Rheumatology

Description of Department/Service

Welcome to Rheumatology

The Rheumatology Multidisciplinary Team (MDT)

Professor David Kane, Consultant Rheumatologist
Dr. Diana Gheta, Consultant Rheumatologist
Dr. Catherine Hughes, Consultant Rheumatologist
Dr. John Paul Doran, Consultant Rheumatologist
Dr. Colm Kirby, Consultant Reheumatologist
Mr. David Askin, candidate Advanced Nurse Practitioner in Osteoporosis
Ms. Stephanie Naramore, Advanced Nurse Practitioner in Osteoporosis
Ms. Patricia O’Neill, Advanced Nurse Practitioner in Osteoporosis
Ms. Louise Brennan, Clinical Nurse Manager in Osteoporosis
Ms. Aisling Brennan, Musculoskeletal Clinical Specialist
Ms. Sarah O’Driscoll Senior Rheumatology Physiotherapist
Ms. Caitriona Ni Se, Muskuloskeletal Clinical Specialist
Ms. Susan Somerville, Senior Occupational Therapist
Ms. Mairead Flanagan, Clinical Secretary
Ms. Mary Kelly, Clinical Secretary
Ms. Susan O'Donnell, Clinical Secretary
Mr. Paul Moorhouse, Clerical Team Lead for Rheumatology 

Specialist Registrar (rotating)
Research Registrar (rotating)
Senior House Officer (rotating)
Medical Intern (rotating)

The Rheumatology Mission Statement

To provide State-of-the-Art, Patient-centred care for people with arthritis and specifically Autoimmune Inflammatory Disease and to attain the highest standards of Education and Research into Rheumatological disease. 

Overview of Rheumatology Services

The Rheumatology Multidisciplinary team (MDT) aims to provide a comprehensive set of services for the patients within the catchment of TUH. To cater for the growing needs of our patients the team has pioneered new models of care for patients with inflammatory and non-inflammatory conditions. We have successfully established novel ultrasound technology as both a routine part of patient care at Tallaght University Hospital but also have led in ultrasound education and in developing ultrasound as a cutting edge research technology.

The Early Inflammatory Arthritis Clinic

In recent years, rheumatologists have realised that effective early diagnosis and treatment of patients with Inflammatory Arthritis will lead to better long-term health outcomes for their patients. When the disease is treated early, patients experience less pain and maintain better long-term joint function. In order to ensure patients with new inflammatory arthritis symptoms are seen quickly we have offered a offer a rapid access, Early Arthritis Clinic at TUH. Your GP may refer you to the Early Arthritis Clinic using our Early Arthritis Referral Form which is available here.

The Early Inflammatory Arthritis Clinic at the Hospital provides a “One Stop Shop” model for the diagnosis and management of inflammatory arthritis. Blood tests and x-rays are performed prior to the appointment so that the results are available on the day of appointment. Further X-rays and an ultrasound scan of affected joints may also be performed during the appointment. Once the diagnosis is confirmed a nurse is available to immediately educate patients on their disease and on disease modifying anti-rheumatic medication prescribed. All newly diagnosed patients are then managed in a multidisciplinary team setting through the Early Arthritis Allied Health Clinic, and at the Rheumatology clinic.  This follows a Patient Centred, “Treat to Target protocol” which is supported by a telephone helpline, with out of hours and urgent appointments available on request. This care pathway also covers a cardiovascular risk assessment and osteoporosis risk assessment at specified time points.

The Early Arthritis Allied Health Clinics

In addition to seeing their rheumatologist at the rheumatology clinic, all patients with a new diagnosis of inflammatory arthritis also attend a single specialist Allied Health Professional clinic early in the course of their disease where they see a Rheumatology Specialist Nurse, Physiotherapist and Occupational Therapist on the same day. This clinic exists for patients with recent onset of inflammatory arthritis to provide a comprehensive and coordinated service. The clinic will ensure regular monitoring of patients within their first year of diagnosis in a way that makes the best use of available hospital resources. It is popular with patients who use the service as it provides excellent access opportunities to members of the rheumatology team. All new inflammatory arthritis patients also have access to Hydrotherapy services in the hospital, where weekly classes take place for this cohort of patents to opt in to.

Physiotherapy Triage and Rapid Access Clinics

A Physiotherapy Rheumatology Musculoskeletal Clinic was established in TUH in 2007 as a waiting list initiative. Due to its success it has been developed over the years. The aim of the clinic is to provide early access to patients with non-inflammatory musculoskeletal complaints. At the clinic they are seen by a Musculoskeletal Specialist Physiotherapist who carries out a comprehensive assessment to establish a clinical diagnosis and management plan. Evidence Based protocols devised by the Consultant Rheumatologists and Specialist Physiotherapy staff are used. The clinic runs alongside the medical rheumatology clinics and therefore patients may also be seen by the Consultant Rheumatologist/ Specialist Registrar as required. Musculoskeletal Ultrasound may also be used at these clinics to enhance clinical diagnosis.

Musculoskeletal Ultrasound Guided Injection Clinics

The Musculoskeletal Ultrasound guided injection clinics have been designed as a ‘one stop shop’ for patients requiring a joint or soft tissue injection to treat painful symptoms which restrict movement in specific joints. By using musculoskeletal ultrasound the rheumatologist can often more accurately treat the specific cause of pain using a guided injection to the affected area. The use of ultrasound at the clinic prevents the need for patients to attend a separate ultrasound appointment in the x-ray department. Following on from any injection procedure patients may be referred for physiotherapy to ensure you get the maximum benefit from your injection in terms of your physical function.

