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EULAR recommendations for the role of the

nurse in management of chronic

inflammatory arthritis

Taken from NRAS magazine, Autumn 202

This collaborative study involving 25 health professionals from 14 European countries was set

up to develop recommendations for the role of the nurse in the management of patients with long

term inflammatory arthritis and to identify both research and educational agendas.10 recommendations emerged from a comprehensive systematic literature search. Seven of these

covered care and management education! satisfaction with care! disease management!

psychosocial support! self management and efficiency of care. The remaining three covered

professional support for nurses! availability of guidelines or protocols! access to education andencouragement to underta"e e#tended roles.

The authors conclude $These recommendations provide a basis for emphasising and optimisingrheumatology nursing care in order to contribute to a more standardised level of professional

nursing across Europe.%

Meeting the Rheumatology Clinical Nurse Specialist (RCNS)

Hearing about your diagnosis

&hen you are first diagnosed with rheumatoid arthritis this may come as a shoc"! but it may alsocome as a relief at finally "nowing what has been causing your pain! 'oint swelling! stiffness and

fatigue. (owever you feel about your diagnosis you are probably going to need a lot of support

and it is accepted that early support after diagnosis is beneficial to people with rheumatoid

arthritis. )ou will undoubtedly receive support from your family members and friends! but the

*+,S can also provide invaluable support at diagnosis! through the early stages and later on as

re-uired.

What is an RCNS?

The *+,S is a nurse who has chosen to specialise in caring for people with arthritis and they

will have received e#tensive training in rheumatology and musculos"eletal care.

How do I access my RCNS and what serices do they o!er?

ost rheumatology departments provide at least one *+,S and many have teams of *+,S/s.

The services offered may vary but most patients can e#pect the following


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• " dedicated rheumatology helpline

• Nurse#led $ollow up clinics

• %pportunities $or education

What is a dedicated rheumatology Helpline?

The helpline service provided by the *+,S may be an answer phone where you can leave a

message and the nurse will get bac" to you! usually within 24 hours or sooner. Sometimes

rheumatology helplines are manned by the *+,S and you will be advised to call at a specified

time when a nurse will be available to spea" to you directly and deal with your en-uiry. The

helpline ta"es calls from patients seen in the rheumatology clinics! carers! members of the public

and other health professionals wor"ing in the hospital or community. )ou can be reassured that

confidentiality is always upheld.

"dice may be gien $or the $ollowing&

• 'ealing with the symptoms o$ a are up o$ arthritis

• Managing side#e!ects $rom drug treatments

• roiding sooner appointments i$ re*uired especially $or are ups o$ arthritis

• +iaison with other members o$ the rheumatology team such asphysiotherapist or occupational therapist etc,

• %ther general adice about arthritis

What happens in nurse#led $ollow#up clinics?

t the time of your diagnosis your rheumatologist may introduce you to the *+,S and if this is

not possible they will usually provide you with the rheumatology helpline number. t is good

practice for your care to be pic"ed up by the *+,S within the first 12 wee"s after diagnosis

where you will be given an appointment in the nurse led clinic. ncreasingly patients will be

starting drugs to control the arthritis at diagnosis or very soon after as early treatment will get

you feeling better more -uic"ly and will help to reduce the longterm damage caused by the

arthritis.

-he assessment in the clinic may inole&

• .lood pressure/ weight/ urine and blood test monitoring i$ re*uired

• "s0ing you about your general well being


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• Recording which 1oints are a!ected and what other symptoms you aree2periencing

• Recording your current drug treatment

• In$orming you about the results i$ you don3t already 0now o$ blood tests and2#rays that were carried out when you saw the rheumatologist

• 4inding out what you already 0now about arthritis and the treatments ando!ering you indiidualised education and written in$ormation

• 4inding out how well you are managing and i$ you need adice on your dailyactiities such as wor0/ caring $or yoursel$ and your $amily/ and ta0ing part inleisure and hobbies

• Re$erring you to another health pro$essional who may help eg/physiotherapist/ dietician/ psychological support etc,

• -he RCNS will proide you with education and written in$ormation on&

o -he process o$ inammation in R"

o ain relie$ and disease modi$ying treatments

any *+,S services support the day to day management of patients with * and other types of

inflammatory arthritis and they may be wor"ing with you to introduce a disease modifying drug

such as methotre#ate. f so they will be responsible for monitoring the safety and effectiveness of

the treatment. The *+,S may be responsible for altering the dose and changing some of your

drug treatments via agreed guidelines and some *+,S/s will be able to prescribe your

medication. ncreasingly *+,S/s are now using a goal setting approach to your care which

involves partnership wor"ing to enable you to develop better coping strategies. t is li"ely that

the *+,S will e#amine your 'oints to establish more clearly how active your arthritis is. This is

"nown as the 3S score! and helps to decide whether the treatments you are having are wor"ing

or whether you need a change in drug therapy.The *+,S may be able to offer you group

education outside of the one to one education they can offer in their nurse led clinics. roup

education is an invitation to attend classes where you will meet other people with arthritis in a

similar position to you.

