MANAGING PAIN
WHAT IS ARTHRITIS
ASSESSMENT AND MONITORING |
ASSESSMENT - GENERAL ASSESSMENT - EXAMINING JOINTS ASSESSMENT - X-RAYS GENERAL
MONITORING |
When you see the doctor or nurse there will be a general assessment of your health. In addition, the team will also want to focus on the assessments necessary to see how your arthritis is.
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The level of assessment and monitoring you have will depend upon your condition. That is why it is important for you to understand your arthritis and know how to cope with your arthritis. |
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Your
doctor, nurse or healthcare practitioner will need some information from
you about your arthritis to help them assess how well controlled the
arthritis is and how you are coping generally. Some of the questions you
will be asked by your healthcare will include:
Do you have stiffness of the joints? |
Do you have any pain?
When do you experience
the pain?
What have you been
doing to relieve the pain?
It is important to mention all treatments you are using to reduce the pain. This should include any alternative or complimentary therapies or other tablets you might have bought from your local chemist or health food shops. |
What other tablets are your taking for other problems? The doctors and nurses need to be sure that the medications will not interact with any other treatments you are taking or cause unacceptable side effects. It may also help them to decide what tablets they choose to prescribe for you, for instance some important types of pain relief for arthritis can be a problem for people who have problems with their heart, stomach or kidneys.
See What is Arthritis, How to Manage your Arthritis, Why See a Nurse? |
Your joints will be examined when you attend clinic. The number of joints that will be examined will vary depending upon the type of arthritis you have, how your arthritis is at the time of the consultation and whether you need a regular joint assessment because of the treatments you are receiving. In many hospital clinics a full joint assessment is undertaken by a rheumatology specialist nurse/practitioner. Sometimes you might be seen in a clinic in the community by a physiotherapists, nurse or doctor. These are sometimes called Triage, Musculoskeletal clinics or Clinical Assessment Teams.
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For example, you may be unable to make some movements due to pain or swelling. Some patients, particularly with inflammatory arthritis (for example Rheumatoid Arthritis) require regular treatment for their arthritis and will be asked to have a regular assessment called a Disease Activity Score 28 (DAS 28). This set of measures is used to assess the how active the disease is at the time and also includes a measure of how you feel your arthritis is. Only a certain numberof joints are assessed using the DAS 28. This is an assessment tool that has been well researched and shown to be a good measure of overall disease activity. The DAS 28 is an important assessment tool that is often used for ensuring someone is eligible for new therapies such as biologics).
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The National Institute of Clinical Excellence have set out criteria for treatment with some of these drugs (usually given by subcutaneous injection or intravenous infusion) and information can be seen on www.nice.org.uk. The key information you need about treatment and access to treatment can be found on the NICE website. All documents and information are regularly updated on this site. The decisions NICE make are is very important as NHS organisations in England and Wales have to follow their recommendations including who can receive these therapies and when they can be started or stopped.
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You may be asked to have an x-ray before attending the hospital department to be seen. However, again, this will depend upon what your problems are and whether they will help the diagnosis.
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Unnecessary exposure to X-rays means that you should only be having an x-ray if:
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An example of an x-ray can be seen
on this page. The x-ray of the hand shows different types of damage as a result of Rheumatoid Arthritis. Women who think there is any risk that they might be pregnant should make sure they inform the doctor or nurse – x-rays should be avoided wherever possible, particularly in the early phases of the
baby's development.
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Increasingly it has been shown that other types of examinations (other than the usual type of x-ray) can be more effective in identifying early signs of inflammation and possible early signs of damage or changes in the bone and tissues surrounding the bone. Ultra sound can see more of the inflamed tissues that surround the joint before x-rays can identify any changes. This is becoming an area of great interest for some types of arthritis where it is now clear that the earlier we treat these very early signs of inflammation in the joint the less long termlong-term damage that can occur to the individual with arthritis.
