Provision of a comprehensive, professional and superconsulting care, in particular in the field of diagnosis, using currently available complementary services, consulting examinations performed by professionals in borderline fields working in the Institute or in the facilities with which contracts and agreements have been concluded; provision of consultancy services in the field of rheumatology to other professional facilities in the territory of Prague which have asked for such services or which have concluded relevant agreements with the Institute (General Teaching Hospital, Institute for the Care of Mother and Child);
This care is provided by the Institute having 54 acute beds. All 54 beds are classified as acute beds in the field of rheumatology. Our Institute has concluded contracts for the provision of health care with all medical facilities in the entire territory of the country.
Patients from the entire Czech Republic are hospitalized in the in-patient department of the Institute.
Patients are admitted to the in-patient department based on the referral of health-care specialists - out-patient specialists or other professional departments of hospitals.
The following procedures are performed in the Institute:
- Examinations of conditions which canīt be diagnosed in lower level health-care facilities (complicated autoimmune conditions) and canīt be performed in an out-patient setting;
- Treatment of highly active rheumatoid arthritis which is refractory to any other treatment; initiation of a combination DMARDs treatment;
- Administration of different high-risk treatment procedures - high-dose corticoids, corticoid pulse therapy, pulse therapy with cytostatics, high-dose cytostatics and immunosuppressants, administration of biological drugs in the Center for biological treatment;
- Treatment of severe, often critical forms and stages of rheumatic diseases (systemic lupus erythematosus, dermatomyositis, polymyositis, systemic sclerosis, vasculitis);
- Approaches to prepare patients for therapeutic procedures (radio elimination of bone marrow, bone marrow transplants);
- Administration of expensive treatment procedures as ultimate refuge in critical situations (high-dose immunoglobulins);
- Treatment and care of critical, often fatal complications of inflammatory rheumatic diseases accompanied by failure in vital functions (lupus - nephritis, pericarditis, brain damage due to lupus and vasculitis, etc.),
- Diagnosis and preparation of large rheumatological surgical procedures and stabilizing follow-up treatment;
- Preparation of documents for complicated assessments of rheumatoid diseases and solution of forensic situations;
- Preparation and special treatment of young patients suffering from SLE before and during planned pregnancy and preparation for delivery;
- Stratification of patients undergoing a long-term treatment with corticoids with regard to the risk of osteoporosis; its prevention and treatment.
Therefore, there are also other specialists working in the Institute - immunologist, orthopedist, cardiologist, neurologist, radiologist, and a specialist for physiology, balneology and medical rehabilitation - who perform relevant specific examinations of patients and work in professional teams together with internal specialists and rheumatologists. In addition to that, the Institute has concluded agreements and contracts with special facilities (clinics, institutes) where preferential examinations are provided for our patients - e.g. nephrology, dermatology, neurology (CT), pneumology, hematology, gynecology, maternity clinic, etc.
In order to strengthen diagnostic methods, two physicians have received special training in capillaroscopy and the Institute has been provided with the relevant equipment.
One of the physicians has received professional training at the Clinic of Nuclear Medicine and is able to perform radionuclide synovectomy.
In the Institute, there is a small OR where diagnostic and treatment joint punctures, injection intraarticular treatment, and other procedures are performed.
Special attention has been given to individual complementary units. At present, the Institute has a Department of Imaging Methods equipped with relevant technology where, in addition to diagnostic methods, ultrasound and densitometry are performed.
Clinical laboratories in the fields of clinical biochemistry, hematology and immunology meet the common needs related to diagnostic procedures but also to special examinations, e.g. detection of biochemical markers of osteoresorption, cytological examination of synovial fluid, including crystals (in the field of biochemistry), comprehensive diagnosis of antinuclear and anticytoplasmic autoantibodies - immunoblotting, anti-CCp antibodies, detection of anti-ENA antibodies using counter electrophoresis and their detailed specification, anticardiolipin antibodies, antiperinuclear factors, rheumatoid factor isotypes, anti-Borrelia antibodies (in the field of immunology). The immunology laboratory serves also as a reference laboratory for the System of external quality control for rheumatoid factors and circulating immune complexes.
Laboratory examination methods serve to examine biological material collected from patients of the Institute, as well as biological samples of a high percentage of patients (almost 50%) submitted by out-patient specialists and hospitals from the entire country.
Out-patient care is complementary to in-patient care. It is classified into individual fields where specialized laboratories focus on long-term follow-up and treatment of the following diagnoses and provide special health-care programs:
- Unit for Lyme borreliosis - focuses on joint symptoms of borreliosis stage III, cooperates with the State Health Institute and the Department of Neurology Motol. It is headed by a physician having a specialized qualification in the field of rheumatology.
