Coronavirus/Covid-19 key information for patients and visitors

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Rheumatology

The Rheumatology Team offers a wide range of services for the diagnosis and treatment of arthritis and other musculoskeletal conditions.

Coronavirus/COVID-19 advice for Rheumatology patients

Covid-19 guidance for rheumatology patients

Do I need to self-isolate or shield with my rheumatology medication?

Flare Care – Inflammatory arthritis advice

Vaccines for Covid-19; your questions answered

If you are under the care of the Harrogate Rheumatology Team and are taking a medication for your arthritis that is prescribed by the hospital (eg. Injected treatments, baracitinib or tofacitinib), you should be in priority group 6 for the Covid-19 vaccination. If you have not yet been invited to book an appointment for vaccination, please contact your GP to discuss this.

Blood tests for rheumatology patients during the COVID-19 pandemic

There are more than 200 forms of arthritis, the most common of which can be organised into the following categories:

  • Inflammatory Arthritis (including Rheumatoid Arthritis and Psoriatic Arthritis)
  • Osteoarthritis
  • Connective Tissue Disease (including Systemic Lupus Erythematosis, Myositis and Vasculitis)
  • Polymyalgia Rheumatica and Temporal Arteritis
  • Gout and Pseudogout

Please note that while we see many new patients with osteoarthritis, we do not manage osteoarthritis on an ongoing basis as this is best done by a patient’s GP. We also see new patients to make a diagnosis of Fibromyalgia and Hypermobility and plan treatment but do not routinely offer long term care in our clinics.

Rheumatology at Harrogate District Hospital

The Rheumatology Team aim to provide a patient-centred service for the diagnosis, management, and treatment of all types of arthritis. Our objective is to assess, diagnose, and treat arthritis in the most appropriate manner for the particular condition and patient.

The Rheumatology Service is led by five Consultant Rheumatologists who are responsible for your initial assessment and diagnosis, deciding the care that you should receive, the implementation of your care pathway, and reviewing its effectiveness. The consultants are closely supported by two junior doctors, including a Core Trainee training in General Medicine and a Specialty Trainee in Rheumatology. The Specialty Trainee is training within the Yorkshire Rheumatology Training Programme. The service is also complemented by the specialist rheumatology nurse team, musculoskeletal specialist physiotherapists and occupational therapists, and support staff who all work closely with the Consultant Rheumatologists.

The medical staff and specialist nurses will prescribe specialised medication where appropriate.

We are involved in a number of local, regional, national and international research studies. You may be asked whether you would like to participate in one or more of these studies. Research allows doctors and patients to gain access to and experience new innovative treatments and contributes to the development of our understanding of rheumatology conditions and the optimal management of our patients.

Almost all of the research we do involves licensed and approved treatments for arthritis, but looks at using them differently or sometimes earlier looking to improve outcomes for patients. We are starting to get involved in studies using treatments not yet licensed in the UK.

There are several reasons why patients may benefit from taking part in research including:

  • A new treatment may be effective in treating their condition.
  • Earlier access to treatment.
  • Participation in a Clinical Trial may bring benefit to others in the future.
  • Taking part in research may help find a cure for the disease.
  • May meet others suffering from the same disease whilst taking part in research.

We also develop tailored treatment plans in conjunction with the Physiotherapy Department. These plans may include special exercises, manual therapy, acupuncture and/or hydrotherapy. More information can be found here.

Our Occupational Therapy team provides aids to daily living (such as splints), assess the home/workplace to see if individuals need special equipment and adaptations to enable them to work or live independently.

Our Rheumatology Podiatry team accepts referrals via the Rheumatology team or your own GP. They also provide treatment for children and young adults under our care. Working as part of the Rheumatology team, Podiatry can provide:

  • In-depth foot assessments
  • Diagnosis and treatments of foot problems in order to optimise foot function and comfort
  • Nail surgery
  • Treatment of Lymphodema
  • Monitoring for disease activity and refer back to Rheumatology when needed
  • Vascular and neurological tests are carried out as part of the assessments and again referrals will be made to appropriate specialists

Treatments may include orthotics, padding and strapping, exercises or wound care for those with current ulcerations or other active problems.

Clinics

We run a number of regular clinics, specialist clinics, nurse-led clinics and an advice line. A consultation is an opportunity to discuss your health and treatment with the team and voice any concerns. You will undergo a physical examination and we may weigh you, take your blood pressure, and check a urine sample. You may also be required to have a blood test or an x-ray.

