Rheumatology patient advice

Concerns

Flares

Use maximum doses of pain relief, such as paracetamol and anti-inflammatory drugs if prescribed: ask your GP for something stronger if necessary.

Rest the affected joints on a pillow or footstool and apply cold packs or ice if helpful. If you have no ice, a bag of frozen peas wrapped in a towel would do just as well, but be careful to avoid direct contact on the skin as this can result in burns.

Some people find hot packs more soothing but if your joints are already warm and swollen, cooling them down may be preferable.

If there is no improvement within five to seven days contact your GP for further advice. Your GP may advise a course of oral steroid or an intramuscular steroid injection to settle your flare.

If your GP feels this is warranted you may need to email us.

Email: rheumatologyadviceline@ouh.nhs.uk

Swollen knee / shoulder / elbow

Ice packs may help to reduce the swelling.

Aspiration and injection of the joint(s) with steroid is sometimes helpful; however, if more than one joint is affected, your medication may need adjusting.

Some GPs are able to perform joint aspiration and injection, however, if your own GP cannot do this, please email us.

Injuries

If you have suffered an injury please see your GP. If your GP has ongoing concerns they may refer you for further treatment.

Smoking

Smokers are at increased risk of developing rheumatoid arthritis, and patients with rheumatoid arthritis who smoke have worse arthritis than those who don't.

Any inflammatory condition increases your risk of cardiovascular disease, and if you smoke that risk is increased further.

We strongly encourage you to stop smoking.

Test results

We will give you the results of any investigations at your next review, or sooner if appropriate. A copy of your results will be available to your GP.

We will send you copies of all letters that we send to your GP.

When to contact your doctor

Contact your doctor urgently if your joint becomes red and you have a temperature: this may suggest that your joint is infected.

If so you will need hospital treatment.

You may also need to contact your doctor if:

• your flare doesn't begin to settle after a week or two
• you think you may need a joint injection
• your painkillers aren't strong enough
• you need advice about steroids
• you have developed a side-effect from your medication.

General medical enquiries

For any general medical enquiries you should contact your GP in the first instance.

The email address given above is intended to supplement the advice of your GP, not replace it.

Steroid injections

Special occasions

If your arthritis is particularly active we may consider giving you a steroid injection to settle your symptoms, especially if you are waiting for new treatments to start working.

However, regular use of steroids can be harmful, so we do not routinely offer this before holidays or other special occasions.

If you require this, please discuss it with your GP or the Rheumatology nurses, who will decide if it is appropriate.

Frequency

There is no rule about the number of steroid injections a person can have, but long-term continued steroid use is associated with significant side-effects, so repeated injections are best avoided and should only be used if your condition has flared.

This is the reason many doctors limit the number of injections they offer to patients. If a steroid injection wears off quickly, or does not improve things, then repeating it may not help either.

If you need steroid injections often, it may be a sign that your disease is not well-controlled, and we may need to think about making changes to your medication.

Conception and pregnancy

Some drugs used to treat arthritis can harm an unborn baby. We recommend that you let your rheumatologist know if you are planning to become pregnant or father a child.

Your treatment may need to be changed before you stop using contraception.

If you have an unplanned pregnancy, and are stopping / have recently stopped taking regular medication for your arthritis, please seek advice from the Rheumatology team as soon as possible.

Employment

Information for employers

Please see 'Useful links' for good sources of information to share with your employer.

Time off work

If you have been unwell, and not able to go to work for up to seven days, you do not need a Fit Note unless there are limitations that your workplace has imposed on you.

Certificates to return to work after seven days or in limited circumstances are provided by your GP.

If you have been admitted to hospital under the Rheumatology team we will provide you with your certificate before you leave the hospital.

If you have had orthopaedic surgery, the team responsible for looking after you will also provide this.

PIP paperwork

If you need assistance with PIP paperwork, please talk to your GP.

The Rheumatology team cannot normally help, but can provide advice in unusual circumstances or a medical report if necessary.

Research

Clinical trials

University of Oxford, Oxford University Hospitals and the Kennedy Institute have many current studies into RA, AS and PSA.

All research is optional, and not all studies involve drugs: most require a few minutes of your time and possibly a small blood sample.

If you are interested, please contact your Rheumatology team.

For more information about trials currently recruiting please visit:

Clinical research studies - Oxford University Hospitals

You can also sign up for the National Rheumatology Arthritis Society email newsletter:

National Rheumatology Arthritis Society | Newsletter