Over 5000 outpatient visits are recorded annually at the adult arthritis clinics of our affiliated hospitals. Children with rheumatic diseases are seen on the consultation services at all four hospitals and there are affiliated Pediatric Rheumatology clinics at Montefiore and Schneider Children's Hospital of the Long Island Jewish Medical Center that can be attended on an elective basis. On the East Campus there is a weekly Arthritis Clinic, weekly Early Diagnosis Clinic and weekly Lupus Clinic. Fellows have the option to attend Hand and Foot Clinics, Rehabilitation Clinics and Podiatry Clinics on an elective basis during the East Campus rotation. On the West Campus there are two weekly Arthritis Clinics at Montefiore, a weekly Arthritis Clinic at NCB, and a weekly Lupus Clinic.
All fellows are required to maintain minimally the equivalent of two full days of clinic for the first 12 months and two half day clinics for the second 12 months for patients with rheumatic diseases. This experience continues with progressive responsibility through the fellowship and is appropriately supervised by dedicated attending faculty members. The goal of this experience is for the fellows to gain expertise in the outpatient evaluation and management of rheumatic problems. The experience provides an opportunity to develop an understanding for the natural history of these conditions over an extended period of time.
- East Campus
Out-patient services are provided by the Division of Rheumatology in two weekly clinics at Jacobi Hospital. The Arthritis Clinic, which meets on Thursday mornings, serves 25-30 patients per session. It is staffed by the 3-4 of the divisional faculty, first and second year Rheumatology Fellows, house staff and medical students on elective or as part of a primary care rotation. This clinic provides long term follow-up for patients with connective tissue diseases and serves as the clinical base for ongoing studies of rheumatoid arthritis and systemic lupus erythematosus. Each Arthritis Clinic patient is assigned to one physician who is responsible for that patient for as long as the patient or the physician attend the clinic; this affords the fellow the opportunity to follow a cohort of patients throughout the 2-3 year period of their training. The fellows see 4-8 patients at each session, with at least one new patient per session; many of their patients were originally seen by them as hospital in-patients. Divisional faculty are present in the clinic and available for consultation at all times.
The Monday morning Early Diagnosis Clinic is directed by Dr. Keiser and attended by the Rheumatology Fellow assigned to the East Campus, house staff and medical students on Rheumatology elective, and two or three primary care residents on a rotating basis. This clinic sees patients referred for rheumatic complaints by the Urgent Care Department and other clinics. It provides screening and short term care services for these patients, as well as instruction and guidance on their management for primary care physicians in training. Ten to twelve new patients are scheduled weekly, with three or four seen by the Fellow. All patients are presented to the group and seen with the clinic attending, so that house staff and fellow are exposed to a broader range of the rheumatic complaints than those presented by their own patients. Patients found to have soft tissue rheumatism are treated with anti-inflammatory medications, physical modalities or local injections usually performed or supervised by the fellow in the clinic. Other patients are sent back to their referring physicians with instructions as to future management, still others are referred to Orthopedics, Physical Therapy or Surgery Clinics for additional evaluation or treatment. The patients found to have a rheumatic disease requiring long-term follow-up by a rheumatologist are referred to the Thursday morning Arthritis Clinic.
- West Campus
The Division of Rheumatology provides out-patient services at both West Campus sites. The Montefiore Arthritis clinic meets every Wednesday morning throughout the year. It begins with a 45-minute Journal club, with articles presented by Fellows and Attendings. The clinic itself runs for 3 hours. Fellows see an average of 5-8 patients per week. Except for systemic lupus, followed at another clinic, the full range of rheumatologic illnesses is seen. This includes rheumatoid arthritis, DJD, MCTD, psoriatic arthritis, scleroderma and variants, myositis, fibromyalgia and soft-tissue rheumatism. The fellows follow their patients regularly, and are responsible for their ongoing management. They are supervised by three Attendings who are available at all times for assistance. At each session there are 3-5 Residents, from Internal Medicine, Social Medicine, and Primary Care residencies. There are also medical students rotating through the clinic. A second Arthritis Clinic was established at Montefiore in 1999 because of increasing patient visits. This clinic is directed by Dr. Tagoe and sees 15-20 patients per week with a similar mix of patients as the Wednesday clinic. This clinic is attended by the West Campus Fellow and one second or third year Fellow.
The Montefiore Lupus Clinic has been in existence for twenty years. There are currently approximately 180 patients with SLE, as well as another 20-30 with antiphospholipid syndrome or overlap syndrome followed in the clinic. The patients are divided among the three to four fellows. New patients and some of the follow-ups are seen by residents and students on rotation. Two full time and one voluntary attending serve as preceptors for the fellows, and oversee all residents and students. Dr. Peeva is the Director of the Clinic. Patients with SLE are referred from all over the Bronx from Montefiore clinics and satellite clinics, private physicians' offices, and after discharge from the hospital. Lupus Clinic meets on a weekly basis, and during 2005, an average of twenty patients were seen weekly, including one or two new consults. All fellows attend Lupus clinic each week and see between four and seven patients in a session. They are each assigned a panel of patients who they follow closely for two years. On a regular basis fellows assess the Lupus Clinic's activity of their patients with SLEDAI scores. Over the past 6 months, electronic SLEDAI have been implemented in the Clinic. The severity of SLE in this largely Black and Hispanic population provides trainees with a good opportunity to see and treat this complicated disease. There is a high-risk obstetrics service at NCB Hospital and fellows are able to closely follow patients with rheumatic diseases along with the obstetrician throughout pregnancy and post-partum periods.
NCB Rheumatology Clinic is held weekly. 10-15 patients are seen per week, 3-5 of these are new consults and the rest are seen for follow up care. The clinic is directed by Dr. Hong Xu and attended by the West Campus fellow and residents and students on elective in rheumatology. The clinic follows patients with the full range of rheumatic diseases, and fellows have the opportunity to observe and treat common forms of soft tissue rheumatism. Patients seen in consultation on the in-patient service at NCB are followed in this clinic after discharge, allowing trainees to follow the course of disease and therapy over the course of time.