The Fracture Prevention Service

In 2009 the Hospital Rheumatology Department appointed David Askin to establish a Fracture Prevention Service. This service supports both national policy and international standards in preventing future fracture. It is the responsibility of the Osteoporosis CNM to screen all patients attending Adult Trauma Orthopaedics over 50 years of age with a low trauma fracture at TUH. This seeks to identify patients that could be at a highest risk of fracture. During the assessment patients are advised of their risks for a future fracture. Individualised information is given to patients on modifiable and non-modifiable risks for future fracture. This is supplemented with written information. Patient management will be dependent on risk of a future fracture leading to a bone density x-ray (DXA). This protocol driven service is filtered by osteoporosis CNM with medical support from Rheumatology and Gerontology department.

ARThritis – arts programme for patients with Rheumatoid Arthritis

Art therapy can provide unique holistic benefits to patients with chronic diseases. At TUH a unique arts programme for patients with chronic rheumatoid arthritis has been in existence since 2007. The purpose of the programme is to give patients the chance to try art, explore their creativity and to express their feelings about their condition through a creative medium. The works of masters such as Renoir, Dufy and Klee, who also suffered from arthritis, provide the main source of inspiration behind the arts programme . X-rays of the patients’ own arthritic joints are used as inspiration for the final designs. “The Claw” is a large scale painting that was created by our patient Jo Killalee as part of ARThritis, and was inspired by an x-ray of the artist’s hands. Jo first started painting when she was a patient at the hospital in 2007. In 2011 “The Claw” painting was entered in the World Congress for Physical Therapy (WPCT) Art and Health Competition 2011 where it won the Runner-up award in the painting category.

Patient Resources

Information on Rheumatological Conditions

Rheumatoid Arthritis (RA)

Psoriatic Arthritis (PsA)  

Ankylosing Spondylitis (AS)

Osteoarthritis (OA)

Lupus

Gout

Fibromyalgia

Polymyalgia rheumatica

Medication Information

An A to Z of Patient Information on all of our commonly used medications is available here

Societies and Foundations

For further information here are some useful additional resources for patients.

Arthritis Ireland 

Ankylosing Spondylitis Association of Ireland

ICAN Ireland

Irish Osteoporosis Society

FibroIreland

Patient Support during COVID-19

Dear Rheumatology Patients

Please be advised that our Rheumatology services have been restricted due to COVID-19.

Our overall aim is to reduce your physical contacts and thus reduce your risk of contracting and passing on COVID-19 in order to end this pandemic as soon as is possible.

We will prioritise existing patients on immunotherapies and urgent new patients but please understand that as this goes on we will have to spend more and more time in managing the COVID-19 pandemic. This is going to happen with all hospital specialists.

For the moment we will move all review appointments to telephone or video consultation in order to ensure your treatment continues safely.  We will manage your queries but please understand there may be delays in responding.  We will do our best.

If you need to contact us, please download this patient query form and follow the instructions.

We will have to do the minimum of monitoring blood tests to further reduce your contacts and because blood testing services will be restricted.

Please see current advice for patients with rheumatological conditions that is posted on the Arthritis Ireland website – there is also a Q&A on the Arthritis Ireland Facebook page that we hope you will find helps answer your questions.

There is also a helpful information leaflet that we have put together.

Please stay safe.

David Kane & Ronan Mullan

Consultant Rheumatologist’s

Tallaght University Hospital
We understand that rheumatology patients on immunosuppressives (biologics, steroids, drugs such as methotrexate) are feeling particularly vulnerable and anxious due to the novel Coronavirus disease Covid-19.

What we know so far is:

By far, the  most effective thing that you can do now to protect yourself is to prevent the spread of infection for yourself and others by following the advice on www.hse.ie
- Wash your hands very regularly for at least 20 seconds using soap and water. Dry hands thoroughly afterwards
- Avoid touching your face, especially eyes and mouth
- Cough or sneeze only into an elbow or a tissue put the tissue into the bin afterwards. Do not reuse it
- We recommend to wear a mask as per HSE guidance – on public transport and when indoors and unable to keep a social distance
- Practice sensible social distancing (currently 2m but under review) especially from people who appear to be ill, e.g. coughing or sneezing
- Don’t shake hands, and avoid hugs
- Avoid busy public transport and large groups of people
- If you are in a high risk group you should be socially isolating as much as is possible

Most patients will have a mild illness and recover but if we all take the actions listed above we will protect those who will develop severe illness if infected. The mortality is 1-2% and high risk groups for severe disease have been identified as age over 70, chronic heart and lung disease, diabetes and active cancer. The data from studies of the outbreak that identified these risk factors did not identify immunosuppressive treatments prescribed in rheumatology patients as a high risk factor for mortality. However patients on immunosuppressives have a reasonable cause for concern as this is an infectious disease and we are monitoring data and international guidelines on the disease in order to best advise you, our patients.

Our advice is to not stop steroids suddenly or you may become very unwell.  At present there is no known benefit to stopping your immunosuppressive rheumatology medication but if you have stable disease you should discuss with your rheumatologist whether the dose of the immunosuppressive medication can be safely reduced during this pandemic. The COVID-19 pandemic may last several months so if you reduce or stop your medicine you will be more likely to have a flare during this period and need to restart your treatment or have to take more intensive treatment with steroids.

If you are on immunosuppressives and have other high risk factors for COVID-19 or have had a history of recurrent or opportunistic infections while on immunosuppressive therapy you are high risk and should socially isolate (cocoon) to protect yourself.  If you have symptoms of a viral infection - cough. shortness of breath, breathing difficulties, fever (high temperature) – continue steroids but hold your other immunosuppressives and seek advice with your GP or rheumatologist or consult the HSE website – do not stop steroids suddenly without medical advice

COVID-vaccine-advice-for-rheumatology-patients.pdf

Q&A

Who is catered for at the Rheumatology Clinics?