How group education is proided aries around the 56 but they usually coers the

$ollowing aspects&

• How to manage a are

• How to manage your pain


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• How the rheumatology department wor0s and what serices it can o!er you

• -he members o$ the multidisciplinary team and what serices they o!er

• -he cause o$ arthritis and drug and non drug treatments

• In$ormation on support groups locally and nationally

Some group sessions include information on blood tests and #rays! the patient held record card!

rela#ation! diet! physiotherapy! a -uestion and answer session with a rheumatologist! access to

benefits etc. nce you have come to terms with your diagnosis and you have been stabilised on

an effective treatment for your arthritis you may li"e to consider going on a self management

programme "nown as 6 The e#pert patient6. These are run over 7 # two hour sessions in the

community and are available through your local 8rimary +are Trust. ,*S are currently

researching the best way to provide self management training to patients with *.

What other actiities might the RCNS be inoled in?

• 7ducating and training other health pro$essionals about rheumatology

• Research to help improe care o$ the rheumatology patient

• 'eeloping $uture rheumatology serices

• Wor0ing on national groups

• "ssessment o$ patients $or biologic drugs such as ini2imab/ etanercept/

adalimumab and ritu2imab, -hese RCNS8s are o$ten re$erred to as 9.iologicsNurses9

References a!aila"le on re#uest

$a%n &omer, Nurse 'onsultant Rheumatology, Rheumatology $e(artment, Uni!ersity &os(ital )irmingham N&S Trust, Selly *ak

riginal article 0490492007

*eviewed 2090792014

,e#t review due 209079201:


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If this information has helped you, please help us by making a donation.

Thank you.

• What is R"?

•

How is R" managed?

o Who can help me?

-he -eam o$ 72perts Inoled in :our Care

Rheumatology Consultant

Rheumatology Specialist Nurse

Meeting the Rheumatology Clinical Nurse Specialist(RCNS)

Results o$ the NR"S surey on the role o$ therheumatology nurse specialist

75+"R recommendations $or the role o$ the nurse inmanagement o$ chronic inammatory arthritis

odiatrist

%ccupational -herapist

harmacist

Changes to Healthcare # what is means $or ;s and patients

How NR"S can help

o -reatment

o Symptom control

o 72ercise

o 4oot health

o ;uidelines on the management o$ R"

o "nnual Reiew in Rheumatoid "rthritis

o %ral Health

http://www.nras.org.uk/make-a-donationhttp://www.nras.org.uk/what-is-ra-http://www.nras.org.uk/how-is-ra-managed-http://www.nras.org.uk/who-can-help-me-http://www.nras.org.uk/the-team-of-experts-involved-in-your-carehttp://www.nras.org.uk/rheumatology-consultanthttp://www.nras.org.uk/rheumatology-specialist-nursehttp://www.nras.org.uk/meeting-the-rheumatology-clinical-nurse-specialist-rcns-http://www.nras.org.uk/meeting-the-rheumatology-clinical-nurse-specialist-rcns-http://www.nras.org.uk/results-of-the-nras-survey-on-the-role-of-the-rheumatology-nurse-specialisthttp://www.nras.org.uk/results-of-the-nras-survey-on-the-role-of-the-rheumatology-nurse-specialisthttp://www.nras.org.uk/eular-recommendations-for-the-role-of-the-nurse-in-management-of-chronic-inflammatory-arthritishttp://www.nras.org.uk/eular-recommendations-for-the-role-of-the-nurse-in-management-of-chronic-inflammatory-arthritishttp://www.nras.org.uk/podiatristhttp://www.nras.org.uk/occupational-therapisthttp://www.nras.org.uk/pharmacisthttp://www.nras.org.uk/changes-to-healthcare-what-is-means-for-gps-and-patientshttp://www.nras.org.uk/how-nras-can-helphttp://www.nras.org.uk/treatmenthttp://www.nras.org.uk/symptom-controlhttp://www.nras.org.uk/exercisehttp://www.nras.org.uk/foot-healthhttp://www.nras.org.uk/guidelines-on-the-management-of-rahttp://www.nras.org.uk/the-annual-review-in-rheumatoid-arthritishttp://www.nras.org.uk/oral-healthhttp://www.nras.org.uk/what-is-ra-http://www.nras.org.uk/how-is-ra-managed-http://www.nras.org.uk/who-can-help-me-http://www.nras.org.uk/the-team-of-experts-involved-in-your-carehttp://www.nras.org.uk/rheumatology-consultanthttp://www.nras.org.uk/rheumatology-specialist-nursehttp://www.nras.org.uk/meeting-the-rheumatology-clinical-nurse-specialist-rcns-http://www.nras.org.uk/meeting-the-rheumatology-clinical-nurse-specialist-rcns-http://www.nras.org.uk/results-of-the-nras-survey-on-the-role-of-the-rheumatology-nurse-specialisthttp://www.nras.org.uk/results-of-the-nras-survey-on-the-role-of-the-rheumatology-nurse-specialisthttp://www.nras.org.uk/eular-recommendations-for-the-role-of-the-nurse-in-management-of-chronic-inflammatory-arthritishttp://www.nras.org.uk/eular-recommendations-for-the-role-of-the-nurse-in-management-of-chronic-inflammatory-arthritishttp://www.nras.org.uk/podiatristhttp://www.nras.org.uk/occupational-therapisthttp://www.nras.org.uk/pharmacisthttp://www.nras.org.uk/changes-to-healthcare-what-is-means-for-gps-and-patientshttp://www.nras.org.uk/how-nras-can-helphttp://www.nras.org.uk/treatmenthttp://www.nras.org.uk/symptom-controlhttp://www.nras.org.uk/exercisehttp://www.nras.org.uk/foot-healthhttp://www.nras.org.uk/guidelines-on-the-management-of-rahttp://www.nras.org.uk/the-annual-review-in-rheumatoid-arthritishttp://www.nras.org.uk/oral-healthhttp://www.nras.org.uk/make-a-donation


