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Home > Services > Rheumatology > Patients > My symptoms and concerns

My symptoms and concerns

Here you will find some information about rheumatology drugs and medications which we hope you find helpful.

What to do if I have an infection

Knowing what to do if you have developed symptoms of infection is very important.

You can reduce the risk of severe infection by making sure you are up to date with your routine vaccines.

Regular hand washing and wearing a facemask in crowded public places will help to reduce your risk of catching infection. However, we will all get infections from time to time and knowing what to do with your rheumatology medication can reduce the risk of severe infection.

If you have a very high temperature, shaking and shivering, mottled skin or severe vomiting and diarrhoea you should call NHS 111. You should call your GP for all other symptoms of infection in the first instance.

Symptoms of infection include sore throat, sneezing, swollen glands, mild temperature, aching in your muscles and joints, pain when you pass urine or passing urine much more often, pain and redness in your skin and acute diarrhoea.

Steroids (prednisolone) MUST NOT be stopped in the event of an infection. Specific advice on how to change your steroid dose if you have an infection can be found by looking at the steroid sick day rules leaflet.

Most tablet or injected rheumatology medications should be STOPPED until you feel well again. You can find information about each of the drugs you take on this page.

If you have your rheumatology medication by infusion/drip on the Day Case Unit, please call to seek advice. We may postpone your treatment until you feel well again. If you are still not sure what to do, you can contact our advice line on 0191 213 7967.

Flare of my arthritis

A flare of arthritis is often described as a sudden onset of stiffness, swelling and pain in the joints or spine. It is often coupled with fatigue and can lead to low mood. You are more likely to experience the onset of flare in the morning and your early morning stiffness may be longer or more severe.

A flare can last 2 or 3 days on average, sometimes longer.

Flare is commonly transient [it comes and goes] but, with the right treatments your autoimmune inflammatory arthritis can be well controlled, reducing or eliminating the risk of a flare. The absence of inflammation and flare is known as remission.

Why does flare happen?

A flare of your autoimmune inflammatory arthritis can occur anytime, more commonly after infection (for example if you have missed your rheumatology medication). Some people believe stress can induce a flare.

If your medication has been reduced, stopped or missed, the risk of a flare is increased. If you have a new diagnosis, your disease might flare when the initial treatment (usually a steroid injection or tablets) wears off and before your main treatment has become fully effective.

What can I do if I experience a flare of my autoimmune inflammatory arthritis?

Apply a hot or cold pack to the affected joint/s and rest to begin with. However, it is important to try to move the joint/s every hour to keep them flexible.

Paracetamol can be used to reduce pain from a flare. Anti inflammatory gel is recommended as an alternative. You could also take regular non- steroidal anti -inflammatory drugs (NSAIDS) (e.g. Ibuprofen or Naproxen). Please note that some people cannot tolerate this medication. Please discuss the use of an NASAID with your pharmacist if you have asthma, kidney disease, heart failure or a history of stomach ulcers before taking them.

For more severe episodes of pain and in exceptional circumstances, other pain killers may be prescribed by your GP. However, this is is not usually necessary or recommended.

Please continue your rheumatology medication except if you have an infection at the time of flare. In this case you must stop your rheumatology drugs until you are well again.

What if I still have a flare after 4-5 days and it doesn’t look like its getting better?

If after 5 days your flare has not stopped, you can contact the advice line to arrange to speak with a specialist nurse or doctor. Visit the useful contacts page for more guidance.

Do I inform my rheumatologist at the next appointment that I have had experiences of flare?

Absolutely. Please inform you doctor or nurse that you have experienced flare at your appointment. Keeping a note of symptoms during flare and how severe it was, how often you have flares and how long they last, will help us plan you medical care more effectively.

Frequent flare could mean your medication to treat your auto-immune inflammatory arthritis needs to be changed or increased.

Remember absence of flare is a good indicator that your condition is well controlled and responding to treatment. This will almost certainly improve your general health in the future.

Visit the Versus Arthritis website for more information on how to maintain movement during a flare up and understanding flare ups.

