The Role of the Specialist

Rheumatology Nurse

Janice Mooney, BSc, MSc Norfolk and Norwich University Hospital, lectures at the University of East Anglia
(Peer reviewed by Nicky Kennedy, April 2011)
Original article: 04/10/2004
Reviewed: 28/09/2009
Next review due: 28/09/2012

Rheumatoid arthritis (RA) is an autoimmune disease with an unknown cause where the body attacks itself. The immune system is disrupted and causes inflammation of  the lining in the joints. It is unpredictable and patients may experience periods of remission or a flare-up of symptoms. The aim of disease management is to suppress the inflammatory process, relieve pain, maintain fully functioning joints and reduce the emotional and coping issues which can become part of living with this disease. It is now treated aggressively and much earlier than previously. The mainstay of treatment is with drugs such as non-steroidal anti inflammatory drugs (NSAIDs), disease modifying anti-rheumatic drugs (DMARDs), biologic drugs such as anti-TNFα therapy and occasionally steroids. Many patients will be on a combination of these drugs.

A specialist team approach to the treatment and management of rheumatoid arthritis will involve not only the rheumatology consultant but the expertise of a rheumatology specialist nurse, physiotherapist, occupational therapist and podiatrist as required.  Most rheumatology departments will have a specialist rheumatology nurse who will probably be based in the outpatient department. However, there are some departments with no specialist nurse support.

The role of the rheumatology nurse will vary from hospital to hospital, but most nurses will be involved in patient education, monitoring of DMARDs, biologic treatments and other drug regimes. In some units, patients are regularly followed up in nurse run clinics and in these your joints may be examined, blood test monitoring will be checked, drug doses may be changed or a joint injection undertaken to optimise the control of the arthritis. Some nurses will have undertaken further study and will be able to prescribe medications.

Most rheumatology units have a telephone advice line where patients and carers can contact the specialist nurse in between visits to the hospital, for advice, support and information. There is usually an answering machine to record calls when the nurse is in clinic or busy.

The specialist nurses have a very patient centred approach to care and the following is a list of some of the services that you might be able to access if you are fortunate to have a specialist nurse involved in your care.

Patient Education

• Regarding the disease process and treatment options
• About the specific drugs that you are prescribed and the monitoring process
• To enable you to make informed choices regarding your treatment
• On how to manage disease flares
• On how to cope with an unpredictable disease
• On pain management
• On what benefits you may be entitled to; for example Disability Living Allowance
• Advice on employment issues

Nurse Run Clinic

In the nurse run clinic you will be able to access the following services:

• Physical assessment of joints
• Monitoring of the safety and efficacy of your drug treatment
• Review of your blood tests to ensure that they are within the defined safety limits
• Some nurses are trained to aspirate and inject swollen joints
• The nurse can act as source of referral between the multi-disciplinary team
• The nurse can act as a liaison between the patient/GP and the hospital.
• The nurse may refer you to other members of the team for treatment or advice from time to time
• The nurse will provide support to you if needed
• The nurse may request that you are seen by a doctor if a particular problem arises
• The nurse will have more time to spend with you than the doctor will so please ask him or her any questions that you may have.

References available on request

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