Rheumatology - Top tips for patients with inflammatory arthritis

Top tips for managing inflammatory arthritis

The outlook for patients with inflammatory arthritis (e.g. rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis) is better than ever. With the advent of newer, more effective treatments, our aim (where possible) is for disease remission. This leaflet lists some areas which can help us to achieve the best outcomes.

Vaccinations

We recommend that you have influenza immunisation every year, and have had the pneumovax immunisation (for pneumonia) at least once.

Please check if you are eligible for covid vaccination at https://www.nhs.uk/vaccinations/covid-19-vaccine/

Please ask your GP or Rheumatology team if you are eligible for the new shingles vaccine (Shingrix). This is offered to adults aged 50 and over treated with certain immunosuppressive therapies.

You should avoid live vaccines if on certain immunosuppressive treatments including biologic therapies and some doses of steroid tablets. Please check with your clinical team if you need a live vaccine (for example MMR, rotavirus, Zostavax, oral typhoid, chickenpox, yellow fever).

General Health

Anxiety and depression are common in patients with arthritis and can make your symptoms feel worse. If you are affected, do not hesitate to seek help from your GP.

Cardiovascular disease is more common in patients with inflammatory arthritis. Please ensure that you are on your GP register for monitoring of cardiovascular risk factors, including blood pressure, cholesterol and diabetes.

Lifestyle

Keeping physically fit and strong and maintaining a healthy weight have many benefits for inflammatory arthritis. Our aim is to control your arthritis so that you can take part in exercise and physical activities that you enjoy.

You may wish to follow the principles of a Mediterranean diet (more bread, fruit, vegetables, fish [especially those rich in omega-3 fatty acids], lentils, nuts and extra-virgin olive oil. Plus eat less red or processed meats.

Medications used to treat arthritis have been shown to be more effective in non-smokers. Stopping smoking also has many other health benefits, including lower risk of infection and cardiovascular disease.

Multidisciplinary Team

Occupational therapy (OT)

The OT team can help you with activities that are important to you by exploring different ways of doing things and providing equipment and splints/supports. They can also advise on hand exercises, joint protection and managing fatigue/relaxation.

Podiatry

The role of the podiatrist is to reduce foot pain, improve foot function and mobility and protect the skin and toenails.
Treatments offered include insoles/orthotics, footwear advice, joint protection and treatment of nail problems and foot ulcers.

Physiotherapy

The physio team can help you with general exercise/fitness advice and can teach you exercises to improve joint flexibility and muscle strength.

Any member of the rheumatology team can refer you to OT/ podiatry/physio if required. If you are a Salford resident or registered with a Salford GP, then you can self-refer to OT/physio using the Go2Physio portal at
https://www.northerncarealliance.nhs.uk/go2physio

Medication

Anti-inflammatory tablets (e.g. ibuprofen, naproxen) can sometimes help pain/stiffness. But they have a number of important side effects and should only be taken regularly if they definitely help.

DMARDs (Disease Modifying Anti-Rheumatic Drugs), Biologic therapies and JAK inhibitors (JAKi)

Please check with your rheumatologist/specialist nurse each time you attend, how often blood monitoring tests are required, as the frequency may change.

If you have an infection that is severe enough to require antibiotics, please stop the DMARD/biologic/JAKi until you have recovered.

If you are planning a pregnancy, please discuss with your rheumatologist/specialist nurse, as certain medications (especially methotrexate and mycophenolate) are not safe in pregnancy.

If you are due to have surgery, please discuss with your surgeon and rheumatology team about whether your medication needs to be stopped beforehand.

Supplements: Some over the counter supplements can interact with your prescribed medication. Please mention which additional supplements you take to your health-care professional.

Useful Information Sources

National Rheumatoid Arthritis Society (NRAS)
www.nras.org.uk
Tel: 0800 298 7650

Versus Arthritis
www.versusarthritis.org
Tel: 0800 5200 520

National Axial Spondyloarthritis Society (NASS)
www.nass.co.uk
Tel: 020 8741 1515

Psoriasis and Psoriatic Arthritis Alliance (PAPAA)
www.papaa.org
01923 672837