Step 3: Seeing the specialist for
the first time following referral
Information to help you with your first appointment with your specialist, possible treatments, personal care plans and the multi-disciplinary team
At your first visit to specialist care to see the specialist, we suggest that you read a leaflet like NRAS – ’RAise it with your Dr’ before you go so that you are as fully prepared as possible to get all your questions and concerns answered. It is possible that you will get a firm diagnosis at this visit, although as these diseases are sometimes difficult to diagnose in the very early stages you may or may not need further tests and visits to get to that stage. This step will cover details about the first appointment with your consultant, possible treatments which may be recommended, information about your personal care plan and the multi-disciplinary team who will look after you.
The following topics will be covered in this step:
- Preparing for appointment in advance
- The Multidisciplinary Team
- Drug Treatments in Inflammatory Arthritis
- Commonly prescribed DMARDs for those with RA
- Guidance on diagnosis, treatment options and information on plans to help you manage your care
Preparing for appointment in advanceNRAS – 'Raise it with your Doctor'
- This booklet aims to provide information and practical advice to help you understand and communicate the physical and emotional impact of your RA to healthcare professionals, loved ones and colleagues.Patient Association Guide - Consultant Checklist Patients Association Guide - You and Your DoctorARMA Standards of Care for IA
- ARMA’s Standards of Care for people with inflammatory arthritis are intended to support people of all
ages with inflammatory arthritis to lead independent lives and reach their full health potential through:
- access to information, support and knowledge that optimise musculoskeletal health for everyone and enable self-management
- access to the right services that enable early diagnosis and treatment
Understanding NICE guidance (RA)
- access to ongoing and responsive treatment and support.
- a booklet designed to help you understand the care and treatment options that should be available in the NHS for those with rheumatoid arthritis .
The Multidisciplinary Team
The importance of the multidisciplinary team cannot be underestimated in the care of those with RA and knowing how the teams are made up and how they can help is crucial.NRAS table describing the different members of the multidisciplinary team The role of the occupational therapist The role of the specialist rheumatology nurse The role of the physiotherapist The role of the podiatrist
Drug Treatments in Inflammatory ArthritisNRAS article on management of early RA Combination therapy for rheumatoid arthritis
– Evidence suggests that DMARDS used in combination are an effective way to treat those who are newly diagnosed.Getting established on DMARD therapy
- DMARDs (Disease Modifying Anti-Rheumatic Drugs) These drugs have the effect of dampening down the underlying disease process, rather than simply treating symptoms.NRAS article on steroids in rheumatoid arthritis NRAS booklet on Biologics, the story so far...
- A comprehensive booklet that looks at the more newly developed RA drugs, including information about NICE and its role in their prescription.
Commonly prescribed DMARDs for those with RAGetting established on DMARD therapy
- DMARDs (Disease Modifying Anti-Rheumatic Drugs)These drugs have the effect of dampening down the underlying disease process, rather than simply treating symptoms. This article contains a list of the commonly prescribed DMARDs used in the treatment of RA. For further information please call our helpline 0800 298 7650NRAS article on Methotrexate in RANRAS article: An introduction to Arava (leflunomide)
Guidance on diagnosis, treatment options and information on plans to help you manage your careNRAS article on imaging techniques
- Information on imaging techniques such as x-ray, ultrasound, MRI and CT scans
Disease activity scoring (DAS) in RA
– this is an assessment used to measure the level of disease activity in people with rheumatoid arthritis and is important in determining whether your disease is being well controlled.NRAS informaton on the DAS28 score (videos, booklets and article)
- The DAS28 is a measure of disease activity in rheumatoid arthritis (RA). The score is calculated by a complex mathematical formula, which includes the number of tender and swollen joints (out of a total of 28), the erythrocyte sedimentation rate (ESR, a blood marker of inflammation), and the patient’s ‘global assessment of global health' (indicated by marking a 10 cm line between very good and very bad). A DAS28 score greater than 5.1 implies active disease, less than 3.2 well controlled disease, and less than 2.6 remission. NRAS booklet Newly Diagnosed – next steps
- An essential booklet for those who have been newly diagnosed with RA. Topics discussed include:-
- What rheumatoid arthritis is and how it can affect you
Personal Care Plans (PCP)
- Thinking about the future
- A care plan is an agreement between you and your health professional (and/or social services) to help you manage your health day-to-day. It can be a written document or something recorded in your patient notesNHS Choices what is a PCP? NB NRAS has produced a Members’ Care Plan which is provided free of charge to Members but which can be purchased for £2.00 by non-members: Care Plan information
Therapies Understanding NICE Guidance
- The booklet is to help you understand the care and treatment options that should be available in the NHS for people who have RA.Foot Standards
– set of standards which outlines defines the foot services that should be available to people with RA