Many rheumatology teams include other people apart from rheumatologists. The role of some of these professionals are covered below however for further experiences see orthopaedic surgeons (see Surgery); physiotherapists (See Physiotherapy and hydrotherapy); occupational therapists (see Occupational Therapy); radiographers and phlebotomists (see Regular Monitoring and other diagnostic tests).
People we interviewed often had appointments with the rheumatology nurse (also called specialist nurse or nurse practitioner). Sometimes patients attended only the nurses clinic to discuss particular issues problems medication monitoring etc. and were examined. Other times people saw the nurse immediately before the consultant and liked this because they had more time to discuss things with the nurse whereas they knew their time with the doctor would be short. The nurse could then tell the doctor about relevant problems.
Sees the specialist nurse before the consultant each time she visits the rheumatology clinic.
Two women were given steroid injections by their rheumatology nurse. Rheumatology nurses often answered questions over the phone e.g. via an official telephone help line which reassured people. Several people had asked for advice or about side effects or problems with medication or to get an earlier appointment if they needed one.
The rheumatology nurse has given her steroid injections; she has also used the helpline.
The National Rheumatoid Arthritis Society chair felt that nurse practitioners should be available in all areas which they are not. For more information about specialist nurses see Arthritis Research UK.
Describes her charity work to increase the number of nurse clinics so patients have quicker…
Orthotists and podiatrists mainly provide insoles for shoes off the shelf supportive shoes/boots or made to measure shoes/boots. Orthotists also provide other supports e.g. neck collars and back supports. One woman used a neck collar to ease her pain around the house and when travelling by car but didnt like wearing it in public. One woman had an ankle splint that she could wear on its own in the house but could not fit inside shoes.
RA often affects the small joints of the feet and problems such as dropped arches bent over or hammer toes can all make walking painful and difficult. Some women said the only shoes they could wear were sandals flip flops or slip on shoes with open toes but these do not adequately support the feet and are not recommended. The orthotist/podiatrist makes special insoles are by for peoples own shoes. Several people found these very helpful and had new ones made from time to time for different shoes. Sometimes it was difficult to get them into shoes and two women found they hurt their feet. One woman who could not bend to put on fitted shoes persuaded the orthotist to make insoles for her slip-on shoes but was disappointed with the made to measure shoes they also gave her.
Has insoles made for his shoes and boots which he finds ‘pretty good’ and can get new ones when…
The orthotist has provided made to measure shoes and also insoles for her slip-on shoes.
Off the shelf orthotic shoes and made to measure shoes were liked by the three men who all found them comfortable and lightweight whereas only a few women found them acceptable. Many women thought them unattractive clumpy and heavy and although they may have tried wearing them a few times many abandoned them. One woman said they were excellent and enabled her to walk with her hammer toes another had special boots made for many years although it was sometimes a long process. Other people also reported long waiting times for insoles and shoes – one woman waited over a year. However some people had direct access to the orthotics clinic and needed no further referrals from the rheumatologist.
Insoles, special shoes and visits to the podiatrist to remove hard skin on his feet have all been…
The shoes that the orthotist made her were unattractive and she didn’t wear them but insoles helped.
Her special boots and insoles are made to measure but she has had to wait and had problems…
Trainers and shoes made by Ecco, Scholl, Hotter and Goretex were often found to be comfortable and fairly supportive.
Some people had visited a podiatrist or chiropodist to have nails cut, ingrowing toenails treated and hard skin and calluses removed from their feet. Weight-bearing on bones in the foot that have moved out of place due to the arthritis puts pressure on the skin causing it to harden which unless removed can be very painful. One man visited the chiropodist regularly (Interview 13 see above).
Optometrists are eye experts and a rare problem with RA is inflammatory eye disease – iritis. One woman had annual check-ups with the optometrist and a man had experienced problems including eye swelling and floaters in his vision particularly when his arthritis was in flare. Sjogrens syndrome (dry eyes dry mouth and other membranes) was reported by some people we interviewed. It often accompanies RA; artificial tears can be used to lubricate dry eyes.
Two people asked whether RA affected their teeth and one man was worried as several teeth had recently fallen out. Two women said finding a dentist who understood that certain positions for dental treatment were uncomfortable was important and one with arthritis in her jaw could not keep her mouth open for long.
Pharmacists can advise people how to take medication and on supplements. A few people emphasised that having a good relationship with their local pharmacist meant they could offer advice if they spotted problems with combinations of drugs or with drugs used for another illness. One woman wanted clear dosage instructions on packaging not just Take as directed as people with RA often took different drugs and so had several to remember. Her pharmacist helped by taking tablets out of blister packs which she found difficult and dispensing them in bottles.
Reports about social workers were mixed. They helped two people advising them on welfare benefits they were entitled to. One woman had help in assessing her possible return to work. However two people found they lacked up to date knowledge of available benefits and one felt she got less support than she expected.