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• +iing with R"

• Inammatory "rthritis In$ormation athway

• 6ey 4acts

Results o$ the NR"S surey on the role o$ the rheumatology nurse specialist

22+0+0-. NRAS

/m(ortance of Rheumatology Nurse S(ecialists highlighted "y ne% sur!ey "y the National

Rheumatoid Arthritis Society Thank you to e!eryone %ho contri"uted to this sur!ey1

&e received almost 1000 responses and will be using the information to demonstrate the

importance of the Specialist *heumatology ,urse.

The survey revealed that fourfifths of patients believe that ,urse Specialists are good value formoney in the ,(S! at a time when many of these nurse positions are under threat from ,(S 'ob

cuts.

t highlighted that ;:< of patients said they would contact their 8 or as" for a consultant

appointment if they didn=t have access to a nurse specialist when they had a problem with their

disease! which would be a huge additional burden on the consultant! 8 time and ,(S

resources.

The *heumatology ,urse Specialist is often the cornerstone of the multidisciplinary team as far

as rheumatoid arthritis patients are concerned. +onsultant *heumatologists focus on getting the

patient established on the right treatment and monitoring their reaction to the range of drugs

which they have to ta"e. ften they have less time to be able to help their patients come to terms

with a diagnosis of * however much they would li"e to > a crucial role that the ,urse

Specialist plays.

ne of the vital roles performed by the ,urse Specialist is that of being able to tal" through all

the emotional issues and fears a patient may have following diagnosis and also e#plain and

answer -uestions about the drug therapy a patient has been started on. The survey findings

support the important role that the ,urse Specialist plays in patient care

• Nearly o$ patients $elt that nurses added a lot o$ alue to their care

• "s0ed whether they would rather see the Nurse Specialist or another 'octorwho didn3t 0now them/ nearly said they would rather see the nurse,

http://www.nras.org.uk/living-with-rahttp://www.nras.org.uk/the-inflammatory-arthritis-patient-information-pathwayhttp://www.nras.org.uk/key-facts-and-messageshttp://www.nras.org.uk/living-with-rahttp://www.nras.org.uk/the-inflammatory-arthritis-patient-information-pathwayhttp://www.nras.org.uk/key-facts-and-messages


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• In answer to the *uestion @when you hae a problem with your R" hae youcontacted the Nurse Specialist3/ A answered @yes3 and o$ those/ A=> saidthat this had been help$ul,

• In answer to the *uestion @i$ you hae a bad are or other emergency relatedto your R" can you access help *uic0ly?3/ B> said that they could accesshelp through a nurse#led helpline either the same day or within D hourswhich is ery reassuring $or patients,

The most important thing that patients value about their ,urse Specialist is the ability to access

rapid review and treatment with over 41< selecting this option.

ilsa ?osworth ! +hief E#ecutive of ,*S and who has had * for 27 years! comments $&e

"now from research that people who are more informed and educated about their disease and its

impact on the body! are able to self manage effectively and have better long term outcomes.

,urses play a vital role in the care of people with * and we are very concerned at the prospect

of losing their "nowledge and e#pertise in the current round of ,(S cuts.%

bout the Survey

• ED patients with rheumatoid arthritis (R") too0 part in the surey $romthroughout the 56, Nurses adised patients the surey was being underta0enand indiiduals logged onto NR"S website to download the *uestionnaire,

bout ,*S

• -he National Rheumatoid "rthritis Society (NR"S) was launched in %ctober

FFB and in a relatiely short time has become established as thecampaigning oice in the 56 $or people with Rheumatoid "rthritis,

• NR"S proides a total one#stop#shop with support/ in$ormation and adocacy$or all people in the 56 with R"/ their carers and $amilies,

• NR"S has a national olunteer networ0/ a group o$ people with the diseasewho proide peer to peer support and proide additional resource to helpNR"S in many di!erent ways,

+lic" here to view 83@


Thank you.