At the Rheumatology Clinics priority is given for the assessment and treatment patients with inflammatory arthritis and connective tissue diseases. Examples of the conditions we prioritise include Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA), Ankylosing Spondylitis (AS), Lupus, Scleroderma and Vasculitis.

We also see patients and provide a management plan to patients with other bone and joint related problems such as osteoarthritis but these are seen on our routine list. 

How can I contact the Rheumatology Department?

The Rheumatology secretaries are contactable on 01 414 3350 on Monday-Friday. 

How can a new referral appointment be arranged?

Patients need a letter from their General Practitioner (GP) or referring doctor/health professional. We also accept appointments from other consultants and from the Emergency Department. For further information on referring patients please refer to the Healthcare Professionals section of the site. 

For Patients with Early Inflammatory Arthritis GPs can download in our Early Arthritis Referral Form here and forward it to us together with a referral letter.

Before your appointment you will receive a letter. You may be asked to attend for blood tests or x-rays in advance of your appointment so that these results will be available on the day you see the doctor. This is done in order to avoid further delays for you.

If you have had x-rays or scans done at another hospital then it is important that you bring the actual films (or a CD of them) with you. You can use your appointment letter from us in order to obtain them from the hospital/clinic where you had them done.

How can a return appointment be arranged?

Patients seen at our clinics who have non-inflammatory joint symptoms are usually discharged without return appointments once a management plan is in place. If you have an inflammatory condition however and you do not have a return appointment arranged, or if you would like to find out the time of your next appointment please contact the Rheumatology team at 01 414 3350

What should I do if I am going to be late or can't attend for my outpatient appointment?

On the day of your appointment, if a patient is going to be late for an appointment please call the clinical area on 01 414 4778. We will be able to tell them if they can still attend. If you know that you are going to be unable to attend in advance of your appointment you must let us know in advance on 01 414 3350 so we can cancel your slot and reschedule you for another. If they make contact after a clinic has occurred we cannot guarantee an appointment will be given.

Who Can I contact about my Day Hospital Appointment?

If you are attending the day hospital for a treatment at Tallaght University Hospital and you need to speak to someone or if you need to changes to your admission date please call 01 414 4363.

How do I get prescription refills?

For most rheumatology medications your GP will be able fill out a repeat prescription if your existing prescription runs out between appointments. For patients receiving a biological drug by injection a special prescription is filled out by the doctor at the rheumatology doctor at the rheumatology clinic. If you are receiving a biological drug, please ensure that you will have an adequate prescription supply to cover you before your next appointment.

Who do I call if I am feeling unwell between appointment between appointments?

If you are feeling unwell between appointments the most common causes of this are either that you may be suffering from a form of infection, or you are experiencing a flare of your inflammatory disease.

Signs of infection include fevers, shivers and sweating. Other signs of infection include a worsening cough with green sputum or pain on passing water. If you begin to experience these symptoms please seek medical attention from your GP. If you are on specific anti-rheumatic medication for inflammatory disease your GP should perform basic blood tests to make sure your blood count is not low.

Symptoms of a flare of inflammatory arthritis include worsening fatigue, loss of energy, reduced appetite, and increased pain and stiffness in your joints along with increased swelling. If you are experiencing a flare of your arthritis, this can be helped with rest or by taking anti-inflammatory or analgesic pain relieving medications as prescribed by your doctor. An ice pack to an affected joint can also help. If your flare lasts for more than two weeks, then you should contact your GP initially for treatment.

Research & Education

Research & Education

The continued strategic development of academic rheumatology services at Tallaght University Hospital is key to the overall evolution of the specialty both within the framework of Trinity Health Ireland (THI) and at a national level. In addition to providing a base with which to attract talented researchers and clinicians, the existence of clinical and biomedical research facilities within the extended campus of THI will enable synergies in the areas of improved patient services, in research funding allocation, and future industrial partnerships. Most importantly, a continued drive for the highest standards of professional and academic excellence will foster an environment of innovation in the provision of world class patient-centred care.

The Department of Rheumatology at Tallaght University Hospital has a proven track record in both postgraduate research and in both undergraduate and post-graduate education. Through the stewardship of a successful post graduate MD programme, the Rheumatology Department has actively contributed to musculoskeletal ultrasound research, with the results of innovative research being presented at scientific meetings both nationally and internationally and published in high impact factor peer reviewed journals.

David Kane is Clinical Professor in Rheumatology at Trinity College Dublin. His principal clinical interests are musculoskeletal ultrasound and inflammatory arthritis. He is an international invited speaker and teacher in musculoskeletal ultrasound having published widely on this subject in peer reviewed journals. He is an active member of the EULAR Working group on Musculoskeletal Ultrasound since 2003, regular lecturer on the British Society for Rheumatology, EULAR and ACR musculoskeletal ultrasound courses, Honorary Treasurer of the Irish Society for Rheumatology, a current Board Member of Arthritis Ireland and previous Board member of the Irish Osteoporosis Society.

Prof. Ronan Mullan was recruited to Tallaght University Hospital as a Consultant Rheumatologist and Clinical Senior Lecturer in July 2012. He completed his undergraduate studies at Edinburgh University and a PhD in Translational Medicine Research at UCD Dublin and McGill University Montreal in 2008. In 2010 he was awarded a Paul Beeson Clinician Scientist Career Development Award by the American Federation for Aging Research and Atlantic Philanthropies to develop a Post-Doctoral research programme. His research interests include the molecular mechanisms of synovial inflammation in Rheumatoid Arthritis, and common inflammatory mechanisms of systemic autoimmune disease, metabolic syndrome and ageing.

Publications

Winchester R, Minevich G, Steshenko V, Kirby B, Kane D, Greenberg DA, FitzGerald O. HLA associations reveal genetic heterogeneity in psoriatic arthritis and in the psoriasis phenotype. Arthritis Rheum. 2012 Apr;64(4):1134-44.

