World-class teaching unit focuses on spondyloarthritis (SpA)

Posted on 16 Nov 2021

The Institute of Orthopaedics and Rheumatology places strong emphasis on academic research and teaching.

The Institute of Orthopaedics and Rheumatology (IOR) at Mediclinic Winelands Orthopaedic Hospital, is dedicated to the management and rehabilitation of non-emergency musculoskeletal conditions. As specialist physician Dr Gareth Tarr explains, this world-class unit is always striving to improve its innovation and capabilities in the areas of musculoskeletal and rheumatological care.

“The rheumatology part of IOR offers a dedicated rheumatology practice and rheumatology clinical trial unit,” he says. “We focus on all rheumatological conditions, specifically autoimmune conditions. Our clinical research centre places us at the forefront of medicine development.”

In December this year, IOR will host a preceptorship programme for 15 rheumatology fellows and registrars from Groote Schuur and Tygerberg hospitals. This will consist of interactive lectures, workshops, and visits to the clinic and research units.

The objective of the programme is to improve clinical outcomes for those with, and at risk of developing, ankylosing spondylitis (AS), psoriatic arthritis (PsA) and other types of spondyloarthritis (SpA), Dr Tarr explains. “We aim to do this by training rheumatologists confronted with these uncommon, but complex pathophysiological conditions. The course encompasses SpA diagnostic and management techniques, including treatment options to implement in daily clinical practice.”

Biologics are molecularly engineered drugs designed to control immune conditions in a very specific way. “They’re highly effective but very expensive, and although 30-40% of patients will eventually require them, they need to be on high-paying medical aid plans to be reimbursed for the costs of these medications,” Dr Tarr says.

“When rheumatologists go into private practice, they’re exposed to many more prescription medications – a lot of which they wouldn’t have had access to at a state hospital. Large-scale international congresses often fail to address the challenges of treating SpA patients in many third-world countries. A strong need exists for an Afrocentric approach to the management of SpA, learning from the levels of clinical excellence we have here in South Africa.”

As Dr Tarr adds, the specialists at IOR are passionate about sharing knowledge and teaching. “At IOR, we have specific biologic experience and we want to educate the fellows and junior rheumatologists. We want to give back to the medical community.  “The preceptorship programme will include meeting with a multidisciplinary team of two rheumatologists, an ophthalmologist, radiologist, and spinal surgeon, who work together to fulfil the IOR’s teaching objectives.

Mediclinic Winelands Orthopaedic Hospital, in partnership with IOR, opened in 2019. “Combining rheumatology and orthopaedics made sense as we can optimise both medical treatment as physicians, plus many of our patients needing surgical intervention from the orthopods,” Dr Tarr explains. “All interventions are managed as academically as possible. When working at government hospitals, your time is taken up by seeing patients – and you’re not able to spend as much time doing research. We have a strong emphasis on research, producing academic papers, and teaching.”

Dr Tarr explains the synergy between rheumatologists and orthopaedic specialists: “As we deal with the musculoskeletal system, patients may need orthopaedic input for surgery, after years of arthritis,” he says. “On the other hand, orthopods may have patients with complicated conditions that become purely inflammatory. That’s where rheumatologists step in to control inflammation before it spreads to surrounding joints.” He adds that the IOR set-up works because the continuity of care is quick and it’s easy to get a second opinion. “If I’m dealing with a complicated case, I can walk down the hall, speak to several orthopaedic surgeons and in minutes, a patient can be seen by another specialist. As a unit, we constantly liaise and communicate. We have plans for future preceptorship programmes because we want to continue teaching and sharing knowledge. We hope to break down the traditional bench-to-bedside, bedside-to-bedside and primary care-secondary care silos that have been barriers to a truly integrated, multidisciplinary, patient-centred approach to treating chronic inflammation.”


Dr Tarr is engaged in PhD research on biologic medication in the South African setting, through the University of Stellenbosch.




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