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Your Rheumatology appointment
With many patients now having virtual consultations please click on the links below for more details about this aspect of our service.
Click here to join Rheumatology waiting room (video consultation)
Clinics
Appointments are held at Poole, Christchurch, and Wimborne Hospitals, for directions to Wimborne Hospital please click here.
My Arthritis App - Welcome
We are delighted to be able to offer patients with inflammatory arthritis the opportunity to use the My Arthritis app. This tool has been created by Ampersand Health in combination with UK patients and rheumatology teams to enhance your care at all stages of the condition.
What is My Arthritis and what can it do for me?
My Arthritis is a smartphone app, available free of charge. Not only does it have a raft of educational resources and tools to help you understand treatments and manage symptoms, but it also enables you to interact with us – via a messaging service if you have a problem or by submitting symptom related data which helps to inform the management strategies we use to improve your condition.
Why have I been chosen to take part?
The app has been openly available for some time now via the App Store/Google Play Store but when a hospital signs up there are additional benefits to patients such as the messaging and remote monitoring mentioned above.
As this is a new venture for the rheumatology department we have invited a small number of patients with inflammatory arthritis, chosen at random, to take part in using the app so we can understand how it works for patients and the clinical team at Christchurch. Subject to the app being well received by patients and staff, our intention is to open the offer to all patients with inflammatory arthritis currently under the long-term care of a Rheumatology team in Dorset.
Do I have to take part?
We recognise that apps and smartphones are not for everyone. This is very much an additional service for patients who would like to use a digital way of helping to support their long term condition. We hope you will find that using the My Arthritis App enhances both your consultations with us and also how we manage your condition together between appointments.
What if I do not find it helpful?
That is okay – as outlined above this is an additional service that should complement the care you get from us but is not intended to replace it. Part of the reason to offer the App in a staged way is to help us understand who might benefit most from My Arthritis and what the overall appetite for digital tools is within our patient population.
Is it safe?
The App has been through all the necessary approvals in the UK and also within the Hospital Trust and Dorset Clinical Commissioning Group to ensure that it meets the expected standards for a digital healthcare technology.
Where can I find out more about the App?
Click the link below to take you to the My Arthritis section of the Dorset Digital Library. From there you can read more about the app and download the software to get started today!
https://ourdorset.nhs.uk/digital/#myarthritis
Click here to see a guide on "How to get started".
Rheumatic conditions
Very often the first symptom that causes someone to visit their doctor is pain. If this pain is located in the joints or muscles and does not settle quickly, then a referral may be made to a rheumatologist if your doctor suspects inflammation is the cause. Pain may be associated with stiffness, joint swelling, fatigue or skin rashes and these are all symptoms that may be relevant.
There are a large number of musculoskeletal conditions but some of the more common ones are:
Rheumatoid arthritis (RA) is an auto-immune disease in which the immune system starts to attack the body instead of defending it. It is an inflammatory disease mainly affecting joints and tendons. Inflamed joints may become swollen, red and warm. It usually starts in the wrists, hands or feet, and can spread to other joints and other parts of the body. There is no cure, but symptoms can be treated effectively. RA may develop at any age. The cause is unknown.
RA is characterised by flares, when the disease is active, and periods of remission. During a flare you may feel generally unwell and tired and have pain and loss of strength and movement in inflamed joints. Your joints may feel stiff, especially first thing in the morning, or after sitting still for a long time. You may feel frustrated at times, particularly during a flare up, however most people are able to carry on as normal, with some adjustments to their lifestyle.
The main aims of treatment are to reduce pain and inflammation and slow down the disease process. Different kinds of drugs may be used, including disease modifying anti-rheumatic drugs (DMARDs), immuno-suppressants, non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids (in cases of severe inflammation). Biologic therapies are also used in severe uncontrolled disease. You will need to have regular blood tests to enable the rheumatology team to monitor the effects and safety of these drugs.
More information is available at:
Psoriatic arthritis (PsA) causes inflammation in and around the joints and is associated with the skin condition, psoriasis. The exact cause of PsA is unknown. In most cases the arthritis develops after the appearance of psoriasis, however sometimes the arthritis precedes the skin symptoms. There is no connection between the severity of skin disease and joint disease.
The symptoms of PsA may be similar to those of other forms of arthritis. It can affect most joints. Stiffness first thing in the morning or after resting is common, as is pitting and discoloration of nails. You may also suffer with spondylitis - a stiff, painful back or neck caused by inflammation in the spine and/or iritis - inflammation around the pupil of the eye.
Drug treatment for PsA is similar to that of rheumatoid arthritis. The skin is usually treated with ointments, but you may also need tablet treatment and light therapy. Exercise is important to maintain muscle strength and mobility, and relaxation techniques may be useful to aid rest.