-he Role o$ the odiatrist in the Management o$ Rheumatoid "rthritis

Introduction

http://www.nras.org.uk/data/files/About%20RA/How%20is%20RA%20managed/NRAS%20survey%202006%20ARMA.pdfhttp://www.nras.org.uk/data/files/About%20RA/How%20is%20RA%20managed/NRAS%20survey%202006%20ARMA.pdf


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8odiatry is part of the healthcare team that wor"s together to care

for people with inflammatory arthritis. ost people will be familiar with the term Achiropody=

but this is being superseded by the term Apodiatry=! this being the profession/s preferred title. n

essence! these are interchangeable protected titles. ll chiropodists9podiatrists must be (ealth

and +are 8rofessions +ouncil B(+8+C registered if they are to use this title. The (+8+ role is to

protect the public whether they receive care through the ,(S or via private practitioners!ensuring practitioners update and develop "nowledge and s"ills relevant to clinical practice.

-he $oot and rheumatoid arthritis (R")

*heumatoid arthritis B*C is the commonest type of inflammatory arthritis. Dp to 0< of people

with this condition will report associated foot problems. @or some people! the foot is the first

area of the body to present with signs and symptoms of *. @or others! it may be months! years

or maybe never that the foot is a problem for them. The difficulties people can e#perience vary

from soreness! warmth and swelling Ba flareC of one or more foot 'oints that lasts a few days or

longer! through to 'oint erosions! with 'oint instability! pain and associated changing foot shape.These changes can alter the individual/s wal"ing ability. * and some medications can also have

an effect on the s"in and underlying tissues! ma"ing them more vulnerable to damage and

infection. * can cause bursae and nodules to form that may be susceptible to rubbing. Shape

changes in the front of the foot can create pressure sites that develop corns and calluses Bhard

s"inC. These may develop into areas of ulceration if not treated appropriately! so it is advisable to

re-uest podiatry guidance if hard s"in or corns are present on your feet. Some people can

e#perience decreased blood supply to feet and legs associated with atherosclerosis Bwhere the

inner lining of arteries become progressively thic"ened and impair the blood supplyC and vaso

spastic disorders Bwhere spasms of the blood vessels occur and the diameter of the blood vessels

is decreasedC such as *aynauds. These are less common.

-he podiatrist8s role

The podiatrist role is to identify! diagnose and treat disorders! diseases and deformities of the feet

and legs and implement appropriate and timely care. This may be provided directly by a

podiatrist or in association with other healthcare team members as re-uired by the individual=s


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foot problems. The goal of the podiatry element of rheumatology care is to reduce footrelated

pain! maintain 9 improve foot function and so mobility! while protecting s"in and other tissues

from damage. This and the need for timely access to podiatry services for people with

rheumatological conditions is recognised within nationally published guidelines.

Range o$ treatments used by podiatry

8odiatry advice and treatments are based on information gained from the history and assessment

of a person/s foot problem. n assessment of the lower limbs may include the s"in! vascular

Bblood vesselsC and neurological BnervousC systems! the musculos"eletal structures and wal"ing!

as well as footwear.

The types of treatments used will be dependent on the individual/s particular assessed problem9s

with reference to wider health and social matters and wishes. &here appropriate! people are

encouraged and enabled to manage their foot and an"le aspects of their condition. (owever!

treatments may include

• alliatie $oot care, -his may include assistance with general nail care/ whichmay be made diGcult due to hand#related problems or by the nails beingdistorted or altered in some way treatment $or areas o$ hard s0in callus andcorns, (ro$essional guidance should always be sought # you are adised notto use pedicure blades/ corn plasters and paints on these areas),

• Specialist assessment and management o$ wounds ulcers that can occur onthe $oot

•

rescribing specialist orthoses $or the $eet e,g, insoles/ splints, -hese ary$rom so$t deices that cushion tender areas under the $oot to Jrmer deicesthat realign the $oot/ encouraging it to $unction better, %$ten these principlesare combined in a deice,

• "ssessment and adice about appropriate $ootwear choices/ $ootwearadaptations and accessing specialist $ootwear serices, Some NHS odiatristdepartments hae $ootwear clinics/ either independently or in associationwith an orthotist or shoeJtter,

• "dice related to the lower limb including 1oint protection/ management o$acute and chronic inamed 1oints/ appropriate e2ercise/ surgical options,

• 7ducation groups in con1unction with the rheumatology education sessions, -hese help people to understand the wor0ings o$ the $oot/ how R" can a!ectit and strategies that can be o$ help, -he issues discussed in a $oot and legcare program may include&

o 4oot K leg anatomy related to wal0ing/ outlining the e!ect R" mayhae on this part o$ the body


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o R" K 4oot Structures

o Common signs K symptoms o$ R" in $oot leg

o What can you do to sel$#help/ including use o$ hot K cold/ 1ointprotection/ when to get help

o 4ootwear adice

o Role o$ $oot orthoses

o Sa$e/ appropriate sel$ care

o reention guidance K minor wounds etc

o 72ercise guidance

o Serice access # what are the local arrangements $or annual $ootchec0s (not necessarily by a podiatrist) and access to podiatry i$ youhae a problem,

"ccessing local chiropody podiatry practitioners

8eople with rheumatological conditions may re-uire access to differing levels and types of @oot

