Meet the rheumatology team

Transcription

1 Therapy Meet the rheumatology team Meet the rheumatology team This booklet provides information and answers to your questions about the rheumatology team.

2 Who s in the rheumatology team? If you have arthritis, there may be a whole team of health professionals involved in your care and treatment. In this booklet we ll explain the roles of each member of the rheumatology team, how you get referred and how they may be able to help. We ll also explain any tests you might have. At the back of this booklet you ll find a brief glossary of medical words we ve underlined these when they re first used in the booklet.

3 Arthritis Research UK Meet the rheumatology team What s inside? 2 The rheumatology team at a glance 4 Introduction 4 Consultant rheumatologist 7 Occupational therapist 10 Physiotherapist 13 Rheumatology nurse specialist 14 Who else might I see? Orthopaedic surgeon Orthotist Podiatrist 19 What if I m worried about the tests I ll have? 19 What type of tests are there? Other methods of imaging Other tests Some less common tests 26 Glossary 27 Where can I find out more? 28 We re here to help

4 At a glance The rheumatology team What is the rheumatology team? If you have arthritis your care and treatment will involve a team of healthcare professionals, which usually consists of a consultant rheumatologist, a rheumatology nurse specialist, a physiotherapist and an occupational therapist. Other members of the team may include an orthopaedic surgeon, an orthotist and a podiatrist. Who s in the team? Consultant rheumatologists are doctors who specialise in diagnosing and treating arthritis and diseases related to rheumatology. They ll help confirm your diagnosis and recommend and oversee your treatment. Occupational therapists are trained healthcare professionals who help people to carry out everyday activities and lead fulfilling lives. This includes the physical, emotional and social aspects of everyday life. They can help you overcome everyday problems by advising you about employment, mobility and specialist equipment. Physiotherapists are healthcare professionals who help people stay active and independent. They assess movement, address individual needs, help to improve The team will be happy to discuss any aspect of your condition or treatment. function and manage pain. They can help you to improve your general fitness levels by teaching you specific mobilising, stretching and strengthening exercises. Rheumatology nurse specialists are trained nurses who have specialist experience in looking after the physical, emotional and social needs of people with arthritis. They work with people with all kinds of arthritis-related conditions. They ll help you learn about your condition, oversee your treatment and offer support. Who else might I see? Depending on your condition, you may also be referred to see other healthcare professionals, such as an orthopaedic surgeon, orthotist or podiatrist. Orthopaedic surgeons specialise in problems affecting the bones, joints and other structures involved in making the body move. They can advise you on whether surgery is an option and will perform the operations if you need them. 2

5 Arthritis Research UK Meet the rheumatology team Orthotists specialise in the use of appliances (orthoses) to support weakened joints, correct deformities and reduce pain and strain when the affected joints are being used. Podiatrists are experts on problems with the feet and ankles and can give advice and help with getting special shoes or insoles. to assess how active your arthritis is to predict how your condition will develop to work out the best form of treatment to monitor drug treatments. If you re worried about what tests you may need you can always talk about how you re feeling with a member of your rheumatology team. Tests and investigations There are a number of tests involved in diagnosing arthritis and related conditions. These can be carried out by several members of the rheumatology team, but you may also be referred to other specialists. Tests will be carried out: to make a diagnosis to rule out other explanations of your illness

6 4 Introduction People with arthritis have many different needs, so most hospital rheumatology departments have a team of health professionals to look after all aspects of your care. The team itself may vary from hospital to hospital but will usually include a consultant rheumatologist, a rheumatology nurse specialist, a physiotherapist and an occupational therapist. You may also need to see an orthopaedic surgeon, an orthotist or a podiatrist. Consultant rheumatologist What is a consultant rheumatologist? A consultant rheumatologist is a doctor who specialises in diagnosing and treating arthritis and diseases related to rheumatology. There are over 200 different diseases that affect the joints, Most hospital rheumatology departments have a team of health professionals to look after all aspects of your care. bones, muscles and other soft tissues. Rheumatologists will manage a wide range of these musculoskeletal conditions. Dr Amanda Isdale Consultant rheumatologist Working as a rheumatologist largely involves assessing and managing new and follow-up rheumatology patients referred from GPs. I manage a wide range of conditions, mainly in adult patients, including different types of joint diseases, problems with muscles, tendons and ligaments, and bone disorders including osteoporosis. How can I be referred to a consultant rheumatologist? You should be able to find a rheumatologist in the rheumatology department of your hospital. Your GP will normally refer you to a rheumatologist if they feel that further tests are needed to confirm a diagnosis or if they think you might need more specialist treatment. Dr Amanda Isdale Consultant rheumatologist It s very important to maintain regular and close communication with hospital and GP colleagues to ensure that patients receive the best possible care.

