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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.

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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. 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 do not routinely see new patients to make a diagnosis of Fibromyalgia or Hypermobility as this can be seen and managed in Primary care. We can see patients if there is uncertainty around the diagnosis.  We are a dedicated group of highly trained, motivated and experienced doctors, nursing and specialist nursing staff, physiotherapists and occupational therapists working as a multidisciplinary team.

We constantly strive to improve the services we provide for our patients. Where possible, we provide patients with the necessary knowledge to make an informed decision about their treatment. Questions are welcomed and encouraged.

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 Internal medicine trainee (IM3)  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 Therapy Department.

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. Our junior doctors support the clinics so you may be assessed by them during your appointments and Consultants will review you afterwards if needed. We often have medical students attending our clinics in addition which you can decline if you so wish.

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

Clinic appointments with either be in person or undertaken over the telephone as appropriate. A letter will be sent with the appointment time and place and whether this will be in person or on the phone.  We do have outreach clinics so please check where the appointment is taking place to ensure you attend in the correct place. A text reminder is usually sent a week before the appointment. You may be contacted for telephone appointments an hour either side of the appointment time. If you wish to change your appointment date or to be in person or on the phone please contact our Medical records team.

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.

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

Injection clinic: patients who require targeted injections into joints are seen here, as well as patients who need an early review.

Connective tissue clinic: this clinic is for patients with complex health needs related to connective tissue disease, such as lupus, scleroderma, myositis and vasculitis.

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).

We also run outreach clinics in Alwoodley, and Ripon.

Medical Day Unit (MDU): Patients receiving drug therapies via intravenous infusion, will attending the MDU for their treatment where the experienced staff will take excellent care if you during your treatments. 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)
Jiby Kallarackal, Domini Bryer and Beverley Neville

Rheumatology Research Nurses
Louise Brown, Nadira Singh and Barbara Heath

Our professional and highly experienced Rheumatology Nursing team, with support from Phillipa Shields, 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 is run by the Rheumatology Nurse Specialist team. Email [email protected] or call 01423 553498.

Calls will be taken between the hours of 9am-12pm, Monday to Friday, excluding bank holidays. Before contacting our service please ensure you have accessed the Harrogate Rheumatology webpage for advice and guidance.   If the information you require is not available, please email or leave a voicemail with the appropriate identification including your name, date of birth and Hospital Number.

If your query is regarding your homecare medication please ensure up to date blood test results are available within the last three months. This is required to enable us to process a prescription.

We will not reply to blood results queries unless you have specifically been asked to ring us. Blood results are available via your NHS login. Rheumatology will contact you if there are any abnormalities requiring further action.

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 or Ripon. 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 advice line 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

Blood tests:

There are several options for attending for blood tests – please click for further information on attending in Harrogate, Knaresborough and Ripon.

Rheumatology Therapy Team

The therapy team are:

Susan Burgess – Rheumatology Therapy Clinical Lead /Advanced Rheumatology Physiotherapist

Angela Sheldon – Specialist Physiotherapist

Rotational Specialist Physiotherapist

Kirsty Rider – Specialist Occupational Therapist

Dave Sunderland – Rehabilitation Practitioner

You may see one of the therapy team when you are first diagnosed, if problems occur later, or if you simply want advice on appropriate exercise or how to manage everyday activities.

The Physiotherapists, Occupational Therapist and Rehabilitation Practitioner work closely together to provide care for people with rheumatology conditions. You may see them both at the same appointment. We have clinics at both Harrogate and Ripon hospital sites.

We typically offer 60 minute initial appointments and 30 minute follow up sessions. These are mainly face to face but can be carried out by telephone or video call, if required.

Physiotherapy

The role of the physiotherapist working in rheumatology is to help you improve and maintain your daily activities and keep independence in your work and home life. This is often achieved by increasing the joint movement and reducing stiffness and strengthening muscles that are affected by arthritis.

At the first appointment the physiotherapist will ask you some questions and physically examine your joints and muscles to find out what problems you’re having. This will help them get an understanding of what you want to achieve from the treatment and set goals. Examples of goals could be returning to work, playing with your children/grandchildren or walking your dog. It’s helpful to think of your own goals before you see the physiotherapist.

The physiotherapist will then work with you to help you understand what is happening to your joints and devise a treatment plan. This may include:

  • Provide support and education on how you manage your condition and coping strategies that you can use day to day.
  • A rehabilitation and/or self-care programme agreed with you, that you are responsible for. This may include wider health and lifestyle aspects such as smoking, alcohol intake and general levels of physical activity.
  • Exercise advice, which may include range of movement and strengthening exercises, improving mobility and increasing overall fitness whilst finding the right balance between rest and activity
  • A one-to-one support exercise programme by rehabilitation practitioner (see below)
  • Advice on local exercise groups and classes
  • Walking and balance assessment and provision of walking aids, if needed.
  • General advice on managing arthritis including pacing and improving sleep
  • Advice on pain relief
  • Flare management advice
  • Point you in the direction of other health professionals or services within the trust and wider community that could support you further.

The aims of the sessions are to give you the reassurance and confidences that you can manage your condition long-term and continue with you to do your daily activities.

Rehabilitation Practitioner

The rehabilitation practitioner works with the Rheumatology Therapy Team to offer guidance and support for patients looking to increase their confidence and knowledge of physical activity levels. Following a referral by one of the therapy team you will receive an individualised exercise programme. You are then supported through several weeks of activity in the pursuit of previously agreed goals.

Harrogate Health Hub

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

Occupational Therapy

Occupational Therapy provides patient-centred intervention to support self-management of your condition and maintain your ability to carry out daily activities. This may include:

  • Information and education on your condition
  • Hand strengthening exercises
  • Joint protection advice
  • Orthoses to support your hand or wrist
  • Workplace recommendations
  • Fatigue management and energy conservation education
  • Relaxation techniques
  • Small aids or equipment to increase your independence around the home
  • Advice on community or voluntary services that you may find useful.

It’s helpful to think of the goals you would like to achieve before you see the Occupational Therapist.

Therapy Team

The Therapy Team are located in Silverdale at Harrogate District Hospital and in the Physiotherapy department at Ripon Community Hospital.

The departments are open Monday to Fridays, except bank holidays.

Silverdale contact number: 01423 553472

Physiotherapy Department Ripon Community Hospital: 01423 542923

The departments are open Monday to Friday, except bank holidays.

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

? HYPERLINK TO MAP OF SILVERDALE LOCATION AND RIPON PHYSIOTHERAPY DEPARTMENT