Resources

This page contains resources that have been developed by NZRA members.

On this page are materials for those interested in NZRA Research Grants and on intra-articular and soft tissue injections and our DAS28 instructional video.

Research with the New Zealand Rheumatology Association

 

An objective of the NZRA is to encourage research in rheumatic diseases.

If researchers wish to partner with the NZRA in rheumatology research, please contact Chair of the NZRA Grant Committee for further information: grants@rheumatology.org.nz

For research that involves surveying NZRA members, the following information is required:

  1. Contact details of study Principal Investigator
  2. Lay summary of study
  3. Documentation of ethical approval
  4. At the end of the study, a study report should be sent to the NZRA secretary for dissemination to the NZRA membership.

 

For research that involves recruitment of patients through NZRA members, the following information is required:

  1. Contact details of study Principal Investigator
  2. Lay summary of study
  3. Documentation of ethical approval by a New Zealand ethics committee
  4. Confirmation that all locality and other regulatory approvals will be obtained prior to study initiation at each study site in New Zealand
  5. At the end of the study, a study report should be sent to the NZRA secretary for dissemination to the NZRA membership.
Arthritis New Zealand-New Zealand Rheumatology Association position statement – COVID-19 vaccination in patients with inflammatory arthritis and related autoimmune diseases

 19th February 2021

Studies published to date have not shown that use of oral disease-modifying anti-rheumatic drugs (DMARDs) and biological therapies for arthritis increase the risk of infection, hospitalization or mortality caused by the SARS-CoV-2 novel coronavirus.

Use of prednisone greater that 10 mg per day was, however, associated with an increased risk of hospitalization due to COVID-19 infection.

Previous studies have shown that patients with poorly controlled inflammatory disease are at increased risk of infection.

It is therefore recommended that people with inflammatory arthritis continue to take DMARDs and biological therapies during the current pandemic, and try to minimize use of corticosteroids such as prednisone. 

Research is currently underway to determine the safety and effectiveness of vaccines against the novel coronavirus in patients with rheumatoid arthritis. The results will not be available until later this year.

In the meantime, patients with inflammatory arthritis, including those taking oral DMARDs and biological therapies, have been receiving the COVID-19 vaccine in countries where this is available.

If inflammatory arthritis or its treatment are associated with adverse effects or poor immune responses to vaccines, we should get an early indication of this through the usual reporting channels.

New Zealand is currently in the fortunate position of not having uncontrolled community transmission, and is able roll out its vaccination program in a measured and cautious manner, responding to data from overseas as it becomes available.

The American College of Rheumatology (ACR) has released a COVID-19 vaccine clinical guidance, which recommends (among other things) that patients with auto-immune and inflammatory rheumatic disease should be given priority in the “vaccine queue”. It says that inflammatory arthritis is not a contraindication, i.e. not a reason to avoid vaccination. It says that the response to the vaccine may be somewhat less in this group, and that there is a theoretical risk that disease may flare to some extent after vaccination. Any of the approved COVID-19 vaccine would be appropriate, and in the case of multi-dose vaccines, the follow-up dose(s) should be given. Household contacts should also be vaccinated.

The ACR recommends that methotrexate should be withheld for one week after each vaccine dose, for those with well controlled disease. For patients on rituximab, it is recommended that the vaccine series is initiated approximately 4 weeks prior to next scheduled rituximab cycle. These recommendations have been made to increase the effectiveness of the vaccine rather than due to concerns about safety.

It is important to note that none of the COVID-19 vaccines is 100% effective and that vaccination is not a substitute for public health measures currently in place, such as hand-washing, distancing, and isolation and testing when you have COVID-19 symptoms. 

NZRA Position Statement on Stem Cell Therapies for Arthritis Management

The NZRA is currently working with the Australian Rheumatology Association and Canadian Rheumatology Association on a joint position statement on stem cell therapies for arthritis management. 

The current Australian Rheumatology Association Position Statement on Stem Cell Therapies is available here

The current Royal Australasian College of Surgeons Position Paper on Stem Cell Therapy is available here.

NZRA Position Statement on intra-articular and Soft Tissue Injections

AIM: The purpose of this statement is to comment on current standard practice of intra-articular and soft-tissue steroid injections performed by Rheumatologists in New Zealand.

PREAMBLE:
Intra-articular and soft tissue steroid injections will be referred to as “injections” in this statement.

Injections are used frequently by Rheumatologists to assist with management of a number of musculoskeletal conditions. Injections can be effective in controlling symptoms in many conditions and have a low risk of complications including infection [1]. Joint aspiration is also an important procedure for diagnostic purposes for example infection, haemarthrosis and crystal arthritis.

Injections and joint aspiration are performed as a standard out patient office based procedure by Rheumatologists.

Rheumatologists are trained to perform injections during Physician training and particularly during their advanced training. In Rheumatology [2], a “no touch”, “clean” or “aseptic” technique is used widely in New Zealand, Australia and internationally, however no standard definition currently exists [1,3]. Hand preparation with hand washing or use of alcohol, and skin preparation with alcohol appears to be effective preparation for most procedures [1,3].

Use of full surgical gowning, gloves and draping is not standard procedure for injections and would add significant costs to this procedure with no improved outcome for the patient [1,3]. Delays or deferral of injections by such full surgical procedure may result in an adverse outcome for the patient.

Use of sterile equipment is essential [1]. Gloves should be worn to protect the operator from coming into contact with body fluids, if at risk, and need not be sterile if a “no touch” technique is utilised [1,3].

Joint infection after injection is extremely rare and comparable to the rate of sepsis after venipuncture [1]. The current literature does not identify any difference in infection risk in a “clean” technique compared with sterile technique [3].

STATEMENT:

The New Zealand Rheumatology Association (NZRA) recognises that injections are important in the management of musculoskeletal conditions including diagnosis and treatment. The NZRA note that informed verbal consent is integral to this treatment. The risks of complications with injection are low. A “no touch” technique is essential. Full surgical sterile procedure is unnecessary.

Bibliography:

  1. Courtney, P. and M. Doherty, Joint aspiration and injection and synovial fluid analysis. Best practice & research. Clinical rheumatology, 2009. 23(2): p. 161-192.
  2. PREP Advanced Training Program (2009) Royal Australian College of Physicians webpage Accessed June 7th 2011 from http://www.racp.edu.au/page/specialty/rheumatology
  3. Baima, J. and Z. Isaac, Clean versus sterile technique for common joint injections: a review from the physiatry perspective. Current Reviews in Musculoskeletal Medicine, 2008. 1(2): p. 88-91

 

Acknowledgement:

The NZRA gratefully acknowledges The Australian Rheumatology Association for granting permission for use of the ARA Position Statement on Intra-articular injections and soft tissue injections, on which this Position Statement is based.

Dr Terry Macedo
Dr Simon Stebbings

DAS28 Joint Examination Video

The DAS 28 Joint Count Video can be accessed here.