Further information is available at:
Ankylosing spondylitis (AS) also known as Axial Spondyloarthropathy is a form of inflammatory arthritis that affects the joints of the lower back initially. Ankylosing means stiffening and spondylitis means inflammation of the spine. There is no cure for AS, but like most forms of inflammatory arthritis it can go into remission, often when people reach their fifties.
The disease is more common in people with the HLA-B27 tissue type, one of the HLA genes from the HLA-B family. HLA-B27, while not being the only determining factor in Ankylosing Spondylitis, is present in 95% of people with this condition. It is, however, present in 8% of the general unaffected population. Other diseases such as reactive arthritis and psoriatic arthritis can also be associated with HLA-B27. The cause is not clear. It is more common in men than women and is more frequently seen in younger people. In AS, the sacroiliac joints (which join the base of the spine to the pelvis) become inflamed. This is why your lower back may feel sore first thing in the morning. Longstanding or repeated bouts of inflammation cause scar tissue to form in the spaces between vertebrae (the chain of bones that make up the spine). In time, this scar tissue may turn into bone and fill the space between the vertebrae. This effectively fuses the joint, which limits movement of the spine.
The initial symptoms of AS are pain, aching and stiffness in the lower back. You may also feel pain further up the back and restricted movement of the chest. Some people experience pain and discomfort on and off for a number of years until the inflammation ceases, but most are able to lead a full and active life. In others movement of the spine may be severely limited. You may feel overwhelmingly tired at times. Another symptom is inflammation of the eyes (iritis) which needs immediate treatment to prevent further damage.
Early diagnosis and treatment is important to minimize damage to your joints. Exercise is vital to maintain mobility, prevent the joints from being fused into a bad position and to help relieve pain. You will be referred to physiotherapy for a specific exercise programme. Anti-inflammatory drugs can be prescribed to reduce pain and stiffness.
Poole Hospital holds a dedicated exercise group once a fortnight on Thursdays 5.30-7.00pm in the hydrotherapy pool and gym.
For more information contact This email address is being protected from spambots. You need JavaScript enabled to view it., tel Helen 01202 672487 or Barry 01202 670517.
Or go to National Ankylosing Spondylitis Society (NASS):
Click here for the printable BASDAI form. This questionnaire is a subjective measure of your symptoms and how they impact on you. It will be used by the team to assess the activity of your disease, its response to treatment and in the decision making process in any changes to your treatment that may be required.
Other conditions include:
- Gout - visit versusarthritis.org
- Osteoarthritis - visit versusarthritis.org
- Osteoporosis - visit theros.org.uk
- Polymyalgia rheumatic - visit versusarthritis.org
- Scleroderma - visit sruk.co.uk
- Systemic lupus erythematosis - visit lupusuk.org.uk
- Vasculitis - visit www.vasculitisfoundation.org or vasculitis.org.uk
- Fibromyalgia Syndrome - visit ukfibromyalgia.com
Our Dorset video library:
Rheumatology Medications
The types of medication include:
- Pain killers and NSAIDs
- Disease-modifying anti-rheumatic drugs (DMARDs)
- Biologics and Biosimilars
- Corticosteroids
More information is available at:
Non-steroidal anti-inflammatory drugs (NSAIDs) are used to reduce inflammation as well as pain and may be prescribed for many types of arthritis. They are usually given in tablet or capsule form, often as a slow-release preparation to ensure stable levels of the drug within the body. NSAIDs may also be given in the form of suppositories or as gels and creams for topical application to the skin overlying affected areas. Examples of NSAIDs include Ibuprofen, Naproxen, Meloxicam, Etodolac, Celecoxib, Diclofenac and Nabumetone. There are many different brand names for some of these drugs.
NSAIDs may not be prescribed if you are taking certain other drugs such as Warfarin or if you have, or have had gastric (stomach) ulcers in the past. If you are in any doubt, please discuss this with your GP. Should you experience dyspepsia (heartburn) or indigestion whilst taking NSAIDs you may require additional medication (PPIs) to protect your stomach. Again you should discuss this with your GP. NSAIDs should not be taken on an empty stomach but always with, or immediately after, food.
Some NSAIDs are available over the counter as pain relief medications. Check you are not already taking a prescribed one before buying pain relievers.
These are used for most types of arthritis, including osteoarthritis. Examples include Paracetamol and mild opioids such as Codeine and Dihydrocodeine or combination products such as Paracetamol and Codeine (Co-codamol) or, Paracetamol and Dihydrocodeine (Co-dydramol). Tramadol is also sometimes prescribed. Very occasionally, stronger opioid analgesia such as morphine is required for very severe pain. This may be given in liquid or tablet/capsule form such as oramorph or MST. Very strong opioids are also available as patches e.g. Fentanyl. Simple analgesia such as Paracetamol rarely cause any side effects and may be used safely with most other medication, however it is important not to exceed the maximum recommended dose of any medication. Opioid-based drugs may cause drowsiness in some people. if you are affected in this way you should avoid driving or operating machinery. Please read the information on the packaging or prescription.