Mullan RH, Connolly M, McCormick J, Matthews C, Sullivan O, Kennedy A, FitzGerald O, Poole AR, Bresnihan B, Veale DJ, Fearon U. Acute-phase serum amyloid A regulates tumor necrosis factor α and matrix turnover and predicts disease progression in patients with inflammatory arthritis before and after biologic therapy. Arthritis Rheum. 2012 Apr;64(4):1035-45

Bowes J, Ho P, Flynn E, Ali F, Marzo-Ortega H, Coates LC, Warren RB, McManus R, Ryan AW, Kane D, Korendowych E, McHugh N, Fitzgerald O, Packham J, Morgan AW, Bruce IN, Barton A. Comprehensive assessment of rheumatoid arthritis susceptibility loci in a large psoriatic arthritis cohort. Ann Rheum Dis. 2012 Feb 10.

Mandl P, Naredo E, Conaghan PG, D'Agostino MA, Wakefield RJ, Bachta A, Backhaus M, Hammer HB, Bruyn GA, Damjanov N, Filippucci E, Grassi W, Iagnocco A, Jousse-Joulin S, Kane D, Koski JM, Möller I, De Miguel E, Schmidt WA, Swen WA, Szkudlarek M, Terslev L, Ziswiler HR, Ostergaard M, Balint PV.Practice of ultrasound-guided arthrocentesis and joint injection, including training and implementation, in Europe: results of a survey of experts and scientific societies.Rheumatology (Oxford). 2012 Jan;51(1):184-90.

Bowes J, Orozco G, Flynn E, Ho P, Brier R, Marzo-Ortega H, Coates L, McManus R, Ryan AW, Kane D, Korendowych E, McHugh N, FitzGerald O, Packham J, Morgan AW, Bruce IN, Barton A. Confirmation of TNIP1 and IL23A as susceptibility loci for psoriatic arthritis. Ann Rheum Dis. 2011 Sep;70(9):1641-4.

Bowes J, Eyre S, Flynn E, Ho P, Salah S, Warren RB, Marzo-Ortega H, Coates L, McManus R, Ryan AW, Kane D, Korendowych E, McHugh N, FitzGerald O, Packham J, Morgan AW, Griffiths CE, Bruce IN, Worthington J, Barton A. Evidence to support IL-13 as a risk locus for psoriatic arthritis but not psoriasis vulgaris.Ann Rheum Dis. 2011 Jun;70(6):1016-9.

Gandjbakhch F, Terslev L, Joshua F, Wakefield RJ, Naredo E, D'Agostino MA; OMERACT Ultrasound Task Force. Ultrasound in the evaluation of enthesitis: status and perspectives. Arthritis Res Ther. 2011;13(6):R188.

Ahmed S, Kitchen J, Hamilton S, Brett F, Kane D. A case of polyarteritis nodosa limited to the right calf muscles, fascia, and skin: a case report. J Med Case Reports. 2011 Sep 12;5:450.

Naredo E, Wakefield RJ, Iagnocco A, Terslev L, Filippucci E, Gandjbakhch F, Aegerter P, Aydin S, Backhaus M, Balint PV, Bruyn GA, Collado P, Finzel S, Freeston JE, Gutierrez M, Joshua F, Jousse-Joulin S, Kane D, Keen HI, Moller I, Mandl P, Ohrndorf S, Pineda C, Schmidt WA, Szkudlarek M, Conaghan PG, D'Agostino MA.The OMERACT ultrasound task force--status and perspectives. J Rheumatol. 2011 Sep;38(9):2063-7.

Mandl P, Naredo E, Wakefield RJ, Conaghan PG, D'Agostino MA; OMERACT Ultrasound Task Force. A systematic literature review analysis of ultrasound joint count and scoring systems to assess synovitis in rheumatoid arthritis according to the OMERACT filter. J Rheumatol. 2011 Sep;38(9):2055-62.

Atchia I, Kane D, Birrell F.Comment on: steroid injection for hip osteoarthritis: efficacy under ultrasound guidance.Rheumatology (Oxford). 2011 Apr;50(4):812-3

Atchia I, Kane D, Reid M, Isaacs J, Birrell F. Efficacy of a Single Ultrasound Guided Injection for the Treatment of Hip Osteoarthritis. Ann Rheum Dis. 2011 Jan;70(1):110-6

Bowes J, Flynn E, Ho P, Aly B, Morgan AW, Marzo-Ortega H, Coates L, McManus R, Ryan AW, Kane D, Korendowych E, McHugh N, FitzGerald O, Packham J, Bruce IN, Barton A. Variants in linkage disequilibrium with the late cornified envelope gene cluster deletion are associated with susceptibility to psoriatic arthritis. Ann Rheum Dis. 2010 Dec;69(12):2199-203.

Connolly M, Marrelli A, Blades M, McCormick J, Maderna P, Godson C, Mullan R, FitzGerald O, Bresnihan B, Pitzalis C, Veale DJ, Fearon U. Acute serum amyloid A induces migration, angiogenesis, and inflammation in synovial cells in vitro and in a human rheumatoid arthritis/SCID mouse chimera model. J Immunol. 2010 Jun 1;184(11):6427-37.

Mullan RH, McCormick J, Connolly M, Bresnihan B, Veale DJ, Fearon U. A role for the high-density lipoprotein receptor SR-B1 in synovial inflammation via serum amyloid-A.Am J Pathol. 2010 Apr;176(4):1999-2008.

Gutierrez M, Filippucci E, De Angelis R, Filosa G, Kane D, Grassi W.

A sonographic spectrum of psoriatic arthritis: "the five targets".

Clin Rheumatol. 2010 Feb;29(2):133-42.

