The COVID 19 Pandemic-the Final Straw for Irish Rheumatology Services?

Introduction:

The COVID-19 pandemic has caused disruption to the worldwide provision of acute and chronic care to patients. The effect has been particularly marked in rheumatology in Ireland, where the ability to provide acute and chronic care has been dramatically curtailed due to the combined effects of social distancing, staff redeployment and the repurposing of rheumatology units. Prior to the pandemic, there were significant challenges from an infrastructural and staffing level in Irish rheumatology.

Methods:

Using a questionnaire, the authors evaluated the effect of the first wave of the COVID 19 pandemic on rheumatology services.

Results:

Responses from 87% of Rheumatology specialist services in Ireland indicate that 83% of review appointments were remote, with 87% of new patient assessments in OPD were “in person”. Only 41% of usual outpatient activity could occur within existing infrastructure given guidelines re social distancing which would result a shortfall of 42000 patient appointments. Significant numbers of staff were reassigned from Rheumatology to services elsewhere.

Conclusion:

The COVID-19 pandemic has had a significant negative impact on access to struggling Irish Rheumatology services. Implementation of agreed recommendations for augmenting services must occur urgently.

Establishing Benefit from Vitamin D Supplementation - Adherence to Defined Criteria and Targeting of High-Risk Groups Essential?

BACKGROUND

Vitamin D is the one of the most common nutritional deficiencies worldwide, and insufficiency or deficiency can be associated with musculoskeletal and non-skeletal conditions such as cancer, cardiovascular disease and diabetes mellitus.

OBJECTIVE

Recent data suggests that Vitamin D is relatively safe and toxicity is rarer than previously indicated. However, international guidelines regarding dosage and target plasma levels are conflicting. Moreover multiple well-designed studies of healthy older adults, unselected in terms of Vitamin D status, have revealed largely negative results (with the possible exception of older patients in care homes/hospitals) in terms of improvement in musculoskeletal and non-skeletal conditions to date.

CONCLUSION

On that basis, it is suggested that future trials regarding Vitamin D supplementation should be carried out in high-risk groups. The use of published criteria for evaluating the effect of nutrients and targeting of individuals with Vitamin D insufficiency and deficiency for inclusion in such studies is also proposed. The identification of specific subgroups that will benefit from supplementation and replacement, and the establishment of a scientific basis for such therapy, should be possible with this approach.

Accessory navicular syndrome as a cause of foot pain during stroke rehabilitation

Although usually asymptomatic, an accessory navicular bone can lead to medial foot pain, especially in younger people engaged in high impact sports. In many such cases, the tendon of posterior tibialis (which inverts and plantarflexes the foot) inserts onto the accessory bone resulting in greater strain on the tendon. In the present case, pain due to an accessory navicular bone first developed during stroke rehabilitation in a 69-year-old man. The relative overactivity of posterior tibialis in strokes involving the leg and overuse due to active rehabilitation were likely contributors. An accessory navicular syndrome should be considered as a cause of medial foot pain in patients following a stroke. As in our case, conservative management with rest, ice and elevation is usually successful.