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This is of particular benefit for people with Rheumatoid Arthritis.MRI is not routinely used by maybe used in some circumstances when other types of investigation do not provide sufficient information to help the doctor identify the problems you might be experiencing. MRI uses a powerful magnetic field that is beamed through the body to provide pictures transmitted to a computer system. It is possible to take pictures of all parts of the body from different angles. It can show fluid, fat and other soft tissues in relation to the joints and organs in the body. |
Ultra-sound scanning uses a little probe (like a pen/or wiper) that is run over the area to be looked at – a jelly like substance is used to help the probe pick up the images but it doesn’t hurt and nothing penetrates the skin. Ultra sound is carried out by a trained healthcare professional and can identify very early signs of inflammation.
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You may require some blood tests to be taken, again this will depend upon the type of arthritis you have. An excellent information leaflet from
www.versusarthritis.org is available on blood tests and investigations in
arthritis. |
Other tests will be looking at different types of inflammation or immune responses in your body or levels of certain types of elements that might be a bit higher in some people with certain types of arthritis (for instance gout may have an increase Uric Acid measure in their blood).
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Other tests such as the rheumatoid factor or anti-citrullianted protein antibody (anti-CCP)testsCCP) tests are specifically used if conditions such as Rheumatoid Arthritis are suspected. However, the tests on their own have little value and are only used when you have been properly examined and a good medical history has been taken. You may still have Rheumatoid Arthritis even if you have had a blood test that shows you do not have ‘rheumatoid factor’ present in your blood. Equally you can have a rheumatoid factor positive test but may not have rheumatoid arthritis.
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If you are being reviewed regularly in a community clinic or hospital department for your arthritis it is likely that you will be asked to have blood tests and x-rays from time to time. You should have regular blood tests if you are receiving treatment for any type of Inflammatory Arthritis. Examples of the Disease Modifying Drugs used that require regular blood monitoring include: Methotrexate, Sulfasalazine, Penicillamine, Gold, Leflunomide, Ciclosporin. In addition, you should also be regularly monitored if you are treated with biologics, these include (but not limited to) treatments such as;
Abatacept
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Increasingly this list of new therapies is growing – discuss the full treatment options with your doctor or nurse.
Some hospitals have a special monitoring system in their department and others arrange to share the management of blood monitoring and review of the tests with your own General Practitioner (GP). It is important that you know the system used in your local area and that it ensures you are safe on treatment.
In many units there is an educational programme to help you understand your arthritis and some of these include information on your blood tests and what to look out for in the blood results, depending upon the treatment you are on. |
Ideally you should know what your blood tests are and have a copy of them in a monitoring booklet. This is extremely helpful if you are travelling abroad with your medications, or for you to learn more about these bloods tests. If you are unsure about the blood monitoring arrangements at your hospital or health centre ask the rheumatology team or practice nurse to advise you. Learning about your blood tests may help you to understand a little more about what happens when you have a flare or an infection and how to identify problems with your blood results. |
If you are being seen regularly by your doctor/nurse or rheumatology department because of your arthritis they will want to assess you for a number of reasons. These include:
The monitoring of your arthritis will again vary according to the type of arthritis you have. Not all types of arthritis require a regular assessment and review but information and support should be available for you from your health centre to help you to manage your arthritis and know where to get help should you require it. |
If you are attending clinic regularly it is likely that you will be asked the questions we have discussed in this section. In addition your joints maybe examined, blood tests and x-rays (or an ultrasound scan) will be reviewed and additional examinations maybe necessary depending upon the arthritis you have. You may also be asked to see a member of the rheumatology team to assess you or help to resolve problems identified in clinic. These include:
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All these specialists will have their own specific assessment and monitoring methods. When you have seen one of these practitioners you can ask them how they will measure the benefit of treatment and what they need to know from you when you attend clinic next time. Last updated October 2020
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Susan
Oliver Associates
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