Naredo E, D'Agostino MA, Conaghan PG, Backhaus M, Balint P, Bruyn GA, Filippucci E, Grassi W, Hammer HB, Iagnocco A, Kane D, Koski JM, Szkudlarek M, Terslev L, Wakefield RJ, Ziswiler HR, Schmidt WA. Current state of musculoskeletal ultrasound training and implementation in Europe: results of a survey of experts and scientific societies. Rheumatology (Oxford). 2010 Dec;49(12):2438-43.

Kitchen J, Kane D. Non-steroidal anti-inflammatory drug prescriptions in hospital inpatients: are we assessing the risks? Ir J Med Sci. 2010 Sep;179(3):357-60.

Bruyn GA, Pineda C, Hernandez-Diaz C, Ventura-Rios L, Moya C, Garrido J, Groen H, Pena A, Espinosa R, Möller I, Filippucci E, Iagnocco A, Balint PV, Kane D, D'Agostino MA, Angulo M, Ponte R, Fernandez-Gallardo JM, Naredo E. Validity of ultrasonography and measures of adult shoulder function and reliability of ultrasonography in detecting shoulder synovitis in patients with rheumatoid arthritis using magnetic resonance imaging as a gold standard. Arthritis Care Res 2010 Aug;62(8):1079-86.

Cunnington J, Marshall N, Hide G, Bracewell C, Isaacs J, Platt P, Kane D. A randomized, double-blind, controlled study of ultrasound-guided corticosteroid injection into the joint of patients with inflammatory arthritis. Arthritis Rheum. 2010 Jul;62(7):1862-9.

Gutierrez M, Filippucci E, De Angelis R, Filosa G, Kane D, Grassi W. A sonographic spectrum of psoriatic arthritis: "the five targets". Clin Rheumatol. 2010 Feb;29(2):133-42. Epub 2009 Oct 24.

Moran EM, Mullan R, McCormick J, Connolly M, Sullivan O, Fitzgerald O, Bresnihan B, Veale DJ, Fearon U.Human rheumatoid arthritis tissue production of IL-17A drives matrix and cartilage degradation: synergy with tumour necrosis factor-alpha, Oncostatin M and response to biologic therapies. Arthritis Res Ther. 2009;11(4):R113. Epub 2009 Jul 23.

French HP, Cusack T, Brennan A, White B, Gilsenan C, Fitzpatrick M, O'Connell P, Kane D, Fitzgerald O, McCarthy GM.

Exercise and manual physiotherapy arthritis research trial (EMPART): a multicentre randomised controlled trial.

BMC Musculoskelet Disord. 2009 Jan 19;10:9.

D'Agostino MA, Conaghan PG, Naredo E, Aegerter P, Iagnocco A, Freeston JE, Filippucci E, Moller I, Pineda C, Joshua F, Backhaus M, Keen HI, Kaeley G, Ziswiler HR, Schmidt WA, Balint PV, Bruyn GA, Jousse-Joulin S, Kane D, Moller I, Szkudlarek M, Terslev L, Wakefield RJ. The OMERACT ultrasound task force -- Advances and priorities. J Rheumatol. 2009 Aug;36(8):1829-32.

Aherne CM, McMorrow J, Kane D, FitzGerald O, Mix KS, Murphy EP. Identification of NR4A2 as a transcriptional activator of IL-8 expression in human inflammatory arthritis. Mol Immunol. 2009 Oct;46(16):3345-57.

Taggart AJ, Wright SA, Ball E, Kane D, Wright G. The Belfast musculoskeletal ultrasound course. Rheumatology 2009 Sep;48(9):1073-6.

French HP, Cusack T, Brennan A, White B, Gilsenan C, Fitzpatrick M, O'Connell P, Kane D, Fitzgerald O, McCarthy GM. Exercise and manual physiotherapy arthritis research trial (EMPART): a multicentre randomised controlled trial. BMC Musculoskelet Disord. 2009 Jan 19;10:9

Bruyn GA, Naredo E, Möller I, Moragues C, Garrido J, de Bock GH, d'Agostino MA, Filippucci E, Iagnocco A, Backhaus M, Swen WA, Balint P, Pineda C, Milutinovic S, Kane D, Kaeley G, Narvaez FJ, Wakefield RJ, Narvaez JA, de Augustin J, Schmidt WA. Reliability of ultrasonography in detecting shoulder disease in patients with rheumatoid arthritis. Ann Rheum Dis. 2009 Mar;68(3):357-61.

Veerappan SG, Moinuddin G, Kennedy M, O'Morain CA, Kane D. Early diagnosis of bilateral sub-deltoid bursitis using clinic-based ultrasonography in a patient receiving infliximab therapy for ulcerative pouchitis. Ir J Med Sci. 2008

Keen HI, Lavie F, Wakefield RJ, D'Agostino MA, Berner Hammer H, Hensor EM, Pendleton A, Kane D, Guerini H, Schueller-Weidekamm C, Kortekaas MC, Birrell F, Kloppenburg M, Stamm T, Watt I, Smolen JS, Maheu E, Dougados M, Conaghan PG. The development of a preliminary ultrasonographic scoring system for features of hand osteoarthritis. Ann Rheum Dis 2008 May;67(5):651-5

Balint PV, Mandl P,Kane D. "All that glistens is not gold"--separating artefacts from true Doppler signals in rheumatological ultrasound. Ann Rheum Dis. 2008;67:141-2

Mullan RH, Matthews C, Bresnihan B, FitzGerald O, King L, Poole AR, Fearon U, Veale DJ.Early changes in serum type II collagen biomarkers predict radiographic progression at one year in inflammatory arthritis patients after biologic therapy. Arthritis Rheum. 2007 Sep;56(9):2919-28.