A consultation is an opportunity

    • to discuss your health and treatment with the team and voice any concerns
    • to discuss other medical conditions you may have and any operations you have had in the past, as these may be relevant to your care and treatment plan
    • To review your medications – prescribed by your healthcare team (GP and Consultants) and any over the counter medication or herbal/ complimentary therapies that you take on a regular basis
    • to give a history of known allergies – drugs (Medications) foods, latex and animal
    • to give vaccination/immunisation history

You may also be invited to participate in one of our research studies if applicable- this is optional and will be discussed with you during the appointment

At present, due to the Covid-19 pandemic, most of our clinic reviews are being undertaken over the telephone. You will receive an appointment as usual and will be contacted within one hour either side of the appointment time. Face to Face appointments will be scheduled as required and if you feel that it is necessary for us to review you in person, we can amend the telephone review if possible or give you an alternative date.

Please prepare for your appointment by prioritising any key issues you may wish to mention. Feel free to share any details which may help us determine an appropriate plan for you and think about how to describe your symptoms to us. This is crucial if we are reviewing you over the phone and will help us assess the current status of your condition.

Consultant-led clinics

General Rheumatology clinics: In these clinics new patients are assessed to form an initial diagnosis and treatment plans are made in discussion with the patient. Patients also return to this clinic for monitoring of their condition and adjustment to their treatment. Clinics are run throughout the working week.

Early arthritis clinic: this clinic is an opportunity for patients with new inflammatory conditions to be assessed by the medical team. If appropriate, treatment will start immediately. The clinic is held on Tuesday mornings and afternoons. New patients may find this information helpful:

NRAS – Rheumatoid Arthritis

https://www.nras.org.uk/publications/new2ra-pack

Ankylosing Spondylitis

Psoriatic Arthritis

Medications 

Analgesics: These medications help reduce pain, but have no effect on inflammation.
https://www.versusarthritis.org/about-arthritis/treatments/drugs/painkillers-and-nsaids/

Non-steroidal anti-inflammatory drugs (NSAIDs): reduce both pain and inflammation.
https://www.versusarthritis.org/about-arthritis/treatments/drugs/painkillers-and-nsaids/

Disease Modifying Antirheumatic Drugs- DMARDs: alter the disease process.
https://www.versusarthritis.org/about-arthritis/treatments/drugs/disease-modifying-anti-rheumatic-drugs-dmards/

https://www.nras.org.uk/dmards

Injection clinic: patients who require targeted injections into joints are seen here, as well as patients who need an early review. The clinic is held on Friday mornings.

Connective tissue clinic: this clinic is for patients with complex health needs related to connective tissue disease, such as lupus, scleroderma, myositis and vasculitis. The clinic is held once a month on Thursday mornings.

Osteoporosis and metabolic bone clinic: this clinic is for patients with osteoporosis and other bone-related problems. The clinic is held once every two months on Friday mornings.

Paediatric combined clinic: this clinic is designed to meet children’s health needs in an environment in which children and their parents feel more comfortable. A multi-disciplinary team, including staff from the regional centre in Leeds, is involved in the clinic. The clinic is held once every three months on Friday mornings.

Biologics clinic: this clinic is run by both nurses and consultants and is designed to ensure that patients receiving biologic treatments are continually assessed and monitored as per National Institute of Clinical Excellence guidelines (NICE). The clinic is held once a month of Thursday mornings.

We also run outreach clinics in Alwoodley, Ripon and Wetherby.

Medical Day Unit (MDU): Patients receiving drug therapies via intravenous infusion, will be attending the MDU for their treatment. We would remind patients with any queries about your appointment, to contact the unit directly. Please ensure any blood tests required before your appointment have been taken and the results are available for the team in order to prescribe your treatment in a timely fashion.

Nurse-led clinics

Rheumatology Clinical Nurse Specialist team
Lynsey Hall (Lead Nurse)
Domini Bryer, Pauline Fitzgerald & Beverley Neville

Rheumatology Research Nurse
Esther Gordon

Our professional and highly experienced Rheumatology Nursing team, with support from Lyndsey Dalby, our administrative clerk, provide high quality care, trust and compassion to support our patients, their relatives and carers.

What to expect:

At your clinic appointment, the nurse will assess your disease activity, ask you about your condition, pain and fatigue levels and how these are impacting on your daily life. They will also establish if you are tolerating your prescribed rheumatology medications and discuss any side effects. Safety monitoring of drug therapies is a major part of the visit. Any changes to therapy will be discussed and agreed before implementation.

