How is RA managed
Make the most of your healthcare team
It is important to make the most of your appointments with members of your healthcare team – that is, your doctor, rheumatologist, nurse, occupational therapist, physiotherapist, and so on. Give them as much information as you can and try to be as exact as possible when you’re describing how things are going and how you’re feeling. You are the expert on how your arthritis affects you. Telling the team how you feel and how you’re affected will help them work out how best to help you.
You may find it useful to take a friend or family member along to appointments with you. Also, before your appointment, write down what you want to say or ask. Your appointment may not be when you are feeling at your worst, so having questions and information that you noted earlier can really help to give the full picture. It’s also a good idea to make notes when you are there.
If you don’t understand something, say so. Ask for a more detailed explanation. You need to be sure that you understand and feel confident about any treatment you are given. If your treatment doesn’t seem to be working or you’ve had problems sticking to it, say so. If something you want is not provided, ask for it. Be tactful but firm.
It can sometimes take time to find the treatment that works best for you. There may be some periods when different treatments have to be tried and their effects monitored. Before making a decision, you should understand what you can expect from your medication, what are the possible side effects and other important information. It is important to develop a good relationship with your healthcare team.
Sometimes other treatment may be necessary to control your RA, such as occupational therapy as well as your medications. It is important to keep a record of your progress. You should also discuss a self-management programme with your GP.
Your healthcare team
A number of health professionals may be involved in your treatment:
GPs – General practitioners
Your GP may be involved in monitoring your treatment and should be in close touch with the rest of the team. GPs can also put you in direct contact with physiotherapists, occupational therapists and other professionals who can help.
Rheumatologists are specialists trained in diagnosing and treating arthritis and rheumatic diseases. They are mostly based in hospital rheumatology units. The rheumatologist will diagnose your RA and outline a suitable treatment plan for you. You will probably see the rheumatologist regularly to monitor your disease and treatment.
A rheumatology clinical nurse specialist is a nurse that has experience and training in caring for patients with a wide range of arthritis-related diseases.
Their role is to provide emotional, physical and social support to patients. You may be referred to see the nurse specialist when you get your diagnosis to discuss the treatment of your RA and the medication that the doctor may prescribe. The nurse specialist will provide ongoing support and advice and most nurse specialists run telephone advice lines that you can contact.
Physiotherapists use physical means to assist with movement that will help you maintain the strength and motion of the joints and muscles affected by your arthritis. Your physiotherapist will assess you and may offer you advice and treatment. This may consist of exercise therapy and may also involve heat or ice applications, electrotherapy and hydrotherapy. They will be closely involved in your care and rehabilitation if you have surgery.
Occupational therapists help you maximise your ability to achieve your daily routine, tasks and valued activities despite the symptoms you may be experiencing. For example, they can provide advice and help if you are having trouble with day-to-day tasks like washing, dressing, or cooking. They also help you continue to participate in your hobbies and social activities. Occupational therapists will help you learn how to manage your condition in the best possible way for your lifestyle and life-roles. They will show you how to protect your joints and do things in ways that put as little strain on your joints as possible and help you manage your fatigue in a paced but active routine. They may also provide you with splints and advise you about your environment or equipment that might make life easier for you. Advice on employment may also be provided by an occupational therapist and they can help you remain in or return to work or education pathways.
Podiatrists and chiropodists
Podiatrists and chiropodists can help if you have problems with your feet or ankles. They try to prevent joints from changing and can help to improve the position of joints if there are already deformities. They can provide moulded insoles for your footwear to hold your foot in a better position, adapt your shoes, or recommend the right kind of shoe for you.
Dietitians can help you eat healthily and show you how to change what you eat if you need to lose weight.
Orthotists make splints to support and position joints.
Phlebotomists perform blood tests.
Radiographers take X-rays and perform other diagnostic tests.
You may be referred to a psychologist if pain affects your emotional wellbeing, or if you are becoming depressed or finding it difficult to adjust to having RA.
Pharmacists are a good source of information about the drugs you are prescribed. They can tell you which over-the-counter drugs you can take with your prescribed drugs, and which may cause problems.
Orthopaedic surgeons specialise in operating on bones and joints. They can replace worn joints, repair torn tendons or fuse joints (stop them moving to ease pain).