Naredo E, Bijlsma JW, Conaghan PG, Acebes C, Balint P, Hammer HB, Bruyn GA, Collado P, D'Agostino MA, de Agustin JJ, de Miguel E, Filippucci E, Grassi W, Iagnocco A, Kane D, Koski JM, Manger B, Mayordomo L, Möller I, Moragues C, Rejón E, Szkudlarek M, Terslev L, Uson J, Wakefield RJ, Schmidt WA. Recommendations for the content and conduct of EULAR Musculoskeletal Ultrasound Courses. Ann Rheum Dis. 2008; 67(7):1017-22

Atchia I, Birrell F, Kane D. A modular, flexible training strategy to achieve competence in diagnostic and interventional musculoskeletal ultrasound in patients with hip osteoarthritis.Rheumatology. 2007;46(10):1583-6.

Cunnington J, Platt P, Raftery G, Kane D (2007) Attitudes of United Kingdom rheumatologists to musculoskeletal ultrasound practice and training. Ann Rheum Dis 2007;66:1381-3

Joshua F, Lassere M, Bruyn GA, Szkudlarek M, Naredo E, Schmidt WA, Balint P, Filippucci E, Backhaus M, Iagnocco A, Scheel AK, Kane D, Grassi W, Conaghan PG, Wakefield RJ, D'Agostino MA. Summary findings of a systematic review of the ultrasound assessment of synovitis. J Rheumatol 2007;34:839-847

Meenagh G, Filippucci E, Kane D, Taggart A, Grassi W. Ultrasonography in rheumatology: developing its potential in clinical practice and research. Rheumatology 2007; 46:3-5

Raftery G, Griffiths B, Kay L, Kane D.  Chronic viral hepatitis and TNF-alpha blockade. Rheumatology 2007; 46:1381

Raftery G, Hide G, Kane D. Comparison of musculoskeletal ultrasound practices of a rheumatologist and a radiologist. Rheumatology 2007 46:519-522

Sattar N, Crompton P, Cherry L, Kane D, Lowe G, McInnes IB. Effects of tumor necrosis factor blockade on cardiovascular risk factors in psoriatic arthritis: a double-blind, placebo-controlled study. Arthritis Rheum 2007; 56:831-839

Wakefield RJ, D'Agostino MA, Iagnocco A, Filippucci E, Backhaus M, Scheel AK, Joshua F, Naredo E, Schmidt WA, Grassi W, Moller I, Pineda C, Klauser A, Szkudlarek M, Terslev L, Balint P, Bruyn GA, Swen WA, Jousse-Joulin S, Kane D, Koski JM, O'Connor P, Milutinovic S, Conaghan PG. The OMERACT Ultrasound Group: status of current activities and research directions. J Rheumatol 2007 34:848-851

Fearon U, Mullan RH, Markham T, Connolly M, Sullivan S, Poole AR, FitzGerald O, Bresnihan B, Veale DJ.Oncostatin M induces angiogenesis and cartilage degradation in rheumatoid arthritis synovial tissue and human cartilage cocultures. Arthritis Rheum. 2006 Oct;54(10):3152-62.

Markham T, Mullan RH, Golden-Mason L, Rogers S, Bresnihan B, Fitzgerald O, Fearon U, Veale DJ.Resolution of endothelial activation and down-regulation of Tie2 receptor in psoriatic skin after infliximab therapy.J Am Acad Dermatol. 2006 Jun;54(6):1003-12.

Mullan RH, Bresnihan B, Golden-Mason L, Markham T, O'Hara R, FitzGerald O, Veale DJ, Fearon U.Acute-phase serum amyloid A stimulation of angiogenesis, leukocyte recruitment, and matrix degradation in rheumatoid arthritis through an NF-kappaB-dependent signal transduction pathway.      Arthritis Rheum. 2006 Jan;54(1):105-14.

Markham T, Mathews C, Rogers S, Mullan RH, Bresnihan B, Fitzgerald O, Veale DJ, Fearon U.Downregulation of the inhibitor of apoptosis protein survivin in keratinocytes and endothelial cells in psoriasis skin following infliximab therapy.Br J Dermatol. 2006 Dec;155(6):1191-6.

Naredo E, Moller I, Moragues C, de Agustin JJ, Scheel AK, Grassi W, de Miguel E, Backhaus M, Balint P, Bruyn GA, D'Agostino MA, Filippucci E, Iagnocco A, Kane D, Koski JM, Mayordomo L, Schmidt WA, Swen WA, Szkudlarek M, Terslev L, Torp-Pedersen S, Uson J, Wakefield RJ, Werner C (2006) Interobserver reliability in musculoskeletal ultrasonography: results from a "Teach the Teachers" rheumatologist course. Ann Rheum Dis 65:14-19

Kane D, Bruyn G, Arnold E, Grassi W (2006) A rheumatologist's perspective on musculoskeletal ultrasound in rheumatology: comment on the editorial by Roemer et al. Arthritis Rheum 55:341-342

Mullan RH, Bresnihan B. Systemic Amyloidosis in the Rheumatic Diseases [Review]. ARC Topical Reviews. London. Number 6. June 2005

Cunnington J, Hide G, Kane D (2005) Training in musculoskeletal ultrasound by UK rheumatologists: when is now, but how? Rheumatology (Oxford) 44:1470-1472

Kane D (2005) The role of ultrasound in the diagnosis and management of psoriatic arthritis. Curr Rheumatol Rep 7:319-324

Kane D, Lockhart JC, Balint PV, Mann C, Ferrell WR, McInnes IB (2005) Protective effect of sensory denervation in inflammatory arthritis (evidence of regulatory neuroimmune pathways in the arthritic joint). Ann Rheum Dis 64:325-327

Kane D, Pathare S (2005) Early psoriatic arthritis. Rheum Dis Clin North Am 31:641-657