Blood Monitoring
All disease-modifying anti-rheumatic drugs (DMARDs) have the potential to cause adverse effects and thus require regular monitoring to detect these and ensure your safety.
Regular blood tests are important both to check for adverse effects on your kidneys, liver and blood cells and to monitor how active your disease is and how well you are responding to treatment by checking your inflammatory markers. This can be done at the hospital pathology department by a phlebotomist but many GP practices also provide a phlebotomy service. If this would be more convenient for you please check if your surgery offers this service.
For patients on DMARDs regular blood tests usually include the following: full blood count (FBC), erythrocyte sedimentation rate (ESR) and biochemical profile (liver function tests / LFTs), C-reactive protein (CRP) and renal (kidney) function tests.
A full blood count includes the haemoglobin, white cell count and platelet count. These are briefly explained below.
Haemoglobin
If you become anaemic your haemoglobin level will decrease. Anaemia is common in many forms of arthritis and may be due to a number of reasons. Iron deficiency is a common cause and iron or dietary supplements may be necessary. Non-steroidal anti-inflammatory drugs (NSAIDs) are known to cause stomach irritation (gastritis) and ulceration in some people. This may lead to bleeding from the stomach or bowel resulting in anaemia.
Other causes of anaemia include mal-absorption (where certain nutrients are poorly absorbed via the bowel) – this may occur if you have other conditions such as Crohn's disease or Coeliac disease. Some people have a form of anaemia called Pernicious Anaemia, which requires regular injections of Vitamin B12. Anaemia commonly occurs as a symptom of long term inflammation however and is not always helped by iron supplements. As your arthritis becomes better controlled the haemoglobin often improves and the anaemia resolves. Very occasionally severe anaemia requires a blood transfusion or an iron injection/infusion.
White cell count (WCC)
The white blood cells may be affected by both your disease and its treatment. The number of white cells often increases when infection is present or with long-term use of corticosteroids. However, drugs which suppress the immune system may reduce the number of white cells.
White cells help to fight infection so the number of white cells is checked to ensure that you retain sufficient to be able to fight infection. There are different types of white cells, the most important being neutrophils. If the level of neutrophils falls too low you may need to stop treatment.
Platelets
The number of platelets in the blood is also monitored. These are cells involved in blood clotting and may increase in number when there is active inflammation. Some drug treatments may cause a reduction in platelets which could increase the risk of bleeding, making it necessary to stop treatment.
We also measure important inflammation markers (ESR and CRP) which enable us to assess the activity of your condition.
C-reactive protein (CRP)
This is an enzyme produced by the liver which increases in response to inflammation- it is not specific to arthritis so may be raised even if your arthritis is stable i.e. due to infection. It is usually included with other liver tests to provide an additional means of assessing the extent and activity of your disease.
Erythrocyte sedimentation rate (ESR)
The ESR is a simple test which indicates the level of inflammation in the blood and may increase when your arthritis is more active, but this is not always the case. In some conditions the ESR remains normal despite ongoing inflammation. The ESR may also be affected by concurrent illness or infection. The 'normal' ESR varies: it is often higher in women and increases with age and body mass index.
Some hospitals use a different test, plasma viscosity, which also measures the level of inflammation in the body.
Both CRP and ESR are often referred to as 'markers of inflammation'.
Biochemistry Tests (LFTs, U&Es, Creatinine)
These check how well your liver and kidneys are working as these are the organs predominantly concerned with getting rid of the drug from the body. They assess the balance of salts and calcium levels in the body. These can be affected by many conditions and by drug treatments.
Frequently asked questions
For patients taking Disease Modifying Anti-Rheumatic Drugs (DMARDS)
1. I am having a flare of my arthritis, what shall I do?
Use maximum pain relief regularly, such as Paracetamol and anti-inflammatory drugs i.e. Ibuprofen, if you think you are experiencing a flare of your disease. Ask your GP if you need something stronger if these medications do not help. Resting the joint or joints and using ice/heat packs can be helpful. If this does not improve your symptoms over a few days, have a blood test and contact the Rheumatology Advice Line. There is useful information about managing symptoms on the Versus Arthritis website.
2. Can I take anti–inflammatories with methotrexate?
Yes, the combination of methotrexate and anti-inflammatories is considered safe. There are some contraindications with other medications, if you are unsure contact the rheumatology team.