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8 How can a rheumatologist help me? Helping diagnose your condition A rheumatologist will arrange for you to have tests to find out more about your condition. These may include blood tests and x-rays. If there are complex results from these tests your rheumatologist may discuss them with specialist colleagues. Organising treatments Once the diagnosis is confirmed, a rheumatologist will recommend a programme of treatment. This may include drug treatments, which they may help monitor or carry out. This could be a course of tablets or local steroid injections to address your symptoms, for example. Your rheumatologist can also recommend that you see a physiotherapist, occupational therapist, orthotist or podiatrist for specialist advice in these areas. Some of the rheumatic diseases can affect other aspects of your health besides your joints. If necessary, your rheumatologist will refer you to other hospital specialists. Even if other specialists are involved in your care, your rheumatologist will want to see you on a regular basis to monitor your condition and treatment.

9 Arthritis Research UK Meet the rheumatology team Dr Amanda Isdale Consultant rheumatologist Rheumatology is often misunderstood by the general public as just dealing with old people with aches and pains. However, it s a challenging discipline and with the greatly improved patient outcomes now available has become even more rewarding. Like all consultants in the NHS, consultant rheumatologists develop the service delivered by the local hospital, educate other doctors and allied health professionals about rheumatological conditions and contribute to research in the field of rheumatology. See Arthritis Research UK booklets and drug leaflets Osteoarthritis; Rheumatoid arthritis; What is arthritis?; Drugs and arthritis; Local steroid injections. Occupational therapist What is an occupational therapist? An occupational therapist, or OT, is a trained healthcare professional who works with people of all ages, helping them to carry out everyday activities and lead fulfilling lives. Some OTs have developed specialist skills in treating people with arthritis. OTs may work in hospitals, Social Services or primary care. Debbie Fletcher Occupational therapist I work with adults with a variety of rheumatological conditions including lupus and inflammatory arthritis. The work involves assessing the problems or difficulties people have with daily activity. This includes self-care, work and leisure activities. I help people find solutions to these problems, which could include using a gadget, exercising or doing things differently. The role of the rheumatology team is to help people manage their long-term condition and the OT has an important role in that process. How can I be referred to an OT? You may be referred to a specialist OT by your consultant rheumatologist (or by another member of the team) when you re first diagnosed, or if you have difficulties getting about or managing everyday activities. Some rheumatology departments also offer an open system, where patients can request to see an OT independently. Your GP can also refer you to the primary care OT, or you can approach Social Services yourself if you re having difficulty managing at home. 7

10 Debbie Fletcher Occupational therapist I enjoy working with a multiprofessional team as I feel that it offers support and we learn from each other. That team includes the patients, and they often offer solutions or information that I can share with others. I like the opportunity to have a mix of roles; for example clinical, education and research. How can an OT help me? Discussing your condition and what you can do to help yourself It makes sense to start looking after your joints as soon as you know that you have arthritis. Making changes early on can help you to avoid problems becoming worse in the future. The OT will show you how to look after your joints by reducing strain, which Occupational therapists will try to offer advice that will help you continue doing the things that you enjoy. should also ease aches and pains. This approach is called joint protection. This includes pacing and planning in order to achieve a balance between activity and rest. The OT will help you make these changes. Giving practical advice on how you can overcome everyday problems Making everyday activities easier The OT can help you to analyse your activities, working out where the problems are and suggesting changes. You may need to rethink the way you do things, such as positioning yourself more comfortably, taking frequent rest breaks or asking someone to help with heavier jobs. Specialist equipment The OT can help you identify and obtain specialist equipment to help you get about and manage everyday tasks. Social Services OTs are experts in home adaptations such as level-access showers and ramps. Mobility You may have difficulties getting out and about or with driving. An OT will be able to advise you on special adaptations for your car or about wheelchairs, scooters and walking frames. Offering advice about employment and leisure activities If you have arthritis you may have difficulty doing some aspects of your job. You may have had to take time off work and be concerned about how you ll cope when you return. An OT will be able to assess your situation and advise you. 8

11 Arthritis Research UK Meet the rheumatology team Occupational therapists recognise the importance of being able to continue your hobbies and leisure activities and will try to offer advice that will help you continue doing the things that you enjoy. Providing splints to rest or support painful or unstable joints Wearing splints can help to rest and support painful, swollen joints. For example, a wrist or thumb splint may improve grip if these joints are painful or unstable. The OT may make splints especially for you or prescribe ready-made splints. Debbie Fletcher Occupational therapist Being an OT incorporates very practical skills needed for making splints, or my Blue Peter skills as some patients joke, problem solving and the psychosocial aspects of care needed to support people adapting to living with a long-term condition. Education is also very important and I have the opportunity to teach patients, medical students and health professionals. So it s a very varied job. See Arthritis Research UK booklets Everyday living and arthritis; Looking after your joints when you have arthritis; Occupational therapy and arthritis; Splints for arthritis of the wrist and hand.