Ralph JA, McEvoy AN, Kane D, Bresnihan B, FitzGerald O, Murphy EP (2005) Modulation of orphan nuclear receptor NURR1 expression by methotrexate in human inflammatory joint disease involves adenosine A2A receptor-mediated responses. J Immunol 175:555-565

Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D'Agostino MA, Sanchez EN, Iagnocco A, Schmidt WA, Bruyn GA, Kane D, O'Connor PJ, Manger B, Joshua F, Koski J, Grassi W, Lassere MN, Swen N, Kainberger F, Klauser A, Ostergaard M, Brown AK, Machold KP, Conaghan PG (2005) Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 32:2485-2487

Kane D, Jensen LE, Grehan S, Whitehead AS, Bresnihan B, Fitzgerald O (2004) Quantitation of metalloproteinase gene expression in rheumatoid and psoriatic arthritis synovial tissue distal and proximal to the cartilage-pannus junction. J Rheumatol 31:1274-1280

Kane D, FitzGerald O (2004) Tumor necrosis factor-alpha in psoriasis and psoriatic arthritis: a clinical, genetic, and histopathologic perspective. Curr Rheumatol Rep 6:292-298

Kane D, Gogarty M, O'Leary J, Silva I, Bermingham N, Bresnihan B, Fitzgerald O (2004) Reduction of synovial sublining layer inflammation and proinflammatory cytokine expression in psoriatic arthritis treated with methotrexate. Arthritis Rheum 50:3286-3295

Kane D, Grassi W, Sturrock R, Balint PV (2004) A brief history of musculoskeletal ultrasound: 'From bats and ships to babies and hips'. Rheumatology (Oxford) 43:931-933

Kane D, Grassi W, Sturrock R, Balint PV (2004) Musculoskeletal ultrasound--a state of the art review in rheumatology. Part 2: Clinical indications for musculoskeletal ultrasound in rheumatology. Rheumatology (Oxford) 43:829-838

Kane D, Balint PV, Gibney R, Bresnihan B, Sturrock RD (2004) Differential diagnosis of calf pain with musculoskeletal ultrasound imaging. Ann Rheum Dis 63:11-14

Kane D, Balint PV, Sturrock R, Grassi W (2004) Musculoskeletal ultrasound--a state of the art review in rheumatology. Part 1: Current controversies and issues in the development of musculoskeletal ultrasound in rheumatology. Rheumatology (Oxford) 43:823-828

Curran SA, FitzGerald OM, Costello PJ, Selby JM, Kane DJ, Bresnihan B, Winchester R (2004) Nucleotide sequencing of psoriatic arthritis tissue before and during methotrexate administration reveals a complex inflammatory T cell infiltrate with very few clones exhibiting features that suggest they drive the inflammatory process by recognizing autoantigens. J Immunol 172:1935-1944

Bresnihan B, Kane D (2004) Sonography and subclinical synovitis. Ann Rheum Dis 63:333-334

Mullan RH, Bresnihan B.Disease-modifying anti-rheumatic drug therapy and structural damage in early rheumatoid arthritis.Clin Exp Rheumatol. 2003 Sep-Oct;21(5 Suppl 31):S158-64. Review

Butler MW, Mullan RH, Schaffer KE, Crotty TB, Luke DA, Donnelly SC. Pulmonary cystic hydatid disease in Ireland. Ir J Med Sci. 2003 Oct-Dec;172(4):204-5.

Balding J, Kane D, Livingstone W, Mynett-Johnson L, Bresnihan B, Smith O, FitzGerald O (2003) Cytokine gene polymorphisms: association with psoriatic arthritis susceptibility and severity. Arthritis Rheum 48:1408-1413

Balint PV, Kane D, Sturrock RD (2003) Case number 26: massive cholesterol crystal deposition: unusual location in rheumatoid arthritis. Ann Rheum Dis 62:512

Kane D, Barnes L, Fitzgerald O (2003) Topical corticosteroid treatment: systemic side-effects. Br J Dermatol 149:417

Kane D, FitzGerald O (2003) Re: The role of ultrasonography in the diagnosis and management of idiopathic plantar fasciitis. Rheumatology (Oxford) 42:486

Kane D, Roth J, Frosch M, Vogl T, Bresnihan B, FitzGerald O (2003) Increased perivascular synovial membrane expression of myeloid-related proteins in psoriatic arthritis. Arthritis Rheum 48:1676-1685

Kane D, Stafford L, Bresnihan B, FitzGerald O (2003) A classification study of clinical subsets in an inception cohort of early psoriatic peripheral arthritis--'DIP or not DIP revisited'. Rheumatology (Oxford) 42:1469-1476

Kane D, Stafford L, Bresnihan B, FitzGerald O (2003) A prospective, clinical and radiological study of early psoriatic arthritis: an early synovitis clinic experience. Rheumatology (Oxford) 42:1460-1468

Kane D, Balint PV, Sturrock RD (2003) Ultrasonography is superior to clinical examination in the detection and localization of knee joint effusion in rheumatoid arthritis. J Rheumatol 30:966-971

Kane D, Balint PV, Wood F, Sturrock RD (2003) Early diagnosis of pyomyositis using clinic-based ultrasonography in a patient receiving infliximab therapy for Behcet's disease. Rheumatology (Oxford) 42:1564-1565

Haston JL, FitzGerald O, Kane D, Smith KD (2003) The influence of alpha1-acid glycoprotein on collagenase-3 activity in early rheumatoid arthritis. Biomed Chromatogr 17:361-364

Foell D, Kane D, Bresnihan B, Vogl T, Nacken W, Sorg C, Fitzgerald O, Roth J (2003) Expression of the pro-inflammatory protein S100A12 (EN-RAGE) in rheumatoid and psoriatic arthritis. Rheumatology (Oxford) 42:1383-1389

Balint PV, Kane D, Hunter J, McInnes IB, Field M, Sturrock RD (2002) Ultrasound guided versus conventional joint and soft tissue fluid aspiration in rheumatology practice: a pilot study. J Rheumatol 29:2209-2213

Balint PV, Kane D, Wilson H, McInnes IB, Sturrock RD (2002) Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis 61:905-910

Mullan RH, Ryan PF. Multiple site osteonecrosis in HIV infection. Rheumatology (Oxford). 2002 Oct;41(10):1200-2.

