the patients’ symptoms. Hence, prior to any allergy testing, a careful history is taken to ensure that the tests are individualised to each patient.
Testing may include skin tests (such as prick tests, intradermal and patch tests), blood tests, provocation tests, as well as exercise tests. Different agents and allergic symptoms may be tested through different modalities.
In selected allergic disease, a treatment called immunotherapy (a process to allow the patient to better tolerate the substance that they are allergic to) may be recommended.
Our Allergy clinics are located at Medical Centre Level 3 and are run by a multidisciplinary team of doctors, nurses and pharmacists.
Combined Immunology Clinic
Patients with immunodeficiencies have weakened immune systems and are more susceptible to recurrent infections and autoimmune manifestations. These conditions can be present at birth (congenital) or acquired later in life. Care for this complex group of patients is provided by our immunologists in this clinic. We collaborate with the paediatric immunologists, infectious disease specialists, geneticists and respiratory doctors to ensure patients with immunodeficiencies in childhood are smoothly transited to the adult Clinical Immunology service.
Since 2009, OPIC has provided specialised infusion medications for various medical conditions. The availability of this service has allowed patients to receive their infusions without needing to be admitted to the hospital. This minimizes the time patients need to take off work. Operated by specially trained nurses, the centre has conducted over 6000 infusions and supports specialties within the Department of Medicine and beyond. OPIC is located at Medical Centre Level 3.
1. What is Rheumatology?
Rheumatology is a medical specialty that focuses on diagnosing and treating musculoskeletal diseases and systemic autoimmune conditions (also known as rheumatic diseases). The immune system usually functions to protect our body from harmful infections caused by organisms like bacteria and viruses. Autoimmune conditions develop when the immune system mistakenly attacks the body instead. Any part of the body may be affected. Rheumatologists are the specialists that manage such conditions.
2. What symptoms should I see a rheumatologist for?
Patients with autoimmune conditions may experience varied symptoms depending on which organ system is affected. Common symptoms include joint pain and swelling, early morning stiffness, persistent fatigue, unexplained rashes, or recurring fevers. These symptoms usually occur over several weeks to months. If you're concerned, book an appointment to discuss your condition with a specialist.
3. What are common conditions treated by a rheumatologist?
Rheumatologists manage diverse conditions, including but not limited to:
• Inflammatory arthritis such as rheumatoid arthritis, spondyloarthritis (e.g. ankylosing spondylitis, psoriatic arthritis, reactive arthritis and enteropathic spondyloarthritis), adult patients with juvenile idiopathic arthritis
• Connective tissue disease including systemic lupus erythematous, sjögren’s syndrome, systemic sclerosis, inflammatory myositis, mixed connective tissue disease, overlap connective tissue disease
• Antiphospholipid syndrome
• Systemic vasculitis including takayasu’s arteritis, giant cell arteritis and polymyalgia rheumatica, polyarteritis nodosa, ANCA-associated vasculitis (granulomatous polyangiitis, microscopic polyangiitis and eosinophilic granulomatous polyangiitis), Behcet’s disease, cryoglobulinemic vasculitis
• Crystal arthropathies including gout and pseudogout
• Osteoporosis
• Osteoarthritis
• Soft tissue rheumatism
• IgG4-related disease
• Sarcoidosis
• Relapsing polychondritis
• Still’s disease
• Autoinflammatory syndromes e.g. VEXAS syndrome
4. What tests are performed during a Rheumatology consultation?
Your rheumatologist will perform a thorough clinical assessment with history taking and physical examination. Further tests will depend on clinical need, and may include blood tests, imaging (like X-rays or ultrasound scans) and joint aspiration. Your rheumatologist will discuss with you in further detail.
5. How is rheumatoid arthritis different from osteoarthritis?
Rheumatoid arthritis is an autoimmune condition that causes inflammation in the joints, while osteoarthritis is caused by wear and tear of the joint cartilage. The treatment approach for each differs, so it’s important to get a correct diagnosis. Please refer to the following pages for more information:
Rheumatoid arthritis
Osteoarthritis
1. Can a blood test detect what allergies I have?
Testing may include skin tests (such as prick tests, intradermal and patch tests), blood tests, provocation tests, as well as exercise tests. Different agents and allergic symptoms may be tested through different modalities. It is important to tailor the tests to the patient’s symptoms. Hence, the Allergy doctors will speak to you about your symptom history before recommending appropriate tests. Often times, a provocation test (eating the food or medication that is being tested, while being observed) is needed to complete the test.
2. Can allergies be cured?
The scientific understanding on how to ‘cure’ and allergy is still evolving. In selected allergic disease, a treatment called immunotherapy (a process to allow the patient to better tolerate the substance that they are allergic to) may be recommended. Often, this may require prolonged treatment (up to 5 years for some types of allergies).
3. What symptoms point to allergies to food?
Allergy symptoms typically appear quickly after consumption of the allergenic food (usually within minutes to short hours). Most commonly, patients may present with wheals, redness, and swelling (of the eyes, lips or hands/feet). In severe allergies, patients may have breathlessness, abdominal pain and low blood pressure (patients may feel giddy).
Several non-allergic conditions may lead patients to suspect allergies. Examples include lactose intolerance (abdominal pain and diarrhoea on consuming dairy), caffeine intolerance (palpitations / heart beating very fast when consuming caffeine containing products), and certain bowel diseases which are exacerbated on wheat consumption (Celiac disease). If your symptom history points toward these, allergy tests may not be helpful.
If you're experiencing joint pain, inflammation, or symptoms of an autoimmune condition, don’t wait to seek help. Our Rheumatology and Allergy team is here to provide expert care and support tailored to your needs. For more information or personalised advice, feel free to reach out.