12 A physiotherapist can help you to minimise the effects of arthritis on your life. Physiotherapist What is a physiotherapist? A physiotherapist is a healthcare professional who helps people remain active and independent both at home and at work. They re experts in assessing movement, addressing individual needs, helping to improve function and managing pain. Some specialist physiotherapists have been trained to diagnose and treat people with joint and muscle pain, so when you re referred for specialist treatment you may be seen by a specialist physiotherapist rather than by a rheumatologist or an orthopaedic surgeon. How can I be referred to a physiotherapist? You can be referred by your GP or your rheumatologist to your nearest physiotherapy department, although access may depend on what services are available in your area. You may be able to self-refer, i.e. make your own arrangements to see a physiotherapist without a doctor s referral. Self-referral is a relatively new practice in some parts of the UK. Check with your GP and find out if you have an NHS physiotherapy department in your area that will accept selfreferrals. If you wish to be seen privately you can self-refer to a private physiotherapy practice. It s very important to give a full medical history to the physiotherapist when you self-refer. Carol Doyle Physiotherapist I find that seeing patients referred early by their GP improves their treatment outcome, and it also helps with the education and future management of the problem. How can a physiotherapist help me? Helping you to understand how arthritis affects you Arthritis can affect your joints and muscles in many ways. A physiotherapist can help you understand what happens to your joints and muscles when you have arthritis and how you can minimise the effect these changes have on your life. 10

13 Arthritis Research UK Meet the rheumatology team

14 Helping you to manage your pain There are many strategies that you can use to manage your day-to-day pain, and a physiotherapist can advise you about these. Pacing is one of these strategies. Working with the physiotherapist you can discover the right balance between rest and activity. This means planning your activities so you re always comfortable, and this will enable you to enjoy the things you want to do. Other pain-relief methods that may be used by physiotherapists include transcutaneous electrical nerve stimulation (TENS), massage and acupuncture. These treatments can also be accessed through private practitioners or purchased independently. Improving your fitness Exercise can improve your general fitness and mobility, help you keep to a healthy weight and make you feel better in yourself. You and your physiotherapist can decide what would be the best exercise option for you. Whatever your fitness level, your physiotherapist will support and encourage you through the process. Teaching you mobilising, stretching and strengthening exercises Your physiotherapist will assess the range of movement of your joints and your muscle strength. You and your physiotherapist can work towards achieving your full potential and best functional outcome using manual techniques and exercises.

15 Arthritis Research UK Meet the rheumatology team Carol Doyle Physiotherapist For me this job is able to really make a difference for patients suffering with musculoskeletal problems by seeing and treating them early in their condition and helping them manage their problem. Lynda Gettings Clinical nurse specialist I enjoy working with patients and families from diagnosis and beyond. I do this by working with them one to one in clinic, talking about the disease, assessing its impact and treating symptoms. See Arthritis Research UK booklets Complementary and alternative medicine for arthritis; Keep moving; Pain and arthritis; Physiotherapy and arthritis. Rheumatology nurse specialist What is a rheumatology nurse specialist? A rheumatology nurse specialist is a trained nurse who has specialist experience in looking after the physical, emotional and social needs of people with arthritis. Rheumatology nurse specialists are sometimes called clinical nurse specialists, rheumatology nurse practitioners or liaison rheumatology nurses. Rheumatology nurse specialists work with people with all kinds of arthritisrelated conditions. Some rheumatology nurse specialists are able to diagnose, recommend treatments and prescribe medication. How can I be referred to a rheumatology nurse specialist? People with arthritis are often referred to a rheumatology nurse specialist when a diagnosis has been made by their consultant rheumatologist and their treatment has been agreed. Some rheumatology departments also offer an open system, where patients can request to see the rheumatology nurse specialist independently (usually if a problem arises between appointments). How can a rheumatology nurse specialist help me? Helping you learn about your condition A detailed explanation about what your diagnosis means can reduce any anxiety and fear you may be feeling. The rheumatology nurse specialist will listen to your particular concerns and provide information and support during periods of change. They ll explain what symptoms your condition can cause and will work with you to reduce their impact. 13