Education about your diagnosis and treatments will be discussed and ways to aid independence and keep active shared. Health education is an important aspect of all consultations, please feel free to ask questions and seek advice.

The Rheumatology Advice Line: run by the Rheumatology Nurse Specialist team
Email r.adviceline@nhs.net or call 01423 553498

Calls will be answered in person between the hours of 9am-12pm, Monday to Friday, excluding bank holidays. Please note that during periods of staff leave, it will still be possible for messages to be left between 9am-12pm. The phone will be closed otherwise until the following day. For advice at other times, please access the hospital rheumatology webpage. If the information you require is not available, please email r.adviceline@nhs.net with the appropriate identification including your name, date of birth and Hospital Number, so we can safely reply. Thank you.

When should you use this service?

The Rheumatology Advice Line is available to anyone who attends the rheumatology clinics at Harrogate Hospital or the outreach clinics held at Alwoodley, Ripon and Wetherby. It can also be used by your family or carer, as long as you have given your permission. We will only discuss confidential matters with you.

This is not an Emergency Service.

If you have an acute hot joint out of hours or if the team is unavailable over the weekend or bank holidays, please attend your local Emergency Department or contact NHS 111.

Please contact us on the adviceline if you are worried about any of the following problems:

  • If you have a ‘flare-up’ of your symptoms and these have not responded to your usual self-help treatments (please see this leaflet) and you feel that you need further advice
  • If you are experiencing side effects that you think may be caused by the medication prescribed for your arthritis
  • If you experience an adverse reaction to a treatment given at the rheumatology clinic
  • If you have been asked by one of the rheumatology team to report on your progress
  • If you have any urgent worries or concerns that cannot wait until your next appointment

Our Rheumatology Nurses are very experienced and will listen to your message or concerns.

If we do not speak to you straight away your message will be returned within two working days. If you have not heard from us by the end of the second day, we would advise you to resend the email.

The two major charities we work with also have dedicated helplines which you can access for general advice:

Homecare prescriptions: For patients who receive their medications via our Homecare services, it is vital that your supplies are maintained, to ensure your treatment if fully effective. The Rheumatology nurses receive repeat requests once weekly from the homecare companies used to supply your medications. These can take up to three weeks to process through our hospital pharmacy, via the postal service and then the homecare pharmacy department, before your scheduled delivery can be made. We are unable to do this if your blood results are not up to date and these are normally required once every three months to ensure it is safe for you to continue on your medications. We will aim to contact you twice if your blood tests are not available, but thereafter your treatment may be put on hold.

If you only have two weeks supply left and have not had a confirmation about your next delivery please contact the appropriate Homecare provider. DO NOT ALLOW YOUR SUPPLIES TO RUN DOWN.

Homecare provider Contact details
Health at Home 0333 1039599
Lloyds 0345 2636117
Healthnet 0800 0778737

Physiotherapist clinics

Spondylitis clinic: this clinic is designed for patients with all forms of spondyloarthropathy (including ankylosing spondylitis, colitis-related and psoriasis-related). The clinic is held once every three months on Thursdays.

Physiotherapy clinic: patients are referred to this clinic for advice and exercises to help manage pain, improve joint movement, strengthen muscles, improve posture, and manage activities of daily living. When necessary joint and soft tissue injections may be used to reduce pain and inflammation, while  electrotherapy and hydrotherapy are available if required. The clinics are held in Ripon and Harrogate.

Harrogate Health Hub

This website has been developed by our Physiotherapy team and includes links for common musculoskeletal disorders with advice on how to self-manage them.

Fibromyalgia group sessions

Once a diagnosis has been made by the Consultant patients are referred to be seen in these group sessions. They entail an initial education session, a hydrotherapy and gym session.

Sessions are usually held in the Medical Day Unit (MDU), with some held in the Therapy Services Department. The reception staff will direct you to the correct location and the hospital volunteers are here to help if you are not sure where to go. We also run clinics in some community locations such as Alwoodley, Wetherby and Ripon. Fibromyalgia classes have been temporarily suspended during the Covid-19 pandemic. However, a “Virtual class” is currently being developed in the interim. The link will be provided once available.

Fibromyalgia Action UK also provides useful information if required.

Opening hours

The Rheumatology Department is open between 8.30am–5pm, Monday to Friday except for public holidays.

The Physiotherapy Department is open from 7.30am-6pm Monday to Friday as above.

Referral

We accept referrals from GPs or other hospital departments.

Frequently Asked Questions (FAQs)

Click here to go to the FAQs page.

Useful links

Documents for healthcare professionals