Frequently asked questions

If you do get a flare-up of your condition you should:

• take regular prescribed painkillers (no more than the recommended dose)
• take regular prescribed anti-inflammatory (no more than the recommended dose)
• if you do not wish to or can’t take an oral anti-inflammatory and only 1 or 2 joints are involved then you can use an anti-inflammatory cream
• if joints are swollen then you can use ice on them (cold pack or packet of frozen peas wrapped in a towel, 10 to 15 minutes every 2 to 3 hours)
• if joints are stiff but not swollen then heat can be used.

If things do not get better after 7 days then contact the advice line for further advice.

Typically flares can last between 2 and 7 days before getting better. The rheumatology team will help you to learn how to manage your flares yourself. However, if flares last for more than a week this can be a sign of greater disease activity. If this does happen, please contact the advice line and a decision will be made about whether or not an earlier appointment is needed.

We will explain to you at each appointment when we would like to see you again. If your disease is active or if you have started a new medication for your condition we tend to see you more often. It is good practice that patients with inflammatory arthritis are reviewed every year, even if their disease is stable.

There is no rule about the number of steroid injections a person can have, but there are some concerns that repeated injections to one area of the body can weaken tendons and soften cartilage over time resulting in damage to tissues and joints. This is the reason many doctors limit the number of injections they offer to patients. If a steroid injection wears off quickly or does not improve things, then repeating it may not help either.

If you need steroid injections often, it may be a sign that your disease is not well controlled and we may need to think about making changes to your medication.

We monitor bloods when DMARDs and biologic medicines are used. This is to ensure that the drugs are being used safely and not causing any harmful effects. Blood tests commonly monitored by the rheumatology service are:

Routinely checked bloods are :

Hb (Haemoglobin): The iron rich molecule of red blood cells that transport oxygen around the body. Normal values for a man are 130-180. Normal levels for a woman are 115-165.

MCV (Mean Cell Volume): This is a measurement of the average volume of red blood cells (this can vary if you have low iron stores or if you have pernicious anemia). Normal values 82.0-98.0.

WCC (White Cell Count): These are blood cells of the immune system. There are 5 types and this reflects the total number of all types. Normal values 3.6 – 11.

Neutrophils: These are one of the white blood cells important in fighting bacterial infections. This can be affected by inflammation and medications. Normal values 3.6- 7.5.

Lymphocytes: These are White blood cells important in fighting viral infections. Normal values are 1.0- 4.0.

Platelets: These are blood cells involved in maintaining blood clotting. Normal values are 140-440.

ALT (Alanine Transaminase): This is a liver enzyme that reflects liver health. The normal value is less than 40.

Creatinine: The level of creatinine in the blood is an indicator of how well the kidneys are working. The normal value is 59-104.

CRP (c-Reactive Protein): This is a protein that measures the level of inflammation. Helpful in measuring how active your disease is and whether your treatment is effective. The normal level is less than 5.

ESR (Erythrocyte Sedimentation Rate): This is a  measure of inflammation. Helpful in measuring how active your disease is and whether your treatment is effective. The normal value is less than 12.

It is important to note that all blood values will fluctuate slightly through the day and you may see in your blood monitoring booklet that occasionally blood values fall outside of the normal range. Often this is not a matter of concern. Should there be any cause for concern the specialist nurse, who reviews all blood tests as a part of blood monitoring, will contact you with appropriate advice.

Close contact means being in the same room as someone who has shingles for more than 15 minutes or having face to face contact or contact with someone who has shingles on many parts of their body or where it is exposed. Where possible you should keep away from anyone you know who has chickenpox or shingles.

If you are on a drug that suppresses your immune system (reduces your body’s defence mechanism against infections) and if you come in close contact with anyone who has chickenpox or shingles you should contact your GP for advice as treatment may be required. Drugs that suppress your immune system include: methotrexate, leflunomide, ciclosporin, azathioprine, mycophenolate, adalimumab, etanercept, rituximab, infliximab, golimumab, abatacept.