Pain

Patients with arthritis and other rheumatological conditions sometimes have pain. Pain can mean a flare of your disease and sometimes can reflect damage caused by the condition previously. Sometimes people develop chronic pain.

We will help you to understand your pain when you come to clinic appointments. If you think you have a flare of your condition, take a look at the information on flare ups. If you are still not sure what to you, you can call our advice lines if you are under regular follow up in our service.

If you do not have routine follow up here, please look at the information below. Further advice would then be from your own GP.

Pain not linked to a flare of your condition can be very difficult to live with. We have collected some useful information here for you to look through. We hope this helps you to understand pain and chronic pain better. It may give you some ideas for ways to manage your pain better at home day to day.

Useful links:

Alcohol, smoking and drugs

A diagnosis of a long term condition may make you think about lifestyle changes you could make. We provide some information here to help you think about things that are sometimes difficult to change.

We will always recommend that you stick to national guidelines on healthy limits to drinking alcohol. The upper limit for men and women is 14 units of alcohol per week spread over 3 days or more. Excess alcohol can cause damage to the liver.

We recommend that you stick to the national guidelines for safe alcohol use. These say that the safe upper limit for units of alcohol consumed in 1 week is 14U, spread over 3 days or more. Alcohol has widespread negative health impacts. Normal liver blood tests do not mean that your liver is not affected by excess alcohol. You can discuss your alcohol intake with your doctor or nurse to get further advice. Please also see the links below to access help with alcohol or other drug problems.

Smoking is linked to worse outcomes for patients with rheumatic conditions. We recommend that you stop smoking. We are happy to provide you with information to help you stop.

Useful links:

Contraception, family planning and unexpected pregnancies

Your consultant, nurse or therapist will be happy to discuss your family planning needs at any time.

If you are planning to start a family, please speak to a member of our team. We will review your treatments to ensure that they are safe in pregnancy and, if necessary, change your treatment. We will ensure that your rheumatology condition is well controlled. Pregnancy outcomes are much better when your pregnancy is carefully planned.

We run a dedicated pre-pregnancy counselling clinic for patients to ensure you have the safest pregnancy possible. You will be referred to this clinic by your nurse specialist, therapist or consultant.

Once you are pregnant, you may be referred to our specialist combined obstetric clinic for follow up during your pregnancy.

We are here to help if you have an unplanned pregnancy. Please do speak to us if this affects you, by calling out advice line, 0191 213 7967.

We will also help advise you about the best forms of contraception to use with your condition. You can also speak to your GP or local sexual health clinic if you prefer. You should always tell any health care professional about your rheumatology condition and medication when asking about contraception

Useful links:

Dry mouth, dry mouth and vaginal dryness

Dry eyes, dry mouth, and vaginal dryness are common manifestations of rheumatologic conditions and management often centres on targeted moisture-replacing and moisture-preserving products along with good hydration and avoidance of irritants.

For dry eyes, patients typically benefit from preservative-free artificial tears, long-acting gel drops, and overnight lubricating ointments. Warm compress and Meibomian gland massage can help. It is important to regularly see an optician.

Dry mouth is often managed with saliva substitutes, xylitol-containing lozenges or chewing gum, oral moisturising gels. Examples include biotene gel, oral balance gel or orthana artificial saliva spray. High fluoride toothpaste is recommended to protect against dental decay. It is important to see a dentist regularly.

Vaginal dryness can be addressed with long-lasting vaginal moisturisers, water-based lubricants, and in some cases topical oestrogen preparations if appropriate.

Exercise

Exercising regularly is important for everyone. Exercise is good for everyone with a rheumatic condition too. It helps with pain, sleep and low mood. Starting to exercise again can be easier if you do it with a friend or family member.

For advice on exercises that are good for your condition, visit the My Rheumatology Conditions section of this website. More general advice is available from:

Raynaud’s phenomenon (cold hands and feet)

Visit the Versus UK website for more information this common condition. You can also find out more on the Scleroderma and Raynaud’s website.

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