RITA-Ireland

 A Vasculitis primer from John Mills and co

The RITA-Ireland guidance is aligned with that of the UKIVAS network. Please visit  https://ukivas.ndorms.ox.ac.uk/  for further information.

Rationale for RITA-Ireland

Primary systemic small vessel vasculitis (PSV) refers to a group of rare autoimmune multi-system disorders with an annual incidence of 15/million and prevalence of approximately 2/10,000 and occurs primarily in adults with a median age of onset of 62.

It presents acutely to a wide range of medical and surgical specialities and frequently presents a diagnostic dilemma as many clinicians will be unfamiliar with the condition, with delays in diagnosis of 6-12 months typical. Consequently, organ destruction progresses such that 30% end up with end-stage kidney disease and intensive care unit level care is often required due to multi-organ dysfunction.

However, early diagnosis of PSV and initiation of appropriate immunosuppressive therapy can substantially improve the associated morbidity and mortality, leading to a significant reduction in associated healthcare utilization costs. While effective treatments are available, PSV is a chronic relapsing condition with no cure that requires coordinated long-term multi-disciplinary input. In the “EULAR recommendations for management of primary small and medium vessel vasculitis” the first recommendation is to manage this condition in conjunction with centres of expertise with integrated expertise to manage relapses and complications of therapy.

To address this unmet need in Ireland and improve patient care, five centres across the Republic of Ireland, and one in Northern Ireland, developed a network of specialist units in collaboration with Vasculitis Ireland Awareness, the national vasculitis patient organisation. This network is comprised of dedicated multi-disciplinary centres that provide a coordinated care path from diagnosis to relapse and on to long-term remission, and provide access to clinical trials for patients with PSV. The six centres maintain close ties and difficult cases are often discussed in a cross-centre forum.

To reflect the clinical overlap, importance of care provision across the full life course and the emergence of a broad European Reference Network in rare immune disorders (ERN-RITA - http://rita.ern-net.eu/), two additional units joined RITA-Ireland in 2018: the National Pediatric Rheumatology and National Pediatric Immunodeficiency centres, both based in Children’s Hospital Ireland. The seven clinic centres in the Republic of Ireland, along with Vasculitis Ireland Awareness, comprise the RITA-Ireland network.   

To provide a foundation for developing the service in Ireland and to support translational Vasculitis research, the RITA-Ireland network established the RITA-Ireland Vasculits Registry and Biobank, seeking to enrol all patients in Ireland with PSV, thereby providing a rich longitudinal clinical database linked to one of the most complete PSV biobanks in the world based in Trinity College Dublin. The network is closely aligned with UKIVAS, the Vasculitis Rare Disease Group of the UK and Ireland and with the UKIVAS registry, the largest PSV registry in the world. In addition, RITA-Ireland is linked to the European Vasculitis Society.

Participating units

• Coordinating unit: Tallaght University Hospital
  Lead clinician: Prof. Mark Little
• St James Hospital, Department of Immunology
  Lead clinician: Dr. Niall Conlon
• St Vincent’s University Hospital, Department of Rheumatology
  Lead clinicians: Dr. Eamonn Molloy, Dr John Holian
• Children's Hospital Ireland, Department of Rheumatology
  Lead clinician: Dr Orla Killeen
• Children's Hospital Ireland, Department of Immunology
  Lead clinician: Dr Ronan Leahy
• Cork University Hospital, Department of Nephrology
  Lead clinicians: Dr Michael Clarkson, Dr Sarah Moran
• University Hospital Galway, Department of Nephrology
  Lead clinician: Prof Matthew Griffin
• Southern Health & Social Care Trust, Department of Nephrology and Rheumatology
  Lead clinician: Dr Neal Morgan, Dr John Harty, Dr Nicola Maiden
• Vasculitis Ireland Awareness, Irish Vasculitis patient organisation
  Chairperson: Ms Julie Power

RITA-Ireland coordinator: Ms Pamela O’Neil (ern-rita@tuh.ie)