Meeting the Rheumatology Clinical Nurse

Specialist (RCNS)

Dawn Homer, Nurse Consultant Rheumatology, Rheumatology Department, University Hospital Birmingham NHS Trust, Selly Oak
Original article: 04/04/2006
Reviewed: 26/04/2011
Next review due: 26/04/2014

Hearing about your diagnosis

When you are first diagnosed with rheumatoid arthritis this may come as a shock, but it may also come as a relief at finally knowing what has been causing your pain, joint swelling, stiffness and fatigue. However you feel about your diagnosis you are probably going to need a lot of support and it is accepted that early support after diagnosis is beneficial to people with rheumatoid arthritis. You will undoubtedly receive support from your family members and friends, but the RCNS can also provide invaluable support at diagnosis, through the early stages and later on as required.

What is an RCNS?

The RCNS, sometimes referred to as the 'specialist nurse' is a nurse who has chosen to specialise in caring for people with arthritis and they will have received extensive training in rheumatology and musculoskeletal care.

How do I access my RCNS and what services do they offer?

Most rheumatology departments provide at least one RCNS and many have teams of them. The services offered may vary but most patients can expect the following:

• A dedicated rheumatology advice line
• Nurse-led follow up clinics
• Opportunities for education

What is a dedicated rheumatology advice line?

The advice line service provided by the RCNS may be an answer phone where you can leave a message and the nurse will get back to you, usually within 24 hours or sooner. Sometimes rheumatology advice lines are manned by the RCNS and you will be advised to call at a specified time when a nurse will be available to speak to you directly and deal with your enquiry. The advice line takes calls from patients seen in the rheumatology clinics, carers, members of the public and other health professionals working in the hospital or community. You can be reassured that confidentiality is always upheld.

Advice may be given for the following:

• Dealing with the symptoms of a flare up of arthritis
• Managing side-effects from drug treatments
• Providing earlier appointments if required especially for flare ups of arthritis
• Liaising with other members of the rheumatology team such as physiotherapist or occupational therapist etc.
• Other general advice about rheumatoid arthritis

What happens in nurse-led follow-up clinics?

At the time of your diagnosis your rheumatologist may introduce you to the RCNS and if this is not possible they will usually provide you with the rheumatology advice line number. It is good practice for your care to be picked up by the specialist nurse within the first 1-2 weeks after diagnosis where you will be given an appointment in the nurse led clinic. Increasingly patients will be starting drugs to control the arthritis at diagnosis or very soon after as early treatment will get you feeling better more quickly and will help to reduce the possibility of long-term damage caused by the arthritis.

The assessment in the clinic may involve:

• Blood pressure, weight, urine and blood test monitoring if required
• Asking you about your general well being
• Recording which joints are affected and what other symptoms you are experiencing
• Recording your current drug treatment
• Informing you about the results if you don’t already know of blood tests and x-rays that were carried out when you saw the rheumatologist
• Finding out what you already know about arthritis and the treatments and offering you individualised education and written information
• Finding out how well you are managing and if you need advice on your daily activities such as work, caring for yourself and your family, and taking part in leisure and hobbies
• Referring you to another health professional who may help eg, physiotherapist, dietician, psychological support etc.
• The RCNS will provide you with education and written information on:
  • The process of inflammation in RA
  • Pain relief and disease modifying treatments

Many RCNS services support the day to day management of patients with RA and other types of inflammatory arthritis and they may be working with you to introduce disease modifying drugs such as methotrexate, or biologic treatments such as anti-TNF therapies. If so they will be responsible for monitoring the safety and effectiveness of the treatment. The RCNS may be responsible for altering the dose and changing some of your drug treatments via agreed guidelines and some specialist nurses will be able to prescribe your medication. Increasingly RCNSs are now using a goal setting approach to your care which involves a partnership working to enable you to develop better coping strategies. It is likely that the RCNS will examine your joints to establish more clearly how active your arthritis is. This examination, together with blood test results and your own assessment of your condition enables the Disease Activity Score (DAS28) to be calculated and helps to decide whether the treatments you are having are working or whether you need a change in drug therapy. DAS28 is a calculation used to assess how active your disease is, and involves the examination of 28 joints, as well as looking at your blood test results. You can read about this in more detail and view our videos about DAS28 on the DAS section of the NRAS website.

Patient Education Opportunities

In some units there may also be the opportunity for you to be offered group education outside of the one-to-one education they can offer in their nurse-led clinics. Group education is an invitation to attend classes where you will meet other people with arthritis in a similar position to you, and your RCNS will discuss this with you if it is offered at your unit.

How group education is provided varies around the UK but usually covers the following aspects:

• How to manage a flare
• How to manage your pain
• How the rheumatology department works and what services it can offer you
• The members of the multidisciplinary team and what services they offer
• The cause of arthritis and drug and non drug treatments
• Information on support groups locally and nationally

Some group sessions include information on blood tests and x-rays, the patient held record card, relaxation, diet, physiotherapy, a question and answer session with a rheumatologist, access to benefits etc.

What other activities might the RCNS be involved in?

• Educating and training other health professionals about rheumatology
• Research to help improve care of the rheumatology patient
• Developing future rheumatology services
• Working on national groups
• Assessment of patients for biologic drugs (drugs that are currently subject to criteria set out by NICE and only given to patients after first trying standard disease modifying drugs).

Most hospitals will have an RCNS, so if you have not been introduced to your specialist nurse yet you should ask your rheumatologist about this at your next appointment. It is also worth asking about other members of the multi-disciplinary team (MDT), such as physiotherapists, podiatrists and occupational therapists, who you may require access to at some stage of your care. For more information on the MDT, please click here.

References available on request

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