(ealth Service depending on how active their * is! how long they have had *! and the impact

it has had on their feet! legs and mobility. )our needs may include

• rompt access to a podiatry assessment and the initiation o$ appropriate

management treatment i$ indicated (see aboe)/ with access to specialistpodiatry as necessary,

• -imely periodic reiew o$ care needs as indicated,

• rocesses in place to ensure that an annual $oot chec0 by a healthpro$essional (not necessarily a podiatrist) is carried out when appropriate,

• -imely and appropriate guidance to enable sel$ management,

• "ccess to a range o$ s0ill mi2 within a team o$ health pro$essions to meet the

indiidual8s needs/ including $oot surgery,

f you receive your rheumatology care at a rheumatology department! there will hopefully be a

podiatrist specialising in musculos"eletal9 rheumatological foot conditions! either within the

department or available via a referral by the rheumatology team. Similarly 8s can refer you to

community based services. 8eople can also access podiatry care via private practice. The )ellow

pages Bloo"ing under /chiropodist/ and9or /podiatrist/C and word of mouth are some of the best


11/19

ways to find someone. f you have access to the internet! the +ollege of 8odiatry has a /find a

podiatrist/ facility. Some employers! department stores and leisure centres also provide podiatry!

although the latter is more li"ely to be sports related.

Conclusion

s mentioned earlier! managing people/s foot and leg problems associated with * will often

involve the podiatrist wor"ing closely with other members of the multidisciplinary team. s

such the rheumatology team will try to ensure that problems are addressed in a timely and

appropriate manner! reflecting the needs and wishes of the individual who has *.

s part of the wor" that has been done on foot standards a patient leaflet has been produced

called /@eet @irst/ and this can be obtained by opening the lin" below or by calling the ,*S

office to re-uest a copy.

+lic" here for 83@

@or further information! please visit the foot health section on the ,*S website.

References a!aila"le on re#uest

Ro"ert ield, Lead 3odiatrist 4Rheumatology Ser!ices5, )ournemouth and 3oole 'ommunity &ealth Ser!ices

riginal article 190492007

*eviewed 249019201;

,e#t review due 2490192017


Thank you.

• What is R"?

• How is R" managed?

o Who can help me?


http://www.scpod.org/http://www.scpod.org/http://www.nras.org.uk/data/files/About%20RA/How%20is%20RA%20managed/Feet%20first%20leaflet.pdfhttp://www.nras.org.uk/foot-healthhttp://www.nras.org.uk/make-a-donationhttp://www.nras.org.uk/what-is-ra-http://www.nras.org.uk/how-is-ra-managed-http://www.nras.org.uk/who-can-help-me-http://www.nras.org.uk/the-team-of-experts-involved-in-your-carehttp://www.scpod.org/http://www.nras.org.uk/data/files/About%20RA/How%20is%20RA%20managed/Feet%20first%20leaflet.pdfhttp://www.nras.org.uk/foot-healthhttp://www.nras.org.uk/make-a-donationhttp://www.nras.org.uk/what-is-ra-http://www.nras.org.uk/how-is-ra-managed-http://www.nras.org.uk/who-can-help-me-http://www.nras.org.uk/the-team-of-experts-involved-in-your-care


12/19



odiatrist

.est $oot $orward

-he Role o$ the odiatrist in the Management o$Rheumatoid "rthritis

Standards o$ care $or people with musculos0eletal $oothealth problems


harmacist


How NR"S can help

o -reatment

o Symptom control

o 72ercise

o 4oot health



o %ral Health

• +iing with R"


• 6ey 4acts

&ands, 6oint 3rotection, E7ercises and

S(linting

http://www.nras.org.uk/rheumatology-consultanthttp://www.nras.org.uk/rheumatology-specialist-nursehttp://www.nras.org.uk/podiatristhttp://www.nras.org.uk/best-foot-forwardhttp://www.nras.org.uk/the-role-of-the-podiatrist-in-the-management-of-rheumatoid-arthritishttp://www.nras.org.uk/the-role-of-the-podiatrist-in-the-management-of-rheumatoid-arthritishttp://www.nras.org.uk/standards-of-care-for-people-with-musculoskeletal-foot-health-problemshttp://www.nras.org.uk/standards-of-care-for-people-with-musculoskeletal-foot-health-problemshttp://www.nras.org.uk/occupational-therapisthttp://www.nras.org.uk/pharmacisthttp://www.nras.org.uk/changes-to-healthcare-what-is-means-for-gps-and-patientshttp://www.nras.org.uk/how-nras-can-helphttp://www.nras.org.uk/treatmenthttp://www.nras.org.uk/symptom-controlhttp://www.nras.org.uk/exercisehttp://www.nras.org.uk/foot-healthhttp://www.nras.org.uk/guidelines-on-the-management-of-rahttp://www.nras.org.uk/the-annual-review-in-rheumatoid-arthritishttp://www.nras.org.uk/oral-healthhttp://www.nras.org.uk/living-with-rahttp://www.nras.org.uk/the-inflammatory-arthritis-patient-information-pathwayhttp://www.nras.org.uk/key-facts-and-messageshttp://www.nras.org.uk/rheumatology-consultanthttp://www.nras.org.uk/rheumatology-specialist-nursehttp://www.nras.org.uk/podiatristhttp://www.nras.org.uk/best-foot-forwardhttp://www.nras.org.uk/the-role-of-the-podiatrist-in-the-management-of-rheumatoid-arthritishttp://www.nras.org.uk/the-role-of-the-podiatrist-in-the-management-of-rheumatoid-arthritishttp://www.nras.org.uk/standards-of-care-for-people-with-musculoskeletal-foot-health-problemshttp://www.nras.org.uk/standards-of-care-for-people-with-musculoskeletal-foot-health-problemshttp://www.nras.org.uk/occupational-therapisthttp://www.nras.org.uk/pharmacisthttp://www.nras.org.uk/changes-to-healthcare-what-is-means-for-gps-and-patientshttp://www.nras.org.uk/how-nras-can-helphttp://www.nras.org.uk/treatmenthttp://www.nras.org.uk/symptom-controlhttp://www.nras.org.uk/exercisehttp://www.nras.org.uk/foot-healthhttp://www.nras.org.uk/guidelines-on-the-management-of-rahttp://www.nras.org.uk/the-annual-review-in-rheumatoid-arthritishttp://www.nras.org.uk/oral-healthhttp://www.nras.org.uk/living-with-rahttp://www.nras.org.uk/the-inflammatory-arthritis-patient-information-pathwayhttp://www.nras.org.uk/key-facts-and-messages


