Rheumatology Service - Rochdale Infirmary

Consultant rheumatologist

Consultant rheumatologists are qualified doctors who investigate, diagnose and manage patients with a wide range of musculoskeletal conditions. They specialise in treating inflammatory arthritis, spondyloarthropathy, connective tissue /autoimmune systemic rheumatic disorders such as lupus, vasculitis, myositis and bone disorders including osteoporosis. Rheumatologists perform joint and soft tissue injections and procedures, as well as ultrasound scan of joints and muscle biopsy.

Your first appointment in the rheumatology department will likely be with a consultant rheumatologist, who will perform clinical assessment and physical examination. Your rheumatologist may order a few tests to further evaluate your condition. These would include blood tests, x-ray and other imaging. Based on your joint problems you may also have an ultrasound scan of the joints. Your rheumatologist will confirm your diagnosis and recommend and oversee your treatment.

Clinical Nurse Specialists 

A rheumatology nurse specialist is a trained nurse who has specialist experience in looking after your physical wellbeing and will assist the rheumatologist in managing your condition and treatment. They can signpost you to other organisations that can help with your emotional and social needs. Rheumatology nurse specialists work with people with all kinds of arthritis-related conditions. Some rheumatology nurse specialists in our team are able to administer steroid injections, diagnose, recommend treatments and prescribe medication.

Occupational Therapy in Rheumatology

Through assessment and discussion with you, we will tailor make a treatment plan  to help you manage your arthritis so you can maximise your ability to carry out daily living activities for yourself in your home,  work and leisure.

Some of the examples of the daily living activities one may have difficulties with; food preparation, personal care, childcare, domestic tasks, work related activities, sleep.

Using evidence based research our treatments include:

• Joint protection – how best to use your joints without straining them. These methods are used in combination with the treatments below.
• Energy conservation – how to make the most of your energy levels.
• Hand therapy – advice regarding exercises.
• Splinting of the hand or wrist – either moulded to fit you or off the shelf splints.
• Work - Advice regarding issues related to your work or workspace.
• Equipment and adaptations – referral to Social Services or advising you where to get these from.
• Mental health and mood - Advice on coping techniques.

Your treatment may be given one to one, or in a group. The group is a great opportunity for you to discuss and share your experiences in a safe environment and learn with others about managing your condition.

As well as working with community services local to you, we also work closely with other members of the Rheumatology team as what we offer is part of your Rheumatology treatment.

Pharmacists Role

• Medicines Advice - Advise on medication queries from staff and patients
• Drug Education - Run drug education clinics for patients newly starting treatments
• Medicines supply - Liaise with other pharmacy colleagues to ensure timely and safe medicines supply to patients
• Prescriptions - Review prescriptions to make sure they are safe and accurate
• Involvement in development and update of clinical guidelines and protocols
• Funding - Ensuring appropriate funding is in place for high cost drugs

Physiotherapist 

The role pf physiotherapy within the rheumatology service is to restore physical wellbeing, promote independent living and promote positive self-management strategies for long term conditions. 

We use a range of assessment techniques to form a diagnosis and together, a decision is made on the best course of treatment.  This will include a thorough history of your condition, and a physical assessment, that will assess joint mobility, posture, strength, palpation of the affected area and specific diagnostic tests.

A joint decision will be made on the best course of treatment which may include stretching, strengthening, posture correction, manual therapies and manipulation, and acupuncture. Therapist will provide you with an individualised home exercise program to empower you with your rehabilitation. We will also support you with a graded return to exercise and active lifestyle advice. Education will be provided around understanding of diagnosis, pacing strategies, joint protection, sleep hygiene and specific goal setting. You can attend specialist classes run within the physiotherapy department for shoulder, ankle or lower limb conditions, or attend a more general ‘Graded exercise’ program, which will help to build general fitness and confidence around exercise. We can refer you onto community based services for other healthy lifestyle support such as smoking cessation, weight loss and exercise prescription.

Podiatrist

The podiatrist role is to identify, diagnose and treat disorders, diseases and deformities of the feet and legs and implement appropriate and timely care. We work closely with other members of the rheumatology team and also our community podiatry colleagues.

The goal of the podiatry element of rheumatology care is to reduce foot-related pain, maintain / improve foot function and so mobility, while protecting skin and other tissues from damage.

Podiatry advice and treatments are based on information gained from the history and assessment of a person's foot problem. The specialist-led hospital service offers  detailed foot assessment which can include the skin, vascular and neurological systems, the musculo-skeletal structures and walking, as well as footwear, foot health education, direct referral for x-rays, blood tests, MRI scans and foot surgery, soft tissue and intra-articular injections, wound care management, nail surgery, assessment of foot structure and function, provision of orthotics. We don’t usually provide routine ongoing podiatry treatment as where required this is carried out by our community podiatry colleagues.

The types of treatments used will be dependent on the individual's particular assessed problem/s with reference to wider health and social matters and wishes.

Where appropriate, people are encouraged and enabled to manage their foot and ankle aspects of their condition.

Helping you learn about your condition

A detailed explanation about what your diagnosis means can reduce any anxiety and empower you to make informed choices regarding your treatment where possible. The rheumatology nurse specialist will listen to your concerns and provide information and support during periods of change. They’ll explain your symptoms and will work with you to reduce their impact.

Helping you learn about drug treatments and monitoring your needs

The rheumatology nurse specialist will provide you with information before you start any drug treatments so that you’re fully involved in your treatment. If you’re on drugs for arthritis you’ll need regular ‘monitoring’ blood tests, and for some you’ll need regular blood pressure and urine tests. They will also arrange for your drug treatment to be monitored in a hospital clinic or at your GP’s surgery.

Offering telephone support – contact number 01706 517233

Our rheumatology nurse team run a telephone advice line to provide you with easy access to a nurse who knows about your condition and your treatment. This is a handy way for you to contact the nurse if you need advice and support on managing your symptoms or if you have any concerns about your condition or your treatment.

For Inflammatory arthritis eg Rheumatoid Arthritis

What is a flare–up?

• During a flare-up, arthritis symptoms get temporarily worse
• Joints may swell or become more swollen
• You may feel more pain and stiffness, especially in the morning
• You may feel more fatigued

Principles of managing a flare-up

• Try increasing your pain relief (if able)
• If a joint is hot and swollen you can try some ice therapy
• If joints are stiff and achy try warm showers and gentle stretching exercises.
• Allow yourself rest when needed. Pace your activities!
• Don’t push yourself too much at this point - keep yourself moving gently!

What if I am still struggling?

If your flare-up hasn’t settled down after 72 hours and you’ve tried all of your self-management techniques

Contact your Rheumatology Nurse for further advice 01706 517233

The nurses would also advise you to contact them if you are having more frequent flare-ups than your ‘norm’ as this may indicate you need a medication review and possible change in therapy

How to Manage Fatigue

• Acknowledgement - it is something you have to manage not ‘fix’
• Pace yourself
• Get good quality sleep
• Get help for depression/anxiety
• Exercise
• Adapt your home environment
• Establish a good work routines