Early Inflammatory Arthritis

There are a number of urgent clinic slots set each week to see patients who may have a new onset inflammatory arthritis, such as rheumatoid arthritis.

Who is referred for this service?

Patients who present to their GPs with new onset of symptoms suggestive of inflammatory arthritis, such as rheumatoid arthritis.

There is a referral pathway for reference for GPs. All referrals are triaged by the consultants and prioritised according to clinical need.

Location

All early inflammatory arthritis referrals should be seen in Royal Surrey County Hospital, Outpatients 4, or less commonly in a peripheral hospital that should have access to bloods and XRs on site.

If you are not seen at the Royal Surrey County Hospital, you may have to attend at a later date to have investigations (such as MRIs, USS, DEXA)  before a diagnosis will be made.

What should I expect on the first appointment?

In addition to your face-to-face appointment, you may be sent for other investigations. These may include blood tests, X-rays and possibly an urgent Ultrasound scan, ideally all on the day of your attendance, or if not, within a few days.

Be prepared to spend some hours in the hospital getting these tests done.

Ideally you would have a diagnosis made and be started on treatment on the day of your appointment.

Will I start treatment immediately?

If a diagnosis of inflammatory arthritis, connective tissue disease or related condition is confirmed, then you are likely to be started on medication (Disease Modifying Anti Rheumatic Drugs, also known as DMARDs) immediately. You will be given a three month prescription and blood forms. You or a family member will have to return to the hospital to pick up each month of the prescription, to enable your monitoring blood tests to be checked, for safety purposes.

You may also have joint or intra-muscular injections. These may be done on the day, or within a few days in the Medical Day Unit.

What sort of follow up should I expect?

If you have been started on Disease Modifying Anti Rheumatic Drugs (DMARDs) then you will be given blood test forms to have blood tests done at your GPs every fortnight until you have been on a stable dose for six weeks, then monthly.

You should expect a telephone appointment from a CNS (specialist nurse) about six to eight weeks after starting a new drug, and further follow up will involve a mixture of face-to-face and virtual nurse or doctor consultations until your disease is under control. Then you should expect annual review appointments.

You should also expect to be referred to a rheumatology physiotherapist and rheumatology occupational therapist for assessment and education.

How do I get the results of my investigation?

If you’ve been sent for an investigation, such as an MRI, a CT, or an ultrasound, then you would usually be sent a letter with the results, and any appropriate change in your management plan, once the results have made their way back to your consultant.

If you had your investigation more than six weeks ago, and you haven’t heard anything, then contact the department, and the results will be chased up and sent to you.

Will I receive a letter after my treatment?

You will receive a copy of your clinic letter. This is written to your GP, rather than to you, so the langauge used will be more medical and specific, so don't be alarmed if it seems confusing. You can ask your GP any questions you may have. 

Who do I contact if there's an issue with my appointment?

The secretaries and CNS team are not able to book appointments for you. If you wish to change the date of your appointment, or haven’t heard about an expected appointment, please contact the Appointment Centre on 01483 464002 or email rsc-tr.OPDApptCentre@nhs.net.

What do I do if I’m experiencing a side effect of my DMARD medication?

You can contact our CNS team via their email address rsch.rheumatologynurse@nhs.net or via the telephone advice line 01483 571122 ext 4673. They will be able to discuss your difficulties with DMARD medication or inflammatory arthritis and make suggestions to help. They will endeavour to respond to messages within three working days.

They are not able to help with problems that are not related to inflammatory arthritis. They do not provide an emergency service.

Where do I find more information about my condition and medication?

The ‘Versus Arthritis’ website has excellent patient information leaflets on the majority of rheumatic conditions and drugs: www.versusarthritis.org

There are also national and local support groups for many rheumatic diseases. You can find links for support groups here.

What is the role of the CNS team?

Our Clinical Nurse Specialist (CNS) team work closely with the medical team to provide a tailored service to our patients with inflammatory arthritis. They have a wealth of experience in dealing with problems and issues involving your medication and your disease process. They are there to help and educate you, and are contactable via email rsch.rheumatologynurse@nhs.net or via the advice line (01483 01483 571122 ext 4673). They will respond to messages within three working days. They cannot help with appointment requests.

They do not have the expertise to deal with problems that are not related to your medication or your inflammatory arthritis, and they do not provide an emergency service.

Royal Surrey Charity