16 Helping you learn about drug treatments and monitoring your needs The rheumatology nurse specialist will provide you with information before you start taking any drug or biological therapy so that you re fully involved in your treatment. If you re on drug treatments for arthritis you ll need regular monitoring blood tests, and for some you ll need regular blood pressure and urine tests. The rheumatology nurse specialist will also arrange for your drug treatment to be monitored in a hospital clinic or at your GP s surgery. Lynda Gettings Clinical nurse specialist I work with patients to make sure disease activity is stable and prescribe drugs when necessary, as well as organising tests (x-rays or bloods) or refer to multi-disciplinary team members and education programmes. Offering telephone support In most rheumatology departments, rheumatology nurse specialists run a telephone advice line to provide you with easy access to a nurse who knows about you, your condition and your treatment. This is a handy way for you to contact the nurse if you need advice and support on managing your symptoms or if you have any concerns about your condition or your treatment. Providing emotional support The rheumatology nurse specialist can provide expert help and support to improve your mood and discuss how to minimise the impact of the condition both at home and in the workplace. Who else might I see? As well as the team members listed above, you may also be referred to see an orthopaedic surgeon, orthotist or podiatrist, depending on your condition. Orthopaedic surgeon Orthopaedic surgeons specialise in surgical treatments for problems affecting the bones, joints and other structures involved in making the body move. They re involved in treating the problems caused by disease and injury (trauma) in these structures. Most orthopaedic surgeons specialise in particular procedures or regions of the body. For example, some are specialists in hip and knee replacements, while others have expertise in spinal surgery or sports medicine. Some surgeons also have specialist experience in certain diseases, such as rheumatoid arthritis. Your rheumatologist will generally be familiar with the surgeons in your area and refer you when necessary to a surgeon with the relevant specialist interest. 14

17 Arthritis Research UK Meet the rheumatology team Chris Wilson Orthopaedic surgeon I perform all forms of knee surgery, from keyhole surgery through to joint replacement, and I also do trauma surgery all forms or surgery needed with broken bones or joints after accidents. How can I be referred to an orthopaedic surgeon? You ll be referred to an orthopaedic surgeon by your rheumatologist if other treatments aren t providing adequate pain relief. You may also be referred by your GP or by a physiotherapist directly through physiotherapy assessment services provided by the NHS. How can an orthopaedic surgeon help me? Offering advice on surgical procedures Orthopaedic surgeons will discuss the surgical options available to you. They will advise you on the potential pros and cons of having or delaying surgery, taking into account your age, health and level of activity. The surgeon will also give you advice about other treatments (where appropriate), explain the benefits and risks of each method and the likely outcome if you decide not to have treatment.

18 If surgery is suggested, you ll always have the final decision on whether to go ahead or not. Performing surgical treatments Some treatments offered by orthopaedic surgeons include: joint replacements surgical fusion of a joint keyhole surgery to remove bone and cartilage debris fixing of fractures resulting from injury or osteoporosis repairs or reconstructions to tendons or ligaments. It s important to remember that most people with arthritis won t need surgery, and being referred to an orthopaedic surgeon doesn t mean that you ll definitely have orthopaedic surgery. The surgeon will assess your condition and advise you on the potential pros and cons of surgery before you decide whether to go ahead. Chris Wilson Orthopaedic surgeon Most of the operations work well in relief of suffering and disability. The patients are all ages, shapes and sizes, and the operations go from routine keyhole surgery right through to long, challenging cases. See Arthritis Research UK booklets Hand and wrist surgery; Hip replacement; Knee replacement; Shoulder and elbow joint replacement.

19 Arthritis Research UK Meet the rheumatology team Orthotist An orthotist specialises in the use of devices (orthoses) to support weakened joints, correct deformities and reduce pain and strain when the affected joints are being used in everyday life. If you have complex needs you may require several meetings with an orthotist so that they can analyse and discuss with you how best to help you. John Farmer Orthotist My job involves providing patients with appropriate devices, footwear and orthoses to give support, correction and accommodation for deformity that may be a result of injury or conditions such as rheumatoid or osteoarthritis. How can an orthotist help me? The devices most commonly used by an orthotist in treating arthritis are special shoes or insoles for problems in the feet and legs, and splints for the hands and wrists. A number of splints and foot orthoses are available ready-made, and your physiotherapist or occupational therapist can advise on what might be suitable for you. More complex problems may require a custom-made orthotic device, designed and fitted by an orthotist who specialises in that field. Orthotists will use plaster casts of feet or limbs, sketches, drafts, drawings and impression foam models to give manufacturers enough information to make a suitable device. John Farmer Orthotist There are a plethora of items that we have available, and we often find that due to the ever-changing nature of such conditions we have to be innovative and look outside the box. Podiatrist Podiatrists are experts on problems with the feet and ankles, and some specialise further in problems caused by arthritis and related conditions. Oonagh Wilson Podiatrist A change in the shape of the feet can cause further difficulties for patients in getting comfortable shoes that fit and don t make their problems worse so advice on how and where to get shoes is also part of my job. 17