Bresnihan B, Roux-Lombard P, Murphy E, Kane D, FitzGerald O, Dayer JM (2002) Serum interleukin 18 and interleukin 18 binding protein in rheumatoid arthritis. Ann Rheum Dis 61:726-729

Haston JL, FitzGerald O, Kane D, Smith KD (2002) Preliminary observations on the influence of rheumatoid alpha-1-acid glycoprotein on collagen fibril formation. Biomed Chromatogr 16:332-342

Kane D, Sturrock R (2002) Diagnosing gouty arthritis. Practitioner 246:260-262, 264-265

Kane D, Veale DJ, FitzGerald O, Reece R (2002) Survey of arthroscopy performed by rheumatologists. Rheumatology (Oxford) 41:210-215

D Kane, T Greaney, B Bresnihan, M Shanahan, G Duffy, RG Gibney, O FitzGerald. The role of ultrasonography in the diagnosis and management of idiopathic plantar fasciitis. Rheumatology 2001;40:1002-9

PJ Costello, RJ Winchester, SA Curran, KS Peterson, DJ Kane, B Bresnihan, OM FitzGerald, Psoriatic Arthritis joint fluids are characterized by CD8 and CD4 T cell clonal expansions that appear antigen driven. J Immunol 2001;166:1278-86

L Stafford, D Kane, E Murphy, T Duffy, M Lassere, PP Youssef, B Bresnihan, O FitzGerald. Psoriasis predicts a poor short-term outcome in patients with spondyloarthropathy. Arth Rheum 2001;45:485-493

P Balint, D Kane, R Sturrock. Modern patient management in rheumatology: interventional musculoskeletal ultrasonography. Osteoarthritis Cartilage 2001; 9:509-511

V Wright, L Nelson, C McMillan, C Perry, D Kane, M Field. Imperial Weight Measurements (Letter to the Editor) SMJ 2001;46:135

D Kane, O FitzGerald. Ultrasonography in psoriatic arthritis. J Rheum 2000;27:1564

P Costello, D Kane, S Curran, B Bresnihan, R Winchester, O FitzGerald. Psoriatic arthritis - a unified concept. Arth Rheum 2000;43:712-713

D Kane, T Greaney, B Bresnihan, RG Gibney, O FitzGerald. Ultrasonography in the diagnosis and management of psoriatic dactylitis. J Rheum 1999;26:1746-51

P Youssef, F Breedveld, B Bresnihan, N Cassidy, G Cunnane, P Emery, O FitzGerald, D. Kane, M Kraan, S Lindblad, R Reece, D Veale, PP Tak. Quantitative microscopic analysis of inflammation in rheumatoid arthritis synovial membrane samples selected at arthroscopy compared with samples taken blindly by needle biopsy. Arthritis Rheum 1998;41:663-9

D Kane, F McSweeney, N Swan, B Bresnihan. Catastrophic antiphospholipid antibody syndrome in primary systemic sclerosis.  J Rheumatol 1998;25:810-3

D Kane, T Greaney, B Bresnihan, RG Gibney, O FitzGerald. Ultrasound-guided injection of recalcitrant plantar fasciitis. Ann Rheum Dis 1998; 57:383-4

N Flanagan, D Kane, E Sweeney, FM Mulcahy, L Barnes. Crusted Scarring Plaques on the Upper Body. Archives of Dermatology 1998;134:365-70

D Kane, O FitzGerald. Ultrasound-guided injection of plantar fasciitis. Ann Rheum Dis 1998;57:749-50

S Keating, D Kane, FM Mulcahy. Preventing AIDS. Journal of the Royal College of Physicians & Surgeons, Vol 26, No. 2, April 1997

O FitzGerald and D Kane. Clinical, Immunopathogenic and Therapeutic aspects of Psoriatic Arthritis. Current Opinion in Rheumatology 1997;9:295-301

D Kane, B. Bresnihan. Jaccoud's Arthropathy secondary to severe chronic eczema of the palms. Br J Rheumatol 1997;36:1339-40

C Williams, D Kane, G Duffy. Psoriatic Dactylitis-bone scintigraphic appearance. Clin Nucl Med 1997;22:853-4

D Kane, DJ McCarty. Tropical pyomyositis presenting as sciatica in Wicklow. IMJ 1997;90:155

D Kane, S Keating, S McCann, FM Mulcahy. The management of acute myeloid leukaemia (AML) in human immunodeficiency         virus (HIV) infection: a case report and review. International Journal of STD and AIDS 1997;8:272-274

JR Kerr, D Kane, B Crowley, N Leonard, S O' Briain, PV Coyle, FM Mulcahy. Parvovirus B19 infection in AIDS patients. International Journal of STD and AIDS 1997;8:184-6

S Dowling , D Kane, A Chua, S Keating, P Flood, PWN Keeling, FM Mulcahy. An Evaluation of Percutaneous Endoscopic Gastrostomy feeding in AIDS.

International Journal of STD and AIDS 1996; 7:106-109

D Kane, JM Murphy, S Keating, GF Wilson, FM Mulcahy. Renal ultrasonic findings in sulphadiazine-induced crystalluria. British Journal of Radiology 1996; 69:925-928

D Kane, C Bergin, S Keating, FM Mulcahy. Report on the 2nd International Congress on Drug Therapy in HIV infection (18-22 November 1994). JEADV 1994:14:27-8