Resources

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

On this page is information about

  • NZRA Research Grants
  • NZRA-Arthritis NZ statement on Covid 19
  • Intra-articular and soft tissue injections
  • Stem cell therapies
  • The 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 advice for people with inflammatory arthritis and related autoimmune diseases

September 2022
General advice during the COVID-19 pandemic

People with rheumatic disease should get vaccinated against COVID-19, including any recommended booster vaccinations, and observe all public health measures (such as mask wearing and hand washing) as recommended by the New Zealand Ministry of Health.

Studies published to date have shown that use of most oral disease-modifying anti-rheumatic drugs (DMARDs) and most biological therapies for arthritis do not increase the risk of infection, hospitalization or mortality caused by SARS-CoV-2 (the novel coronavirus). Studies have shown that people with poorly controlled inflammatory disease are at increased risk of severe illness due to COVID-19. It is therefore recommended that people with inflammatory disease continue to take their medications during the pandemic, and try to minimize use of corticosteroids such as prednisone. Use of rituximab, mycophenolate, sulfasalazine, or prednisone greater than 10 mg per day have been associated with an increased risk of severe illness due to COVID-19. It is very important to have well controlled inflammatory disease, so do not stop these medicines and discuss this with your rheumatologist.

COVID-19 vaccination advice

COVID-19 vaccination can be given safely to people on DMARDs, and is strongly recommended for all eligible people with rheumatic disease.

People on rituximab, cyclophosphamide, and most oral DMARDs (including methotrexate, leflunomide, azathioprine, mycophenolate, tacrolimus, and cyclosporin) are eligible for a third primary dose of the Comirnaty (Pfizer) vaccine eight weeks after the second dose, in accordance with the New Zealand Ministry of Health guidance.  People on long-term prednisone ≥10mg daily are also eligible for a third primary dose.  Further booster vaccine doses should also be given after the third primary vaccine, as recommended by the Ministry of Health.

After each vaccine dose, oral DMARDs (but not prednisone or hydroxychloroquine) should be withheld for 1-2 weeks, if disease activity and severity allow. This recommendation is to increase the effectiveness of the vaccine rather than due to concerns about safety.

Evusheld (tixagevimab with cilgavimab) for pre-infection prophylaxis

Evusheld is now funded for people who are severely immunocompromised to protect them from getting COVID-19 or from becoming very sick if they get COVID-19. People with rheumatic disease who have received rituximab in the previous 12 months or high dose cyclophosphamide within previous 6 months are eligible for Evusheld, and can discuss this with their rheumatology team. Evusheld is given by injection every 6 months.

Advice for people who develop COVID-19 infection

The New Zealand Ministry of Health provides advice for all New Zealanders about how to look after yourself while you have COVID-19.
Oral DMARDs and biologics (but not prednisone) should be withheld until recovery from COVID-19 infection, if rheumatic disease activity and severity allows.
Anti-viral therapies such as Paxlovid are now funded for those people who were eligible for the third primary dose of the COVID-19 vaccine who have COVID-19 infection. Most people who are on DMARD therapy are eligible for this treatment, which should be initiated as early as possible and within five days of symptom onset.
There are important drug-drug interactions between Paxlovid and medications used in rheumatology care, including cyclosporin, tacrolimus, colchicine, upadacitinib, sildenafil, and prednisone.
For some people on high doses of immunosuppression, particularly rituximab, prolonged COVID-19 infection may occur. The care of these people should be discussed with a specialist infectious diseases team, as longer periods of isolation and additional testing may be needed in this situation.

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.