3. I think I am having side effects from my medication, what should I do?
All medications can cause side effects. With regards to Methotrexate, nausea, mouth ulcers and a dry mouth are common side effects. Increasing folic acid up to 6 days a week, and taking anti-sickness medication is likely to help these symptoms. Shortness of breath and/or a dry cough may require further investigation as rarely these can be due to methotrexate. It is important to report any side effects, even those not listed. Seek advice from the Rheumatology team by contacting the Advice Line if you are concerned.
4. Should I have the flu and /or the pneumonia jab?
We recommend both the 'flu and pneumonia vaccines in patients with rheumatological conditions, particularly for those patients on disease modifying anti rheumatic drugs [DMARDS] e.g Methotrexate, Sulfasalazine, Leflunomide and biologic therapies.
5. Can I have vaccinations while I am on my rheumatology medication?
You should avoid live vaccines such as oral polio and yellow fever while on any immune system suppressing medication such as methotrexate, sulfasalazine, Leflunomide, Etanercept, Adalimumab (etc). If you are likely to require vaccinations we would suggest discussing this with your GP well in advance of any travel dates. Further information about vaccinations is available from Versus Arthritis.
6. I am having an operation what do I do with my medication?
Although it is safe to continue all DMARDs during the time of an operation, they may be stopped at the discretion of the surgeon and after discussion with the rheumatology team looking after you. Oral steroids [Prednisolone] should be taken at the lowest dose possible to reduce the risks of infection and delayed healing. Do not stop steroid tablets abruptly. Do not increase or reduce your dose without consultation with your GP or Rheumatology team. Biologic medication should be stopped before and after surgery under the advice of your Rheumatology team. Please seek advice from the Rheumatology Advice Line on how to do this.
7. I have an infection/ I am on antibiotics; do I need to stop my medication?
DMARDs may take up to 3 months to work, so stopping them for 1-2 weeks is unlikely to lead to a flare of your arthritis, it is not always necessary to stop but always seek advice if you are uncertain. Biologic drugs should always be stopped if you have signs of an infection and re-started once the infection has cleared/antibiotics finished. Trimethoprim and co-trimoxazole [Septrin] must never be taken with Methotrexate.
Steroid tablets should never be stopped during an infection, and instead on occasions the dose of steroids may need to be increased please discuss this with your doctor if you are unwell enough to be confined to your bed, or if you've been admitted to hospital.
8. How do I find out the results of my tests?
Patients on immune suppressing medications need to have regular blood tests to make sure that the drugs are being used safely. We will contact you if they are abnormal, otherwise these will be discussed at your next appointment, unless a clinician has asked you to call the Rheumatology Advice Line for them. Copies of your blood tests are automatically sent to your GP and many patients can access their results directly in an online service from their GP.
9. Why have I not received my prescribed biologic medication?
To ensure all prescriptions for biologics can be generated without delay, please ensure you have your blood tests as agreed with your Rheumatology team instructions. Please also ensure you attend all your Rheumatology department appointments, this will allow us to process your repeat prescriptions and avoid delay. Your prescription may not be renewed if you do not have your blood tests as instructed.
10. Is it OK to use complementary or herbal remedies?
Some people derive benefit from complementary or herbal medicines, but there can be significant interactions with prescribed medications. If you wish to use these therapies please discuss this with your Rheumatology team. Further information may be obtained from Versus Arthritis.
11. What happens if I or my partner gets pregnant whilst taking disease-modifying treatments?
You may need to discuss your medication prior to planning for a family. Some DMARDs are known to be potentially harmful to an unborn child and it is important to notify us via the Rheumatology advice line immediately if you become pregnant on treatment. We will advise you if it is safe to continue with treatment or discuss possible alternatives.
12. What should I do if I come into contact with someone with chicken pox whilst on methotrexate?
Notify the Advice Line or your GP as soon as possible as you may need treatment with anti-viral medication (aciclovir) to minimise the severity of the disease.
13. Can I have the shingles vaccine?
You will need to check with the Rheumatology Advice line as this will depend on what medication you are on and if you have had previous chicken pox. Up until recently all Shingles vaccines have been 'live' and so are avoided in those on immunosuppressants, however, newer (non-live) vaccines have recently become available – please discuss with your GP.
14. I might have shingles, what should I do with my rheumatology medication?
You will need to stop your immune system suppressing medication such as Methotrexate, Leflunomide and Biologic medication and make an urgent appointment with your GP for treatment with aciclovir.
15. Why do I need to take folic acid with methotrexate each week?
Folic acid reduces the side effects of methotrexate such as nausea and mouth ulcers. If these are severe you may be advised to take folic acid more frequently and will be prescribed by your GP. Over the counter folic acid is a different dose to the required dose used in rheumatology.