20 How can I be referred to a podiatrist? Podiatrists (sometimes called chiropodists) may work either in the NHS or in private clinics. All podiatrists/ chiropodists working in the NHS will have been trained to degree-level or higher and must be registered with the Health Professions Council (HPC). Your GP or hospital consultant may refer you to an NHS podiatrist, but many NHS podiatry services will also accept patients on a self-referral basis. If you re self-referring you should make sure you go to an HPC registered podiatrist. How can a podiatrist help me? Podiatrists can help with problems such as corns, calluses and troublesome nails and can also give advice and help with getting special shoes or insoles to correct deformities of the foot. Some podiatrists are also qualified to perform minor surgery. At your first appointment the podiatrist will usually assess your feet, note any current treatment, ask you how long you ve been diagnosed with arthritis and agree a podiatry treatment plan. Depending on the foot problems, this plan may require advice regarding self-care, regular podiatry follow-up or referral for further treatment with other healthcare departments.

21 Arthritis Research UK Meet the rheumatology team Oonagh Wilson Podiatrist We walk on our feet up to 16 hours a day and with every step the feet are supporting the whole of our body weight. Deformity-altered walking patterns, skin and nail problems, and foot pain can make life intolerable and going out of the house almost impossible but the work I do can make a big difference to many patients. See Arthritis Research UK booklet Feet, footwear and arthritis. What if I m worried about the tests I ll have? There are many different tests your rheumatology team may do, for different reasons, including: to make a diagnosis to rule out other explanations of your illness to assess how active your arthritis is to predict how your condition will develop to work out the best form of treatment to monitor drug treatments. You may be worried about what some of these tests are. In this section of the booklet we ll go through some of the most common tests used in rheumatology departments, so you know a bit more about what s involved. You can also always talk about how you re feeling about tests with a member of your rheumatology team. What type of tests are there? Blood tests Blood tests are common tests performed by your rheumatology team. They re usually used to help make a diagnosis, to monitor your condition and monitor the effects of drug treatments. Very occasionally, blood tests are used to help with genetic studies to help a diagnosis. Podiatrists can help with problems such as corns, calluses and troublesome nails. 19

22 For example, they can look for the gene HLA-B27, which can be associated with some conditions, such as ankylosing spondylitis. How it s done Blood is usually taken from a vein in your arm, on the inside of your elbow where your blood vessels are close to the surface of your skin. A blood sample will then be taken using a needle and syringe, either by a member of your rheumatology team or a phlebotomist (someone who s trained to take blood). When enough blood has been taken, the needle will be removed and you ll be given cotton wool or a plaster to cover the small break in your skin. The blood sample can then be analysed in a laboratory. Blood tests shouldn t be painful, but you ll feel a pricking sensation when the needle is first put in. Although you should be able to go home straight after a blood test, it may be several weeks before your results have been analysed and can be discussed with your GP. Blood test results can vary from day to day this is quite normal, and so a small variation in a certain measurement may not be important. X-rays X-rays are a common and reliable way of getting a picture of the inside of your body. They show things that can help the doctor diagnose arthritis, such as damaged areas of bone. But because x-rays don t show damage to soft tissues very well, your diagnosis won t be based on x-rays alone and you ll probably need other tests too. X-rays are usually done in a radiology department by a radiographer. Often people who are having their first visit to a rheumatology department will have a routine chest x-ray. How it s done X-rays themselves are a type of radiation called ionising radiation. To make the image, x-rays are passed through your body and captured on a photographic plate. If you have an x-ray, you ll be asked to stand or lie against a surface containing the photographic film. The x-rays are emitted only for a fraction of a second almost like a camera s flash as this is all the time it takes for the radiation to pass through your body. The x-ray is totally painless you won t see or feel it at all. The captured image on the film is then developed and examined. You ll usually be allowed home on the same day, but you might need to wait a few days before you can discuss the results with your GP. Remember, the amount of radiation used in an x-ray is very low. Although there are some risks, including a very, very small chance of x-rays causing cancer, ionising radiation is only really a risk if you re exposed to a very high dose. 20

