Rheumatology

Q: Should I stop taking my naproxen/ibuprofen? 

 A: No, not at this time. However, the most recent NHS advice is that if you develop a temperature/symptoms then you should use regular paracetamol rather than ibuprofen to reduce your temperature. 

 Q: Should I stop taking my disease modifying (DMARD) medication and/or biologic drug? (disease Modifying medications include Methotrexate, Mycophenolate Mofetil, Azathioprine, Leflunomide, Sulfasalazine, Hydroxychloroquine.) 

A: No, if you’re currently well and don’t have any symptoms. However, as with any symptoms of infection, you should stop your DMARD/biologic and tell a healthcare professional that you normally take a DMARD/biologic drug.  

 If you have symptoms of COVID-19, please follow the NHS 111 advice  

 Q: I am taking prednisolone. Should I stop this if I become unwell or are in contact with a confirmed case of COVID-19? 

A: No. You should never stop taking your steroids (prednisolone) without medical advice, no matter what dose you take. If you develop any symptoms of infection, you should tell a healthcare professional that you’re taking prednisolone, the dose you take and the length of time you have taken it.  

If you have symptoms of COVID-19, please follow the NHS 111 advice  

Q:  Am I more at risk of developing COVID-19 because I take a biologic/DMARD/steroids? 

A: People who have an autoimmune condition and take medication which can affect the immune system may have a greater risk of developing infections. However, there’s currently no medical evidence to suggest that stopping your medication will reduce your risk in the short term.  

Stopping your medication when you’re well may cause your inflammatory condition to flare which can make it more difficult for you to manage your normal activities. 

Stopping steroids abruptly can make you very unwell. You should never stop without seeking medical advice.  

Follow the COVID-19 advice from Gov UK and the NHS to reduce your risk of infection. 

Q: Should I still have my blood test monitoring for my medication? 

A: Yes. It’s very important that we continue to monitor your bloods for safety reasons. We suggest that you attend your GP surgery for blood monitoring instead of coming to hospital where possible. 

If you have to attend the hospital for blood tests we recommend that you attend the phlebotomy service at Amersham Hospital. 

Q: I’m due to have my scheduled biologic infusion. Will it go ahead? 

A: Yes. However, if your condition is stable, and you want to defer your treatment, you can discuss this with your consultant. If you’re unwell and can’t come to your planned infusion appointment, please let us know as soon as possible.  

Q:  I’m due to start/switch to a new DMARD or Biologic. Should I start it now? 

A: Yes if possible. We are now planning to defer starting/switching any new DMARD or biologic drug. However, for some patients, it may be that starting the treatment is more beneficial than deferring. Commencing/switching treatment at this time will depend on consultant advice only after we discuss this with you. 

Q: I’m due to start my Denosumab or have my 6 monthly injection. Should I attend? 

A: We’ll contact your GP surgery to arrange for you to have your injection there if possible. For those starting Denosumab, we’ll defer starting your treatment and contact you to arrange this. 

Q: I’m due to have Zoledronate infusion for osteoporosis. Should I attend? 

A: No. If you’re due for Zoledronate infusion please contact our department to defer it. Your safety from COVID-19 infection takes priority. We’ll rearrange your infusion. 

Useful links for COVID-19 guidance and vaccine information 

• COVID-19 and arthritis 
• COVID-19 vaccination information from Age UK  
• NHS COVID-19 vaccine information 

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.

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