- Biological Treatment Center - used for Rheumatoid Arthritis, Ankylosic Arthritis and Psoriatic Arthritis. Administration of iv therapy.
- Unit for psoriatic arthritis - focuses on peripheral and axial forms of psoriasis, cooperates with the Department of Prof. Novotný. It is headed by a physician having 2nd degree qualification in internal medicine and specialized qualification in rheumatology.
- Unit for systemic diseases of the connective tissue - there it a special consultancy department for SLE, myositis and sclerodermia in the Unit. It focuses, first of all, on patients with visceral affections (lungs, kidneys, CNS), cooperates with the Department of Neurology, 1st Department of Internal Medicine of the General Teaching Hospital, and Department of Cardiology. It is headed by a physician, associate professor having specialized qualification in rheumatology and specialized qualification in allergology and clinical immunology.
- Unit for pregnant patients suffering from a systemic disease of the connective tissue, cooperates with Institut for the Care of Mother and Child. It is headed by a physician, professor having 2nd degree qualification in internal medicine and specialized qualification in rheumatology.
- Bone Center - focuses on secondary osteoporosis, Cs-induced osteoporosis. It is equipped with a DEXA densitometer and comprises a specialized laboratory; there is also specialized treatment provided in the Center.
- Early Arthritis Out-patient Clinic provides treatment to patients with early active rheumatoid arthritis A having poor prognosis. It is headed by a physician having specialized qualification in rheumatology.
- Out-patient unit for radionuclide synoviorthesis where radionuclides are applied into the joints of patient to treat topical synovitis; cooperation with the Nuclear Medicine Clinic of the General Teaching Hospital. The unit is headed by a physician having specialized qualification in rheumatology, special training at the Nuclear Medicine Clinic and a special license issued by the State Office for Nuclear Safety of the Czech Republic.
- Out-patient unit for juvenile chronic arthritis in adults. The unit is headed by a physician having specialized qualification in rheumatology.
- Clinic for osteoarthrosis - provides both conservative and surgical treatment of the progressive forms of the disease (so-called rapidly progressive osteoarthrosis). The clinic is headed by a physician, associate professor, having specialized qualification in rheumatology.
- Separate program for rehabilitation after total hip replacement in patients suffering from inflammatory rheumatic diseases; cooperation with orthopedic clinics; department of medical rehabilitation. The program is headed by a physician having specialized qualification in rheumatology.
Orthopedic out-patient unit
Internal medicine unit
Further, there are other specialist out-patient units in the fields closely related to the diseases treated in the Institute of Rheumatology. These out-patient units and clinics operate on a once-a-week basis and include the following clinics:
makes decisions about rheumatological surgical procedures in patients suffering from underlying rheumatoid diseases (total hip replacement, etc.) and provides follow-up to these patients. The Unit is headed by a physician having 1st and 2nd degree qualification in the field of orthopedics.
provides mainly all necessary testing and preparation before surgical procedures are performed but also deals with internal diseases which often complicate rheumatoid diseases. The unit is headed by a physician having 1st and 2nd degree qualification in the field of internal medicine.
is specialized in diagnosing and treatment of heart diseases complicating underlying rheumatological diseases. The unit is headed by a physician having 1st degree qualification in the field of internal medicine and specialized qualification in cardiology.
cooperates in the field of neurology and pain management in patients with rheumatological diseases. The physician has 2nd degree qualification in the field of neurology and specialized qualification in the field of physiology, balneology and medical rehabilitation. She has received training in pain management providing her with the most suitable qualifications for this field.
deals with complicated cases of rehabilitation treatment of patients suffering from seriously affected locomotory system, patients with a total hip replacement, etc. The unit is headed by a physician having specialized qualification in the field of physiology, balneology and medical rehabilitation.
Patients discharged from in-patient clinics are referred to out-patient clinics for further treatment should their disease require further medical attention of the out-patient medical staff, under specified strict conditions with a regular laboratory follow-ups, provided this type of care canīt be delivered by their local specialist. At the same time, these patients are provided with professional care of other specialists of the Institute (e.g. immunologist, orthopedist, cardiologist), and/or with all necessary procedures (radionuclide synovectomy, pulse treatment with high-dose corticoid, etc.).
Medical professionals of out-patient units serve also as superconsulting specialists for other out-patient specialists and medical professionals from hospitals across the country dealing also with children.