23 Arthritis Research UK Meet the rheumatology team Other methods of imaging There are other ways of scanning the body to produce images and other ways of using x-rays, as well as the standard x-ray of a joint or bone: Arthrography Dye can be injected into a joint to allow it to show up in more detail when x-rayed. This is called arthrography. Occasionally dye can be injected into a blood vessel to look at the circulation under x-ray (this is called an arteriogram or angiography). How it s done First the special dye is injected into the area surrounding a particular joint. A local anaesthetic is usually used for this. An x-ray is then taken in the normal way (see above). The process may take from 30 minutes to 3 hours to complete, depending on the test. You ll usually be able to go home the same day. The injected dye is totally harmless and will pass in your urine, although some people may be allergic to the dye. Computerised tomography (CT) CT scans (sometimes called a CAT scan) can give detailed pictures of the skeleton but will also show other types of tissue, such as the muscles, which can t be seen on an ordinary x-ray. How it s done A CT scan uses x-rays which record images of sections or slices of the body. These multiple images are then transformed by a computer into crosssectional pictures.

24 If you have a CT scan you ll be asked to remove any jewellery or metal fixings on your clothes, as these can interfere with the scan. You ll then be asked to lie on a bed. This will move through a large ring-shaped machine, which contains the scanners. As you pass through the scanners an x-ray machine will take the images of the inside of your body. You ll be able to talk to the radiographer throughout the scan using an intercom. Having a CT scan is completely painless you can t feel or see x-rays at all. The process usually takes about 20 minutes. You should be able to go home on the same day as your scan, although it may take a couple of weeks before you can discuss the results with your GP. If you have a CT scan you ll be exposed to x-ray radiation, which carries a very, very small risk of causing cancer. However, the amount of radiation involved in a CT scan won t cause you harm. Isotope bone scan An isotope is a chemical which gives off a type of radiation called gamma rays. When a very small amount of the isotope is injected into the blood it s taken up by the bones. An isotope bone scan can then show which areas of the bone are inflamed. How it s done You ll be given an injection containing a radioactive substance the isotope. The test only requires a small amount, so it won t do you any harm. This is usually done a few hours before the scan takes place. You ll be asked to lie down on an x-ray bed, and a gamma camera will perform the scan. The camera picks up the gamma rays emitted by the isotope and this can indicate which areas of bone are inflamed or damaged.

25 Arthritis Research UK Meet the rheumatology team An isotope bone scan is completely painless, although it does involve an injection beforehand. An isotope bone scan usually takes about an hour, and you should be able to go home on the same day. Your body will pass the isotope in your urine. Magnetic resonance imaging (MRI) This scan uses high-frequency radio waves in a strong magnetic field. Radio waves interact with the water molecules in the tissues of your body, and the signals that come back are processed by a computer to build up pictures of the inside of your body. MRI scans are often used to detect minor abnormalities in the soft tissues. Unlike x-rays, you won t be exposed to any radiation if you have an MRI scan. How it s done An MRI scan produces pictures of the soft tissues particularly cartilage, tendons and nerves that can t be detected by x-rays. They can also show up signs of inflammation. Before having an MRI scan you ll be asked to remove any jewellery, piercings, dentures or metal fastenings on your clothes, as these will interfere with the magnetic fields used in the scan. You ll then be asked to lie on a bed, which can move through the tunnel-shaped scanner. You ll be able to talk to the radiographer using an intercom during the scan. You re allowed someone in the scanning room with you, but they must also follow the guidelines on metal objects and jewellery. MRI scans are completely painless, and you should be able to go home on the same day. It may be a couple of weeks before you ll be able to discuss the results with your GP. Dual energy x-ray absorptiometry (DEXA) This type of x-ray is used to assess the density of bones and is particularly useful for diagnosing and monitoring osteoporosis. How it s done Rather like a normal x-ray (see above), with a DEXA scan small levels of radiation are passed through your body. Detectors on the DEXA scanner then analyse how much radiation has passed through your bones. This result will show how dense your bones are. You ll have to remove any jewellery or metal fastenings on your clothes before you have a DEXA scan. You ll then lie down on an x-ray bed, with the scanning arm above you. You won t be in a tunnel like you would be for an MRI or CT scan. The scan usually only takes a few minutes and is completely painless. You should be able to go home the same day. Although you ll be exposed to radiation, the amount used in a DEXA scan is only about a tenth of that used in a normal x-ray and won t cause you any harm. Ultrasound An ultrasound scan (sometimes called a sonogram) uses high-frequency sound waves to build up pictures of the inside 23

