Division of Rheumatology at the University of Cape Town, South Africa.
- HOD and 1 Full time consultant
- 3 sessional Rheumatologists (Drs Abrahams, Botha, Breeds)
- 1 Rheumatology Fellow-South African (2 years),
- Supernumery fellows (2 years)
- 4 Fellowship HPCSA training numbers
- 2-3 Rotating medical registrars (3 months)
- 1 rotating medical officer (4 months)
- 1 sessional medical officer (Dr Latief)
Clinical Activities in Rheumatology
- There are 2 dedicated new patient clinics on a Monday morning and Thursday morning respectively. There are 20 new patient booking slots for Monday morning and 14 new patient and 10 “early follow up” slots on a Thursday morning. All new patients are reviewed by a Consultant.
- Two “Arthritis follow up” clinics on a Monday afternoon and Friday morning. On a Monday afternoon starts at 13:00 and 30 patients booked. On Friday morning there are between 70-85 patients booked.The patients seen in these clinics are mostly diagnosed with RA but also crystal arthropathies, spondyloarthropathies, undifferentiated arthritis, among others. Starts at 8am and finishes around 1 pm.
- A ‘Lupus” clinic on Tuesday mornings---- We see all our Connective Tissue Diseases and vasculitis patients at this clinic. There are 6 additional new patient slots and 40-50 follow up slots.
- The 1st Tuesday of every month at 14:00 is a combined Rheumatology /Orthopaedic clinic. We see about 4-6 patients per month
- The 2nd Tuesday of every month we have a “Biologics clinic”. We have authorisation for the use of monoclonal antibodies for 10 patients currently. We also motivate for Rituximab on a named patient basis and currently have 12 patients receiving this therapy.
- Wednesday afternoon is our weekly Disability grant clinic. 5-10 patients booked.
- On a Wednesday morning we have our Academic ward round and we see all patients that are in patients that Rheumatology has consulted. We continue to review these patients until discharge. On average we see about 10 patients per week.
- We have 2 Rheumatology in-patient beds allocated to us in Ward G16. These are used for stable Rheumatology patients requiring investigations or when we take over management of patients from medical firms.
Academic Activities in Rheumatology
- Wednesday mornings
- Academic presentations by Fellows, Medical Regisrars and Medical officers
- Journal club rotates between consultants, fellows, Medical Regisrars and medical officers
- Monthly Rheumatology/Radiology meeting to review problematic radiology (been happening less frequently in last year due to staff shortages in radiology department)
- Academic ward round (see note under clinical activities)
- External meetings
- Regional SAARA meeting on Tuesday evenings (every 2nd month)
- SARAA National Congress every 2 years
- Department of Medicine Physicians Refresher Course every 2 years
- Department of Medicine Thursday Academic meeting on a rotational basis.
Teaching Activities and materials
- 3rd year seminars (done by Prof Kalla and Dr Gcelu)
- 4th year seminars (done by Prof Kalla and Dr Gcelu)
- 5th year teaching: 4 seminars, 9 clinical tutorials, bedside teaching in rheumatology clinic. End of Block OSCE with Clinical examination station at end of 4 weeks. There is a new group of 5th year students every 2 weeks
- Registrar teaching:
- Rheumatology rotating registrars: mainly in new patient clinics on cases they have seen.
- departmental bedside teaching for FCP II candidates: Friday afternoon at 15:00
- departmental teaching for FCP II candidates on a rotational basis
- Teaching materials:
- Rheumatology handbook
- Rheumatology handbook available as an APP on iphone and Android
- Departmental Facebook page
- Departmental website ( currently under construction)
Patient education and outreach
- Dedicated Rheumatology Sister (Sr. M Phillips)
- Talks for the Arthritis foundation - Lupus day, World arthritis day. These are usually arranged in conjunction with the Arthritis Foundation Western Cape Branch.
- Prof Kalla does outreach at Khayelitsha Day Hospital once a month on a Friday afternoon
- Dr Abrahams does outreach at Gugulethu CHC
- Annual visits to Frere Hospital in the Eastern Cape
- Annual visits to Livingstone Hospital in the Eastern Cape.
- The Isaac Albow Chair of Rheumatology is an endowed Chair within the University of Cape Town. The first incumbent was Professor OL Meyers, who retired in 1995.
- Professor AA Kalla became the Head of Division in 2001.
- The Division of Rheumatology at UCT has developed into a world-renowned academic centre of excellence, treating thousands of patients with RA. Over the 40 or so years of its existence, there have been a number of trainees who have achieved post-graduate degrees including the MMed, FCP Rheumatology (certification), MSc and MD/PhD graduations. Research from the unit has been published in several prestigious rheumatology journals such as “Arthritis and Rheumatism”, “Journal of Rheumatology”, and “Rheumatology”, “Lupus”, to name a few. At least four trainees have gone on to occupy Professorial posts at different institutes around South Africa. There are also post graduates who have developed successful private practice in South Africa, New Zealand, the USA and the UK.
- Professor Kalla, the current Head of Division, graduated as a doctor at UCT in 1975 and qualified as a specialist physician at Chris Hani Baragwanath Hospital in 1979. He started his career in Rheumatology in 1981 and has been employed as a full-time Rheumatologist at GSH since 1984. He obtained his doctorate (MD) at UCT in 1989, based on his dissertation on “Osteoporosis in rheumatoid arthritis”. He developed an interest in many different aspects of post-menopausal osteoporosis and RA. This culminated in a special interest in inflammation-mediated osteopaenia and the possible protective role of glucocorticoids (GC) in these diseases. He was among the earliest researchers to show that bone loss in systemic lupus erythematosus (SLE) was due to the disease rather than therapy with GC. This work has been extensively cited in the literature.
- The Unit has trained over twenty subspecialists in Rheumatology and has supervised a number of students in their post-graduate research towards a doctoral or master’s degree. The Unit is capable of supporting the clinical component of this applicant’s training.
- The Division of Rheumatology has several research interests relating to different aspects of the rheumatic diseases. Osteoporosis is an area of interest for many years and there is ongoing collection of longitudinal bone mineral density data in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Age-related bone loss at different skeletal sites is being prospectively studied in collaboration with the Department of Nuclear Medicine and the Endocrine Unit. Clinical drug trials are in progress to study the safety of the newer biologics in RA, SLE and Scleroferma. We have also looked at systemic lupus erythematosus (SLE) genetics in collaboration with the Hepatology Unit at UCT and are currently developing a lupus Africa database called ALUGEN. The rheumatic diseases unit provides in - and outpatient rheumatology services for the entire Western Cape region. Sessions are carried out at the Heideveld and Khayelitsha Community Health Centres 6 times a year. Training is provided on a continuous basis for medical students, allied health professionals, a senior house officer, and two rotating medical registrars. Research is largely clinically orientated, but a laboratory-based approach is being used to study the genetics of SLE and the pathogenesis of Scleroderma. In addition, there is very significant involvement in clinical drug trials in both rheumatoid arthritis, systemic lupus erythematosus. Collaborative research is being carried out with the renal unit in studying outcomes of lupus nephritis.
- There are great opportunities for newer research orientated to basic sciences and clinical aspects of the rheumatic diseases.