13/19

)y 'hristina 8acleod and 6o Adams

Taken from. NRAS magazine, S(ring 202

(ands are so important. &ithout thin"ing we scratch an itch! put on our clothes! pic" up a penand even more important wipe our own bottoms and pic" our noses. "now that these are not

nice things to thin" about but we all do them Bwell most us do even if we don=t admit to itFC ?ut

if you couldn=t do these things they would become really important to you. Some of us don=tmind if we have help to do things whilst of us may really not li"e as"ing for help. @or most of us

though it is important that we do our own personal care! scratch our own itches! clean our own

teeth! put in our own contact lenses and blow our own nose. &ith the fantastic improvement inmedication and care for people with rheumatoid arthritis! most people won=t have problems

doing this "ind of thing. ?ut it is still vital that if you have a flare you do ta"e e#tra care of your

'oints so that once the disease is under control again! as little damage has been done to your

'oints as possible! and you can get bac" to living a normal life without any limitations.

@or your hands to wor" well you also need to ta"e care of your wrists! elbows! shoulders and

nec". The way to do this is to thin" about how you are doing things. 8rotecting your hands can be a threepronged approach 'oint protection! e#ercises! and splinting in that order.

6oint 3rotection

Goint protection includes learning about how to use your 'oints in the

best possible way. This helps you to avoid stress and strain on your 'oints and to treat themwell.

To really get the most benefit from 'oint protection! research has shown that you need to do a 4wee" course of two hours a wee" but sadly not many rheumatology outpatient departments have

the resources to do this. etting a referral to your occupational therapist for advice will help you

access specialist advice on 'oint protection. rthritis *esearch DH publishes a great little boo"let

called Ioo"ing after your Goints which will help you understand what 'oint protection involves.


14/19

et your self a copy! read it! get your family to read it and get them to help and support you

ma"e the changes needed.

Goint protection techni-ues get you to thin" about how you are using your hands to do daily

tas"s. f these daily tas"s cause you pain in your hands! you need to wor" out a way of carrying

out that action without putting strain on those 'oints. Try lots of different ways until you find onethat doesn=t cause you pain. useful tip is to get your family! colleagues and friends involved in

helping you remember the best way to use your hand 'oints. Then they can help remind you

when you forgetF Try to ma"e the new way of using and moving your hand 'oints become a newhabit we all "now that changing habits ta"es time so don=t give upF To help! you may need to

buy some gadgets. )ou might need to purchase a 'ar opener! Ishaped "nife or change your

bathroom taps to levers. 3o try not to thin" of gadgets as disability e-uipment. Thin" of them in

the same way that you would if you were to go on a diet or stretch before e#ercising. adgetsli"e this are a tool to help prevent 'oint damage and even if you don=t have * some hand

deformities are common as you get older and some of us therapists even in our twenties9thirties

use the Ishaped "nife and 'ar "ey for opening 'ars to protect our 'oints. The other thing to

remember is that small 'oints are far more vulnerable to damage than your larger 'oints so loo"after these little 'oints.

E7ercises

This is part of caring for your 'oints Bthereis a large DH national research pro'ect going on about this at the moment in which several

hundred people are involvedC so there is not currently research evidence to prove that hand

e#ercises are beneficial or not. (owever! if you can e#ercise your hand and wrist muscles thisshould help protect from wea"ness and possible hand deformity. (ealthy muscles will help

strengthen the 'oints that are vulnerable. ne of the main things to do is to e#ercise your 'oints to

the fullest range once a day > that=s your shoulders! elbows! wrists! fingers and thumb. 3o fingerwal"ing towards the little fingers using putty if you can. et a referral to a physiotherapist for

general e#ercises and a hand or rheumatology occupational therapist for hand e#ercises specific

to your hands. Everyone=s needs are different but a therapist can help design and advise on anindividual e#ercise routine.

