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Stable Patient Pathway (also known as Patient Initiated Follow Up or PIFU)

The Stable Patient Pathway is a method of regularly reviewing patients who have stable disease in yearly clinics. Patients will either see a consultant or a specialist Nurse. If you experience a flare up in your disease symptoms in the meantime we will aim to see you within 10 working days.

This system has been used successfully in other hospitals and is a way of providing support when you most need it (also known as Patient Initiated Follow Up or PIFU), while ensuring that your condition continues to be reviewed in planned clinics. Creating a ‘stable patient pathway’ improves patient experience and access to clinic appointments.

Why have we set up a stable patient pathway?

Many patients with stable and well controlled Inflammatory Arthritis attend clinics for routine appointments just to ensure they are monitored, even though there is no obvious change in their condition and no changes are required to their treatment. This may be time consuming and costly for some patients who perhaps need to take time off work and incur expenses travelling to the clinic and paying for car parking. Introducing this pathway will free up clinic time for patients who have unstable disease and enable stable patients to be seen at short notice when their arthritis ‘flares’.

Which patients will be entered on stable patient pathway?

Stable Inflammatory Arthritis patient means:

  • Patients who have had a diagnosis of Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) or Sero-negative Inflammatory Arthritis (SNIA) for more than 2 years
  • Patients whose inflammatory arthritis is well controlled without recent ‘flares’
  • Patients whose blood tests have remained stable and are compliant with blood test monitoring

How will it work?

  • Patients who fulfil the criteria will be given their next appointment in 1 year’s time
  • Each year, the appointment will alternate between the Consultant (or a member of their team) and one of the Specialist Nurses.
  • The Specialist Nurse clinic is named the Annual Review Clinic and is designed to assess patients holistically for disease activity as well as cardiovascular and osteoporosis risk assessments
  • For flare ups between appointments, the helpline should be called and an urgent appointment will be given for within 10 working days

What happens if my arthritis flares several times?

If several successive urgent appointments are required, this would mean that a patient’s conditions has become unstable and they would be taken off the Stable Patient Pathway and revert to regular routine appointments until stable again.

Hints and tips

Flares of RA, PsA or SNIA can affect one or two joints or several joints at one time. Flares can occur at any time and can last for a few hours to several days. Flares can be due to the inflammation or can be ‘mechanical’ where pain is caused by damaged joints. Inflammatory pain can be worse in the morning after inactivity whereas mechanical pain is often worse after repeated use of the affected joint.

How to manage a flare can depend on which joints are affected and whether it is inflammatory or mechanical, but the overall aim is to reduce pain and any inflammation. People with Inflammatory Arthritis often know the best way to manage their own symptoms, but here are some tips which may help to manage a flare:

  • Ensure you take your painkillers (analgesics) regularly to avoid the pain building up. Try to take them at least 20 mins before an activity which may induce pain.
  • Take your anti-inflammatories (NSAIDs) if prescribed on a regular basis also, making sure you take them with or after food to reduce irritation of the stomach.
  • Try to rest the joint(s) affected. It may be helpful to elevate the joints such as the knees or feet if possible as this may help with both mechanical and inflammatory pain. Using pillows to support the neck and shoulders may also make these joints more comfortable. If pain is associated with inflammation rest can help but it is also important to put the joints through a range of movements to reduce stiffness. Take your analgesics (painkillers) about 20 mins before you try to do this.
  • Use warmth for stiff, painful joints. A heat pad or hot water bottle is ideal but ensure it is covered to protect the skin. The use of a shower or bath if you are able will help with stiffness and allow more movement of the joints.
  • If you have hot, swollen joints then use a cold pack to reduce the heat and swelling. Again, protect the skin with a towel/cloth when using cold. Do not use cold packs on the back of the neck.
  • Use any splints you have been provided with 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 especially if you need to perform any functions which affect these joints.
  • Ask for help if you can. Do not try and do everything yourself. Recognise that you need to try and pace some of your activities when you are having a flare. Prioritise your activities and only do what you really have to.
  • Joint pain is often helped by strengthening the muscles which support the joints. If you would like advice about this, please ask about suitable exercises or whether physiotherapy referral may be beneficial. A leaflet regarding hand exercises can be obtained from either phoning the helpline or by contacting the Occupational Therapists.
  • You can contact your GP as necessary for advice. Your GP can contact the consultants if necessary to obtain specific advice.  If your flare does persist for more than 2-3 days or if you are having repeated flares then please call the helpline.

Accessing the Rheumatology Helpline

Please leave a message for the Specialist Nurses to return your call on
the Rheumatology Helpline 01296 255770.

Please listen carefully to all the options, but if you wish to speak to the Specialist Nurses or ask for an urgent appointment, you should press option 4.

When you ring the helpline, the information required is:

  • Your name
  • Your MRN or NHS number
  • State that you are on the Stable Patient Pathway
  • A telephone number which you can be contacted on
  • A brief description of the problem/advice you require

Helpline Number:   01296 255770

Other Useful Numbers:

General Appointments:  01296 838888
Option 6 – 8.30- 4.30

Occupational Therapy:   01296 315096 (office) or 01296 315000 ask for bleep 796

Podiatry:  01296 831110

Consultant Secretaries:  01296 831180

  • Stoke Mandeville – press option 1
  • Amersham and Wycombe – press option 2


Useful Web Addresses:

Versus Arthritis:

National Rheumatoid Arthritis Society (NRAS)

Psoriatic Arthritis

National Institute for Care and Excellence (NICE)

Arthritis and Musculoskeletal Alliance (ARMA)