Rheumatology

We treat rheumatoid arthritis patients through the rapid access pathway. It gives you regular access to care and support when you need it.

The pathway follows a 4-step process to help you get the treatment you need.

Step 1: attend an introductory educational session

You’ll need to be in a stable condition and attend this session progress through the pathway. We’ll tell you how to access our flare helpline, as well as occupational therapy and podiatry services.

You’ll get a plan detailing the care you will get. We’ll also send a copy of this plan to your GP.

Step 2: phone consultation

This will happen 3 to 6 months after you enrol on the pathway. A specialist nurse will discuss your symptoms, blood test results, medication and general wellbeing.

We’ll send you a letter detailing what we have discussed. We’ll also tell your GP about any changes to your care.

Step 3: face-to-face consultation

We’ll invite you to a consultation 2 years after you enrol on the pathway. A specialist nurse will:

• do a full assessment of your condition
• review your medication
• assess your bone health
• look at your general wellbeing – how you’re coping
• both physically and emotionally.

We’ll write to your GP telling them about the outcomes of your consultation. If your condition is stable and you’re happy to stay on the pathway, we’ll schedule another consultation in 6 months time.

Step 4: flare clinic appointments

If your condition flares up, you can call our helpline. You’ll get an urgent clinic appointment within 10 days. We’ll assess you and make any changes to your treatment. You’ll continue to get hospital appointments until your condition stabilises. You can then join the rapid access pathway again.

They can affect 1 or 2 joints or several joints at one time. Flares can occur at any time and can last for a few hours to several days.

Inflammation or damaged joints can cause a flare. Inflammatory pain can feel worse in the morning after inactivity. Mechanical pain due to damaged joints often feels worse after repeated use of the affected joint.

How to manage a flare can depend on the affected joints, and if your pain is inflammatory or mechanical.

The aim is to reduce pain and any inflammation. Below are some tips which may help:

• take painkillers regularly to avoid the pain building up
• take your anti-inflammatories regularly, as prescribed, with or after food to reduce tummy irritation
• rest the affected joints
• elevate the joints such as the knees or feet if possible – use pillows to support your neck and shoulders
• reduce stiffness in your inflamed joints by moving them as comfort allows. Take painkillers about 20 mins before you try to do this
• use warmth for stiff, painful joints, for example a heat pad or hot water bottle but make sure you cover it to protect your skin
• have a bath or shower if you can to reduce stiffness and allow more joint movement
  use a cold pack for hot, swollen joints. Protect your skin with a towel or cloth. Don’t use a cold pack on the back of your neck
• use splints for hand or wrist flares. If you find them uncomfortable to wear all the time, try and wear them for short periods during the day
• ask for help, don’t try and do everything yourself – pace and prioritise your activities.

Exercises that strengthen muscles often help with joint pain. If you’d like advice about this, please ask us about any suitable exercises or if you’d like a referral for physiotherapy. We can also give you a leaflet about hand exercises – call the helpline below for more details.

Phone the helpline if your flare persists for more than 2 to 3 days or if you’re having repeated flares.

Our service is piloting a system known as ‘Patient-initiated follow-up’ or ‘PIFU’ for short, that puts you, the patient, in control of when you are seen by the service. If you have been advised by those caring for you that you have been recommended for patient-initiated follow-up please click here to view more information about how it works: Patient-Initiated Follow-Up (PIFU) 

You may receive an invitation to attend an online video appointment. Find out more about our online video appointments system including a link to access the portal for rheumatology video appointments.

• COVID-19 – information for rheumatology patients
• For help and advice about myositis
• Information and support for axial spondyloarthritis
• Support for osteoporosis 
• Support for patients living with rheumatoid arthritis
• Information and advice for patients with scleroderma and Raynaud’s