S(linting


15/19

This is something that a lot of people find useful at some point. Splints are for the most part to protect your 'oints and not to be worn all the time. The

e#ception to this is when you have surgery or if you are trying to correct a swan nec" deformity

in your small hand 'oints. 8eople report that they li"e wearing wristlets for painful wrists! or you

can get wrist splints with metal in to hold the wrist in a more stable position. f you have swannec" deformity of your small finger 'oints then you might want to consider small finger based

oval J splints or a silver ring splint. ll these splints need to be fitted properly and your therapist

can help you with this.

• &hat is *K

• (ow is * managedK

o &ho can help meK

The Team of E#perts nvolved in )our +are

*heumatology +onsultant

*heumatology Specialist ,urse

8odiatrist

ccupational Therapist

(ands! Goint 8rotection! E#ercises and Splinting

8harmacist

+hanges to (ealthcare what is means for 8s and patients

(ow ,*S can help

o Treatment

o Symptom control

http://www.nras.org.uk/what-is-ra-http://www.nras.org.uk/how-is-ra-managed-http://www.nras.org.uk/who-can-help-me-http://www.nras.org.uk/the-team-of-experts-involved-in-your-carehttp://www.nras.org.uk/the-team-of-experts-involved-in-your-carehttp://www.nras.org.uk/rheumatology-consultanthttp://www.nras.org.uk/rheumatology-specialist-nursehttp://www.nras.org.uk/podiatristhttp://www.nras.org.uk/occupational-therapisthttp://www.nras.org.uk/hands-joint-protection-exercises-and-splintinghttp://www.nras.org.uk/pharmacisthttp://www.nras.org.uk/pharmacisthttp://www.nras.org.uk/changes-to-healthcare-what-is-means-for-gps-and-patientshttp://www.nras.org.uk/changes-to-healthcare-what-is-means-for-gps-and-patientshttp://www.nras.org.uk/how-nras-can-helphttp://www.nras.org.uk/treatmenthttp://www.nras.org.uk/symptom-controlhttp://www.nras.org.uk/what-is-ra-http://www.nras.org.uk/how-is-ra-managed-http://www.nras.org.uk/who-can-help-me-http://www.nras.org.uk/the-team-of-experts-involved-in-your-carehttp://www.nras.org.uk/rheumatology-consultanthttp://www.nras.org.uk/rheumatology-specialist-nursehttp://www.nras.org.uk/podiatristhttp://www.nras.org.uk/occupational-therapisthttp://www.nras.org.uk/hands-joint-protection-exercises-and-splintinghttp://www.nras.org.uk/pharmacisthttp://www.nras.org.uk/changes-to-healthcare-what-is-means-for-gps-and-patientshttp://www.nras.org.uk/how-nras-can-helphttp://www.nras.org.uk/treatmenthttp://www.nras.org.uk/symptom-control


16/19

o E#ercise

o @oot health

o uidelines on the management of *

o nnual *eview in *heumatoid rthritis

o ral (ealth

• Iiving with *

• nflammatory rthritis nformation 8athway

• Hey @acts

Standards o$ care $or people with musculos0eletal $oot health problems


17/19

• eople with R" should receie an assessment o$ their $oot health needs,

• eople who e2perience a change in disease status should hae their $oothealth needs reassessed,

• Mechanisms should be in place $or timely re$erral to pro$essionals with thenecessary s0ills and e2pertise as re*uired,

The standards were launched at the ?S* annual meeting in Iiverpool on the 22nd pril 200J.

Electronic versions of the full document detailing standards of care for people with

musculos"eletal foot health problems can also be found at www.prcassoc.org.u"9standards

pro'ect.

s part of the wor" that has been done on foot standards a patient leaflet has been produced

called /@eet @irst/ and this can be obtained by opening the lin" below or by calling the ,ational

*heumatoid rthritis Society office on 0J00 2J :750 to re-uest a copy.

+lic" here for 83@

B8lease note! this may ta"e a few moments to openC.


Thank you.

• What is R"?

• How is R" managed?

o Who can help me?




