Rheumatoid arthritis is a complicated disease, and varies greatly from person to person. A team of healthcare professionals works with individuals to help them manage their condition. However, the availability of various services will vary depending on the area of Ireland where you live. As rheumatoid arthritis is systemic (ie. affects the whole body) and can cause permanent damage to the joints, it is important to seek early attention so that treatment can be started.

Your general practitioner (GP)

The first step in diagnosis and management is arranging a visit to your doctor if you have had symptoms such as stiffness in the morning or pain and swelling in you joints for more than a few days. You may not necessarily have rheumatoid arthritis; there are a number of other musculoskeletal conditions (disorders affecting the muscles, bones or joints) with similar symptoms.

Your GP will ask about your symptoms and do a physical examination. If they believe that you may have rheumatoid arthritis, your GP will refer you to a hospital specialist – a rheumatologist. A GP may also arrange for blood tests and laboratory tests prior to your hospital appointment. The GP will also be involved in your ongoing care and will be kept up-to-date by the rheumatologist.

Rheumatologist

A rheumatologist is a hospital specialist who has had specialist training and experience in the diagnosis and treatment of problems related to the musculoskeletal system (muscles, bones or joints).

The time it takes to get an out-patient appointment in Ireland varies from area to area.

It may be difficult to diagnose rheumatoid arthritis in the early stages. A rheumatologist will carry out the detective work to confirm a diagnosis of rheumatoid arthritis based on blood tests and x-rays. It might take more than one visit for a diagnosis to be confirmed.

Once diagnosis is made, a rheumatologist will be able to develop an individualised treatment plan. Where a comprehensive service is available, they may involve other members of the rheumatology team e.g. nurse specialist, physiotherapists and occupational therapists. A rheumatologist is responsible on an ongoing basis for assessing the disease, prescribing and monitoring the medications you are on to help your pain, deal with inflammation and limit joint damage. The rheumatologist is up-to-date on all the latest developments in therapy.

Rheumatology nurse

Many rheumatology departments have a specialist rheumatology nurse. The role of the rheumatology nurse will vary from hospital to hospital, but most nurses will be involved in educating patients on how to take their medications and on lifestyle issues. They will also carefully monitor patients throughout their therapy. Most therapy will require patient education, support and follow-up. For example, if a person has been prescribed a biologic therapy, a specialist nurse will teach them how to self-inject and store medication correctly.

Physiotherapist

A physiotherapist is usually an important member of the rheumatology team. Their job is to help you improve your physical function so you can be independent. A physiotherapist will provide patient education and exercise guidance. He/she will devise an exercise plan that improves flexibility and strengthens muscles. In addition to exercise, a treatment plan may include using cold/hot applications, electrical stimulation, and hydrotherapy.

Occupational therapist

Usually working with a physiotherapist, when available an occupational therapist will help an individual maintain optimal function at work, in the home and during leisure activities. Their main role is to help a person maintain their independence.

An occupational therapist will usually carry out an assessment of a person’s ability to carry out activities such as dressing, eating, bathing, etc. They provide advice on how a person can protect their joints to avoid excess stress from daily tasks such as cooking and dressing. They may also make recommendations on purchasing aids and appliances that might help with daily activities.

Podiatrist

Podiatrists are healthcare professionals who specialise in footcare. They deal with the assessment, diagnosis and treatment of the lower limb (i.e. foot, ankle, knee and hip). Arthritis frequently affects the feet, making standing and movement very uncomfortable. By understanding the effects of inflammation and degeneration of the joints, the podiatrist can reduce the amount of discomfort associated with arthritis. Podiatrists will conduct a gait analysis to establish the range of motion and forces on the individual joints. They may then prescribe various foot accessories to make the feet more comfortable.

Orthopaedic surgeon

Most people who have rheumatoid arthritis may never need surgery. However, if the joints are badly damaged and medication is not helping, surgery may be suggested by the rheumatologist and a referral to an orthopaedic surgeon will be made. This is a surgeon who specialises in correcting disorders of the skeleton (and associated muscles, joints, and ligaments).