Rheumatology clinic

The majority of medications can take on average 12 weeks to be effective, particularly if they require a gradual dose increase. Some people notice an improvement earlier than this; perseverance is key.

No, we recommend that you continue on your medication, unless you are prescribed antibiotics then stop until you complete the course.

There are a group of medications called bisphosphonates which can interfere with dental healing; please check with your dentist if you are on this medication and need dental work.

Some of the medication can cause side effects, often these are mild and wear off once the body gets used to the medication. The most common are feeling bloated (like you have eaten a big meal), mild nausea (feeling sick) and loose stools (very soft poo). Anything listed below which you feel is severe and failing to settle then please stop your medication and contact us via the advice line:

• nausea
• diarrhoea
• vomiting
• headache
• dizziness
• mouth ulcers
• sore throats
• rashes

Rarely, patients can develop shortness of breath and/or a dry cough, which may require further investigation.

It is important to report any side-effects, even if not listed above, and seek advice from your GP and the rheumatology team about continuing treatment. It is safer to stop the medication and wait for advice then continue unless you are taking a steroid such as prednisolone.

Please read all information provided by our team about your treatment carefully so that you are familiar with any potential side effects.

You may want to take your medication/injections with you, when you go on holiday depending on the length of your trip.

• Please ensure your blood monitoring is up to date before travelling. It would delay ordering medications if your blood tests are due.
• If you get your prescription from your GP, please get in touch with them in good time to request extra medication for when you are on holiday.
• If we supply your medication, make sure you have sufficient supplies of your medication and ‘sharps’ bins for disposal of used syringes.
• A travel letter can be requested via the prescription line or the company who deliver your injections.
• Keep your medication in your hand luggage if you are flying.
• If your medication is a fridge item please ensure you have a suitable fridge to store your medication before you arrive at your destination.
• Some destinations may not have a good electricity supply. We have had some situations were medications had to be disposed as the fridge could not maintain a good temperature due to poor electricity supply.
• If you are abroad we cannot make arrangements for any extra medications to ship or prescribe. You would have to wait until you were back in the UK.

Bring a list of all your medications with you to every appointment: we take all your medications into account when making prescribing decisions.

If your immune system is suppressed due to medication, it is particularly important that you are adequately protected. If you are receiving treatment with immunosuppressive drugs such as methotrexate, leflunomide, azathioprine, biologic therapies or high dose steroids you should avoid ‘live’ vaccinations as they are contraindicated: these include oral polio vaccine, yellow fever vaccine and german measles (rubella).

There may be inactivated vaccines available as an alternative-please check with your GP or your rheumatology team if you are planning to have vaccines for any reason.

If you are on immunosuppressive medications vaccinations are an important method of reducing complications and hospital admission from viruses and infections. We recommend the Covid vaccine & boosters to all our patients as well as the yearly flu vaccination.

Some treatments may reduce the efficacy of the Covid vaccine. The team will discuss this with you when planning your treatment if appropriate. We would still recommend you have the vaccine so you can have some protection.

Likewise, the pneumonia (pneumococcal) vaccine is recommended for all patients with rheumatological conditions on immunosuppressive drugs. This should be repeated after 5 years, with a maximum of two injections per lifetime.

Please contact the company that delivers your medications to reorganise the delivery and ensure you are available on the given delivery slot.

If you have unresolved delivery problems and cannot solve these yourself with the company, please contact the rheumatology nurses and leave a message on the prescription line: 01274 365779.

It should be taken as prescribed. These medications are NOT pain killers and need to taken on a regular basis to be effective.

Injection site reactions include redness, itching, pain or swelling at the injection site. They mostly occur one to two days after an injection and go away within three to five days. They are most common during the first few months of treatment.

• It may help to apply a cold compress to the site
• Antihistamine tablets or creams available from your chemist can help
• Check your injection technique – we may need to check the way you are doing the injection
• Remember to change the injection site each time you give the injection

If you have pain, redness, or swelling around the injection site that doesn’t go away or spreads then stop and contact us via the advice line.

Injection site reactions include redness, itching, pain or swelling at the injection site. They mostly occur one to two days after an injection and go away within three to five days. They are most common during the first few months of treatment.

• It may help to apply a cold compress to the site
• Anti-histamine tablets or creams available from your chemist can help
• Check your injection technique – we may need to check the way you are doing the injection
• Remember to change the injection site each time you give the injection

If you have pain, redness, or swelling around the injection site that doesn’t go away or spreads then stop and contact us via the advice line.

Most patients stay on their medications for a number of years. The aim of treatment is to get the condition into remission, which means a significant reduction in the symptoms of inflammation, but it doesn’t necessarily mean that the condition has gone.

Not everyone will be able to stop their medications, but most should be able to reduce the dose and number of medications they take once their disease is under control. We will aim to ultimately get you on the minimum amount of medication to keep you well.

With any chronic inflammatory condition flares may occur and should not be seen as a sign of treatment failure, though if your flares increase in frequency or severity we will need to adjust or increase your treatment.

Some patients can stop their medication altogether once their disease is controlled and is in remission but in some instances your consultant may recommend you continue your medication lifelong.

Always check over-the-counter medications for possible interactions with prescribed drugs. Speak to the pharmacist and inform them of all medications currently taken so they can advise.

Simple painkillers such as paracetamol are usually safe, providing you do not exceed the maximum recommended dose and ensure that none of your prescribed drugs also contain paracetamol, since this could result in accidental overdose.

Do not take over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) such as Nurofen if you are already taking prescribed NSAIDs. Avoid NSAIDs if you have previously suffered any adverse effects or have a history of gastritis or stomach ulcers. Also avoid NSAIDs if you are asthmatic, have high blood pressure or take anticoagulation medications, unless your GP or rheumatology team advises you to take them.

Please stop your DMARD medication whilst you have an infection requiring antibiotics. You should not stop taking steroids (prednisolone) during an infection. Only restart once the infection is clear and any antibiotics are completed.

If you are on more than one medication such as methotrexate and sulfasalazine or methotrexate and a biologic (injections) then please stop both until the infection has cleared.

If you think you may have Covid then stop your medication for 7 days. Do no restart if you have continued breathing difficulties or fevers, seek advice. If you are taking steroids such as prednisolone then do not stop continue this medication. Hydroxychloroquine can be continued but you may want to stop this is you are feeling unwell.

Book your blood test appointment.

Please remember to bring your blood form with you if you have one. Some GP’s are happy to book patients in at the local surgery for blood tests. If you would like to attend your GP then please contact them.

Your doctor will receive a letter regarding any changes to your treatment made in clinic and will renew your prescription. However, within the first twelve weeks of commencing a DMARD, you will receive your supplies from the hospital team until we know these are tolerated. This is known as a Shared Care agreement within the Yorkshire region.

Biologic drugs are the exception and are only prescribed via the rheumatology department. You will need to attend your clinic appointments and have blood tests as requested, for us to be able to do this. The prescription is then managed with the appropriate homecare delivery company.

To order more medication please contact our prescription line on 01274 365779 and leave a message. Please give us at least a week to respond.