odiatrist

.est $oot $orward

-he Role o$ the odiatrist in the Management o$Rheumatoid "rthritis

Standards o$ care $or people with musculos0eletal $oothealth problems

http://www.prcassoc.org.uk/standards-projecthttp://www.prcassoc.org.uk/standards-projecthttp://www.prcassoc.org.uk/standards-projecthttp://www.nras.org.uk/data/files/About%20RA/How%20is%20RA%20managed/Feet%20first%20leaflet.pdfhttp://www.nras.org.uk/what-is-ra-http://www.nras.org.uk/how-is-ra-managed-http://www.nras.org.uk/who-can-help-me-http://www.nras.org.uk/the-team-of-experts-involved-in-your-carehttp://www.nras.org.uk/rheumatology-consultanthttp://www.nras.org.uk/rheumatology-specialist-nursehttp://www.nras.org.uk/podiatristhttp://www.nras.org.uk/best-foot-forwardhttp://www.nras.org.uk/the-role-of-the-podiatrist-in-the-management-of-rheumatoid-arthritishttp://www.nras.org.uk/the-role-of-the-podiatrist-in-the-management-of-rheumatoid-arthritishttp://www.nras.org.uk/standards-of-care-for-people-with-musculoskeletal-foot-health-problemshttp://www.nras.org.uk/standards-of-care-for-people-with-musculoskeletal-foot-health-problemshttp://www.prcassoc.org.uk/standards-projecthttp://www.prcassoc.org.uk/standards-projecthttp://www.nras.org.uk/data/files/About%20RA/How%20is%20RA%20managed/Feet%20first%20leaflet.pdfhttp://www.nras.org.uk/what-is-ra-http://www.nras.org.uk/how-is-ra-managed-http://www.nras.org.uk/who-can-help-me-http://www.nras.org.uk/the-team-of-experts-involved-in-your-carehttp://www.nras.org.uk/rheumatology-consultanthttp://www.nras.org.uk/rheumatology-specialist-nursehttp://www.nras.org.uk/podiatristhttp://www.nras.org.uk/best-foot-forwardhttp://www.nras.org.uk/the-role-of-the-podiatrist-in-the-management-of-rheumatoid-arthritishttp://www.nras.org.uk/the-role-of-the-podiatrist-in-the-management-of-rheumatoid-arthritishttp://www.nras.org.uk/standards-of-care-for-people-with-musculoskeletal-foot-health-problemshttp://www.nras.org.uk/standards-of-care-for-people-with-musculoskeletal-foot-health-problems


18/19


harmacist


How NR"S can help

o -reatment

o Symptom control

o 72ercise

o 4oot health



o %ral Health

• +iing with R"


• 6ey 4acts

Annual Re!ie% in Rheumatoid Arthritis

/ntroduction "y Ailsa )os%orth, NRAS 'E*

&hat=s one of those can hear people as"ingF&ell! in the ,+E * uidelines which were published in @ebruary 200! one of the

http://www.nras.org.uk/occupational-therapisthttp://www.nras.org.uk/pharmacisthttp://www.nras.org.uk/changes-to-healthcare-what-is-means-for-gps-and-patientshttp://www.nras.org.uk/how-nras-can-helphttp://www.nras.org.uk/treatmenthttp://www.nras.org.uk/symptom-controlhttp://www.nras.org.uk/exercisehttp://www.nras.org.uk/foot-healthhttp://www.nras.org.uk/guidelines-on-the-management-of-rahttp://www.nras.org.uk/the-annual-review-in-rheumatoid-arthritishttp://www.nras.org.uk/oral-healthhttp://www.nras.org.uk/living-with-rahttp://www.nras.org.uk/the-inflammatory-arthritis-patient-information-pathwayhttp://www.nras.org.uk/key-facts-and-messageshttp://www.nras.org.uk/occupational-therapisthttp://www.nras.org.uk/pharmacisthttp://www.nras.org.uk/changes-to-healthcare-what-is-means-for-gps-and-patientshttp://www.nras.org.uk/how-nras-can-helphttp://www.nras.org.uk/treatmenthttp://www.nras.org.uk/symptom-controlhttp://www.nras.org.uk/exercisehttp://www.nras.org.uk/foot-healthhttp://www.nras.org.uk/guidelines-on-the-management-of-rahttp://www.nras.org.uk/the-annual-review-in-rheumatoid-arthritishttp://www.nras.org.uk/oral-healthhttp://www.nras.org.uk/living-with-rahttp://www.nras.org.uk/the-inflammatory-arthritis-patient-information-pathwayhttp://www.nras.org.uk/key-facts-and-messages


19/19

recommendations was people with * be offered an Aholistic= annual review which should

encompass the following elements

• assess disease activity and damage! and measure functional ability Busing! for e#ample!

the (ealth ssessment Muestionnaire N(MOC

• chec" for the development of comorbidities! such as hypertension! ischaemic heart

disease! osteoporosis and depression

• assess symptoms that suggest complications! such as vasculitis and disease of the cervical

spine! lung or eyes

• organise appropriate cross referral within the multidisciplinary team

• assess the need for referral for surgery Bsee section 1.7C

• assess the effect the disease is having on a person/s life.

The guideline is not mandatory! sadly! and therefore rheumatology units can choose whether to

follow the guidance! or not! or to attempt to achieve some of it. Some units have made more progress than others in implementing the elements of the guideline and the @reeman (ospital in

,ewcastle is one such unit and the following article describes what they=ve done! how they have

achieved it and what their patients thin" about it. f you are not having an annual review whichencompasses much of the above! can we suggest that you as" your team if they are planning to

implement holistic annual reviews in line with ,+E guidance any time soonK

ilsa ?osworth! +E
http://www.nice.org.uk/Guidance/CG79/chapter/guidance#timing-and-referral-for-surgeryhttp://www.nice.org.uk/Guidance/CG79/chapter/guidance#timing-and-referral-for-surgery

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