Step 2: Visiting the GP for

the first time

This section covers going to your GP for the first time, and provides links and help about getting your symptoms under control, obtaining the necessary general health advice and information which you may find helpful whilst waiting for your first specialist appointment which should be within 4-6 weeks, or preferably sooner if waiting times in your area permit

Inflammatory arthritis (IA) is difficult to diagnose, and a firm diagnosis can and should usually only be made by a GP with a special interest in musculoskeletal disease (a GPwSI) or by a Consultant Rheumatologist. Because these different forms of IA are treated by specialist teams  led by a consultant rheumatologist and usually, though not always, hospital based, this is a specialist area of care and  unless your GP has had additional training to be a specialist they may not have the level of experience, skill and knowledge needed to make a clinical diagnosis. There is no single test that you can take to tell you that you have Rheumatoid Arthritis, Ankylosing Spondylitis or Psoriatic Arthritis, and it is important that if your GP suspects that IA might be a possibility, the best and most vital thing to do is to refer you as rapidly as possible to a consultant rheumatologist to get a diagnosis.

The following topics will be covered in this step:

• Importance of early signs of IA
• Danger Signs for Inflammatory Arthritis:
• Immediate Symptom Control – Pain
• Support and managing while waiting for your appointment
• Information for specialist appointment
• General symptom control

Importance of early signs of IA

Good patient history and examination - Importance of early signs of IA
‘S’ factor RA/PsA poster The 3 ‘S’ signs in inflammatory arthritis; Stiffness, Swelling, Squeezing
‘S’ factor AS poster Spinal Pain and Stiffness in a young adult

Danger Signs for Inflammatory Arthritis:

NRAS DVD on early diagnosis  - a short DVD featuring NRAS member Jean Burke and her personal history of her diagnosis.  The DVD also features Dr Graham Davenport,GP who talks about the problems in identifying early IA

Squeeze test –  The Squeeze Test is one of the most reliable tests for RA and PsA and involves squeezing the patients hand or foot across the knuckle joints as shown. If this test is unduly painful then it raises the suspicion of RA & PsA
 

Immediate Symptom Control – Pain

NRAS Managing the pain of RA  - article written by Dr Phil Conaghan, Professor of Musculoskeletal Medicine, University of Leeds & Leeds Teaching Hospitals Trust, Leeds UK

NRAS Talking about pain  - in-depth article written by Susan Oliver, RN, MSc, Nurse Consultant Rheumatology,  explaining pain and how to control it in inflammatory arthritis

British Pain Society Understanding & Managing Pain  Publications page featuring in-depth guidance on managing severe pain

Support and managing while waiting for your appointment

NRAS: National Rheumatoid Arthritis Society - Comprehensive help and guidance on living with rheumatoid arthritis
Arthritis Research UK -  Established for 75 years; wide ranging research, information and help for people with all types of arthritis

Information for specialist appointment

NRAS booklet: 'Raise it with your doctor'  Booklet (downloadable on this link) with information and practical advice on how to communicate effectively the physical & emotional aspects of RA

NRAS article on laboratory tests -  Description of the lab tests used in the  diagnosis and monitoring of RA and its treatments
General information on laboratory tests  - Lab Tests Online are a non commercial company providing information about a wide range of tests

NRAS article on imaging techniques  - Information on imaging techniques such as x-ray, ultrasound, MRI and CT scans

NRAS article on patient journey  - What to expect from your first hospital appointment with the Rheumatologist, including possible investigations and treatments

NRAS article on management of early RA  -comprehensive information on how early arthritis is managed

NRAS article: What is RA?  - an overview of the disease – signs and symptoms, treatments and other interventions

Patient Association Guides – a range of guides to help you including a consultation checklist, a guide to pain management and a useful booklet entitled ‘You and your Doctor’

General symptom control

NRAS leaflet on fatigue  - a downloadable booklet with practical tips  to help you cope with fatigue

Link to NRAS article on fatigue  -  a more in-depth look at what causes fatigue, how treatments can help and self management techniques

NRAS article on exercise & RA  - a guide to simple exercises you can do at home, with links to other information on exercise

NHS Live Well Pages on general health advice  - this NHS Choices site covers a range of topics including healthy eating, exercise and smoking cessation

Foot Health Standards leaflet Feet First  - good sources of help for those having problems with their feet