26 24 of your body. It can be used to see if fluid has collected around joints and tendons. It can also be used to determine the risk of osteoporosis. How it s done The scanner used for ultrasound scans is very small and hand-held, and is called a transducer. This is placed on your skin over the target area and kept moving. To keep the movements smooth some gel will be put on your skin first. The transducer sends ultrasound waves into your body, which bounce back and are picked up and turned into a picture by a computer. An ultrasound scan is completely painless, and you ll be able to go home the same day. Other tests Synovial fluid analysis All normal moving joints have a small amount of fluid in them to act as lubrication. If this fluid, called synovial fluid, builds up it can make the joint swell. Examining this fluid can be very important in diagnosing infections or gout. How it s done For the examination, the fluid is taken from the joint using a needle and syringe. Removing this fluid can help to reduce discomfort and swelling. The fluid can then be examined in the laboratory. It ll usually be analysed for colour and clarity, and may be examined under a microscope to check for blood cells, crystals or bacteria. The needle doesn t go into the bone, but rather into the joint space (cavity) between the bones. This is often no more uncomfortable than having a blood test. Urine test A dipstick urine test is a common test in both GP and rheumatology clinics. It s sometime useful in diagnosis. With some patients it s sometimes requested at every visit, particularly if you re on a specific drug treatment such as ciclosporin or have a specific condition such as lupus. If this is the case, staff within the clinic will usually provide you with a sample bottle so that you can come prepared. See Arthritis Research UK drug leaflet Ciclosporin. Some less common tests These include: Arthroscopy A small telescope is used to look inside the joint, e.g. the knee. This examination is used to look directly at the joint, to perform a biopsy or to perform surgery such as removal of a torn meniscus (cartilage). Depending on what is required, it may be performed under a local or a general anaesthetic. Biopsy A biopsy is when a small piece of tissue is removed from the body so it can be examined under the microscope. Virtually any body tissue can be biopsied and it can be done under general or local anaesthetic. It ll only be done when it s absolutely necessary to make a diagnosis.

27 Arthritis Research UK Meet the rheumatology team Some forms of arthritis can affect any parts of the body. This means it s essential to examine the tissue under the microscope to make the proper diagnosis and work out the appropriate treatment. There are several ways a biopsy can be performed. The most common are: scraping cells, where cells are removed from the surface of the tissue a needle biopsy, to get samples from organs within the body (i.e. underneath the skin) a punch biopsy, which diagnose skin conditions by punching a hole through the surface layers of skin an endoscopic biopsy, where tissue can be removed using an instrument called an endoscope, which is used to look inside your body but can be fitted with cutting tools an excisional biopsy, where a large area of tissue is removed during surgery. The method used will depend on the type of tissue that needs to be removed and the body part in question. Biopsies are only used when absolutely necessary to make a diagnosis, and they re rarely used for arthritis-related conditions. Nerve conduction studies/ electromyography (NCS/EMG) These are separate tests but are often carried out at the same time. They re used to assess whether nerves and muscles are functioning correctly. NCS works by recording the impulses sent through the nerves to the muscles, while EMG measures the electrical activity that occurs in the muscles as a result of those impulses. Electrocardiogram (ECG) This is used to check how well the heart is working. The heart can be affected in some forms of arthritis and associated conditions. Pulmonary function tests (PFTs) These are breathing tests to assess how the lungs are working. The lungs can be affected by arthritis and also occasionally by arthritis treatment.

28 Glossary Acupuncture a method of obtaining pain relief that originated in China. Very fine needles are inserted, virtually painlessly, at a number of sites (called meridians) but not necessarily at the painful area. Pain relief is obtained by interfering with pain signals to the brain and by causing the release of natural painkillers (called endorphins). Ankylosing spondylitis an inflammatory arthritis affecting mainly the joints in the back, which can lead to stiffening of the spine. It can be associated with inflammation in tendons and ligaments. Cartilage a layer of tough, slippery tissue that covers the ends of the bones in a joint. It acts as a shockabsorber and allows smooth movement between bones. HLA-B27 (human leukocyte antigen B27) a gene that s often present in people who have conditions such as reactive arthritis, psoriatic arthritis or ankylosing spondylitis. It s also present in many people without a condition. Ligaments tough, fibrous bands anchoring the bones on either side of a joint and holding the joint together. In the spine they are attached to the vertebrae and restrict spinal movements, therefore giving stability to the back. Lupus (systemic lupus erythematosus or SLE) an autoimmune disease in which the immune system attacks the body s own tissues. It can affect the skin, the hair and joints and may also affect internal organs. It s often linked to a condition called antiphospholipid syndrome (APS). Osteoarthritis the most common form of arthritis (mainly affecting the joints in the fingers, knees, hips), causing cartilage thinning and bony overgrowths (osteophytes) and resulting in pain, swelling and stiffness Osteoporosis a condition where bones become less dense and more fragile, which means that they might break or fracture more easily. Rheumatoid arthritis a common inflammatory disease affecting the joints, particularly the lining of the joint. It most commonly starts in the smaller joints in a symmetrical pattern that is, for example, in both hands or both wrists at once. Tendon a strong, fibrous band or cord that anchors muscle to bone. Transcutaneous electrical nerve stimulation (TENS) a small batterydriven machine which can help to relieve pain. Small pads are applied over the painful area and low-voltage electrical stimulation produces a pleasant tingling sensation, which relieves pain by interfering with pain signals to the brain. 26

