New SpA Clinic will help prevent disability due to inflammatory arthritis

A new clinic at the Montreal General Hospital of the McGill University Health Centre (MGH-MUHC) is making it easier for patients with two types of spondyloarthritis — psoriatic arthritis and ankylosing spondylitis – to be treated sooner and prevent serious damage to their joints. The Spondyloarthritis Clinic, also known as the SpA Clinic, was inaugurated in December.

It uses a fast-track referral system from family physicians throughout Quebec to give patients quick access to rheumatologists, specialized testing and personalized therapeutic interventions. Dr. Alexander Tsoukas, rheumatologist at the MUHC and co-director of the clinic with Dr. Michael Starr, answers a few questions about the new clinic.

Why are you treating those two diseases – psoriatic arthritis and ankylosing spondylitis – together?

A.T.: Both diseases belong to the same family, spondyloarthritis. They share similar features in that they affect several joints and tendons throughout the body as well as the spine.  Psoriasis is a common skin disease caused by a dysregulation of the immune system that affects over a million Canadians. A significant proportion – 10 to 20 per cent – of these individuals develop psoriatic arthritis, which can cause inflammation of the joints, tendons, and spine, often leading to chronic pain and disability. Ankylosing spondylitis is an inflammatory disease of the spine which affects up to one per cent of young adults. Chronic inflammation leads to joint damage and fusion of the spine, resulting in pain, restricted range of motion and disability. Unfortunately, the diagnosis can be difficult to make and irreversible spinal fusion often occurs before patients are diagnosed. 

Is the difficulty of diagnosing and the potential results of this the reason fast-tracking is so important?

A.T.: Absolutely. One of our goals is to diagnose patients early and start treatment as soon as possible to prevent damage and disability from occurring. In the case of psoriatic arthritis, we try to establish a program with dermatologists so that they ask certain questions when patients present with psoriasis. If they have inflammatory back pain, i.e. pain that’s worse at night, associated with stiffness in the morning, swollen or tender joints, they should be referred to a rheumatologist for further testing to determine if they have psoriatic arthritis or ankylosing spondylitis.

What services does the clinic offer? 

A.T.: Besides medical treatments, we provide localized corticosteroid injections, therapeutic aspirations of joints, access to diagnostic joint ultrasonography and referral to a network of key medical specialists. Rheumatologists work in close association with other specialists such as radiologists, gastroenterologists, ophthalmologists and dermatologists. We also have a dedicated nurse who provides support and education for patients. In the future, we plan on including physiotherapists and occupational therapists to help patients regain function and return to work. 

You mentioned gastroenterologists and ophthalmologists. Why are these specialists necessary?

A.T.: Many people who have spondyloarthritis often have uveitis, an inflammation of the eyes, and inflammatory bowel disease. We work in close association with physicians who are experts in these types of disorders and can treat patients’ symptoms promptly.

Since the MUHC is also dedicated to teaching and research, how will the clinic contribute in these fields?

A.T.: It’ll be a good opportunity for medical students and residents to learn about diseases they may not be familiar with. The specialized interpretation of physical exams, imaging and blood tests and the application of personalized treatments allows trainees to gain a good understanding of rheumatology as a whole. In addition, we have recently joined the Spondyloarthritis Research Consortium of Canada (SPARCC), which includes physicians and scientists who are world leaders in these disorders. The mission of this organization is early diagnosis and timely management of spondyloarthritis to improve care and quality of life for patients in Canada. By joining and contributing to this internationally-recognized research collaborative, the MUHC will be at the cutting age of treatment and research in this area.