29 Arthritis Research UK Meet the rheumatology team Where can I find out more? If you ve found this information useful you might be interested in these other titles from our range: Conditions Lupus (SLE) Osteoarthritis Osteoporosis Rheumatoid arthritis What is arthritis? Therapies Occupational therapy and arthritis Physiotherapy and arthritis Surgeries Hand and wrist surgery Hip replacement Knee replacement Shoulder and elbow joint replacement Self-help and daily living Complementary and alternative medicine for arthritis Everyday living and arthritis Feet, footwear and arthritis Gardening and arthritis Keep moving Looking after your joints when you have arthritis Pain and arthritis Sex and arthritis Splints for arthritis of the wrist and hand Work and arthritis Drug leaflets Ciclosporin Drugs and arthritis Local steroid injections You can download all of our booklets and leaflets from our website or order them by contacting: Arthritis Research UK PO Box 177 Chesterfield Derbyshire S41 7TQ Phone: Related organisations The following organisations may be able to provide additional advice and information: Arthritis Care 18 Stephenson Way London NW1 2HD Phone: Helpline: Chartered Society of Physiotherapy 14 Bedford Row London WC1R 4ED Phone: Health Professionals Council (HPC) Park House 184 Kennington Park Road London SE11 4BU Phone:

30 We re here to help Arthritis Research UK is the charity leading the fight against arthritis. We re the UK s fourth largest medical research charity and fund scientific and medical research into all types of arthritis and musculoskeletal conditions. We re working to take the pain away for sufferers with all forms of arthritis and helping people to remain active. We ll do this by funding high-quality research, providing information and campaigning. Everything we do is underpinned by research. We publish over 60 information booklets which help people affected by arthritis to understand more about the condition, its treatment, therapies and how to help themselves. We also produce a range of separate leaflets on many of the drugs used for arthritis and related conditions. We recommend that you read the relevant leaflet for more detailed information about your medication. Please also let us know if you d like to receive our quarterly magazine, Arthritis Today, which keeps you up to date with current research and education news, highlighting key projects that we re funding and giving 28 insight into the latest treatment and self-help available. We often feature case studies and have regular columns for questions and answers, as well as readers hints and tips for managing arthritis. Tell us what you think of our booklet Please send your views to: feedback@arthritisresearchuk.org or write to us at: Arthritis Research UK, PO Box 177, Chesterfield, Derbyshire S41 7TQ. A team of people contributed to this booklet. The original content was written by Paula Jefferson, Kay Stevenson and Sarah Ryan, who have expertise in the subject. It was assessed at draft stage by rheumatology specialist nurse Debbie Bond, rheumatology specialist occupational therapist Debbie Fletcher, physiotherapist Donna Morris, consultant rheumatologist Dr Nick Shenker and clinical senior lecturer in orthopaedics Mark Wilkinson. An Arthritis Research UK editor revised the text to make it easy to read and a non-medical panel, including interested societies, checked it for understanding. An Arthritis Research UK medical advisor, Kate Gadsby, is responsible for the content overall. Special thanks to University College London Hospitals for assistance with generating images used within this booklet.

31 Arthritis Research UK Meet the rheumatology team Get involved You can help to take the pain away from millions of people in the UK by: Volunteering Supporting our campaigns Taking part in a fundraising event Making a donation Asking your company to support us Buying gifts from our catalogue To get more actively involved, please call us or us at enquiries@arthritisresearchuk.org Or go to:

32 Arthritis Research UK Copeman House, St Mary s Court, St Mary s Gate, Chesterfield, Derbyshire S41 7TD Tel calls charged at standard rate Registered Charity No Arthritis Research UK 2011 Published April /TEAM/11-1