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Rheumatology

The Rheumatology team provide a comprehensive range of general and specialist rheumatology clinical services to the population of York and North Yorkshire for patients with arthritis and other musculoskeletal health problems.

This involves inpatient hospital care at York or Scarborough hospitals and outpatient clinics at York, Scarborough, Bridlington, Malton and Selby hospitals.

Our team is made up of staff from different specialist backgrounds who work together to deliver the best possible care for patients.

We see patients with varying musculoskeletal problems, primarily managing patients with inflammatory arthritis. Initially a member of the team will discuss your symptoms with you, determine how they affect your day to day activities and examine your joints.

Briefly these conditions include:

Rheumatoid Arthritis
Psoriatic Arthritis
Ankylosing Spondylitis
Connective Tissue Diseases such as lupus
Osteoporosis
Vasculitis

We also have musculoskeletal ultrasound assessment for diagnosing early inflammatory arthritis.

Home delivery of medications: potential scam alert

We have been alerted to a scam which involves those getting medications delivered to their home.

Patients have reported receiving calls or texts requesting bank details to pay for their deliveries. Please do not give out any bank details, this service and your medication is provided for free. If you do receive a call or text requesting bank details, please alert your home care provider so they can investigate.

Our clinics

We hold regular clinics including joint injection clinics and intra-muscular steroid injection clinics at our outpatient departments in York, Scarborough, Bridlington, Malton and Selby hospitals.

Contact us

Our teams can be contacted via the switchboard for any specific queries not directly relating to outpatient appointments (which should be raised via the main hospital appointments office).

Patients Know Best

Patients Know Best (PKB)

Register with the Rheumatology PKB site to access a Flare Care Plan, to monitor your symptoms and receive guidance on managing your condition with a wealth of information available at any time.

More information about Patients Know Best.

Rheumatology at York

The Rheumatology Team at York Hospital provide a comprehensive range of general and specialist rheumatology clinical services to the population of York and North Yorkshire for patients with arthritis and other musculoskeletal health problems.

This involves in-patient hospital care at York Hospital and out-patient clinics at York and Selby Hospitals delivered by all members of our multidisciplinary team.

In addition to the information in the dropdowns below, more York-specific rheumatology information can be found here.

Rheumatology at Scarborough

The Scarborough Hospital rheumatology department offers consultation for diagnosis and management of various rheumatic conditions, both general and specialist.

There are three consultants based within Scarborough, Bridlington and Malton Community Hospitals and a team of specialist nurses, physiotherapists, occupational therapists and podiatrists.

We share a close working relationship with the rheumatology team at York Hospital.

We see patients with varying musculoskeletal problems, primarily managing patients with inflammatory arthritis.

Briefly these conditions include:-

Rheumatoid Arthritis
Psoriatic Arthritis
Ankylosing Spondylitis
Other Spondylorthropathies
Connective Tissue Disorders
Osteoporosis (monthly)
Joint injection Clinics (weekly)

We also have musculoskeletal ultrasound assessment for patients in diagnosing early inflammatory arthritis.

A medical day unit is available on site for day procedures and treatment such as infusion for medications (IV bisphosphonate, IV biological therapies).

Specialist nurses clinics are run regularly for assessment of patients, counselling for disease modifying drugs, training for use of subcutaneous medications (methotrexate). The specialist nurses also operate a helpline service for patients and GPs and work closely with the medical and allied health care team in managing our patients. Multi-disciplinary team meetings are held weekly.

We look after inpatients with specific rheumatological conditions or complications often with close collaboration with our physician colleagues.

Our Rheumatology Services are provided at:

Where to find us

Clinics are run at the main outpatients A & B.

Haworth Unit houses the day procedure medical unit, musculoskeletal ultrasound, joint injection clinics and DEXA scanner.

Lawrence Unit is a similar day procedure area at Bridlington Hospital.

Who to contact

Our team of secretaries can be contacted via switchboard for any specific queries not directly relating to outpatient appointments (which should be raised via the main hospital appointments office). Phone numbers can also be found here.

Further information

You may visit your GP if you have musculoskeletal or joint problems or symptoms; depending on their assessment you may be referred to us for an opinion.

We also see patients from referral by other specialties.

At your first appointment, you will see one of the three consultants here in a ‘general’ clinic. You will usually undergo blood tests and possibly x-rays if needed. We advice you to bring a fresh urine sample if on your first visit.

Following your first assessment you may be discharged back to your GP with a diagnosis and management plan or you may be offered further appointments with a member of the rheumatology team.

Support and advice about your condition or treatment

If you need support and advice about your condition and treatment including medication queries, contact the rheumatology advice line:

York: 01904 721854, between 9:00am-1:00pm
Scarborough: 01723 385058

Please leave a message with your name, date of birth, telephone number and NHS number and we will get back to you as soon as we can.

Please note the rheumatology advice service is not an emergency service.

If you require urgent medical advice you should consider contacting your GP surgery or NHS 111, and in life threatening circumstances please call 999.

If your medication is prescribed by your GP please speak to them in the first instance with any enquires relating to prescriptions and blood monitoring.

Patient information leaflets

Information leaflets on specific conditions, treatment and management are available to order or download at: Versus Arthritis - Free information leaflets

When to use the rheumatology advice service:

If you have a ‘flare’ of your arthritis that has not improved using self-help measures.
If you are experiencing side-effects to your medication and it is prescribed by the rheumatology team.
If you are going to run out of your rheumatology medication before your next rheumatology appointment and it is prescribed by the rheumatology team.
If you are going to run out of your rheumatology medication and your Homecare Company have advised a further prescription is required from the rheumatology team.

If your query is relating to an appointment booking please contact Outpatient Contact Centre: 01904 726400.

Resources for rheumatology patients and pregnancy

Below is a list of resources with information about fertility, pregnancy and medications for Rheumatology patients.

Rheumatology outpatient clinics

Usually on your first visit to the Rheumatology Department, you will be seen by one of the consultants in a 'general' new patient clinic.

Depending on the diagnosis or treatment, you may be discharged back to your general practitioner or offered a subsequent appointment to be seen in a general or specialist clinic or by another member of rheumatology medical, nursing or allied health professional team.

Our specialist clinics include the following:

Early Arthritis Clinics for new and returning patients with early inflammatory arthritis, such as rheumatoid arthritis, which run weekly
Ankylosing Spondylitis Clinics for patients with ankylosing spondylitis or spondyloarthropathy providing specialist medical and physiotherapy assessment and management, which run bi-monthly
Connective Tissue Clinics to provide specialist assessment of patients with conditions such as lupus, scleroderma and vasculitis, which run monthly
A weekly Ultrasound Clinic, which provides the opportunity for further imaging assessments of joints within the rheumatology clinic setting, for example in the assessment of inflammation activity in rheumatoid arthritis
Injection Clinics run twice weekly to administer local joint and soft tissue therapeutic injections
Drug assessment and disease monitoring clinics which are run daily by our Specialist Nurses, to assess the safety and efficacy of therapy
A weekly Research Clinic for patients involved in clinical trials

What to expect when you attend the rheumatology clinic

The Outpatient Department is a busy place, with clinics running for a wide range of specialties, including rheumatology. There are also likely to be a number of different rheumatology clinics running simultaneously.

The Outpatient Nurses and Patient Service Assistants work together with the Rheumatology Team to ensure your visit is as smooth as possible.

On your arrival in the Outpatient Department you should approach the front desk and will be greeted by a Patient Service Assistant who will seat you in the appropriate clinic area. Following this the Outpatient Nurse assigned to your clinic may take your blood pressure, weight and height and you may be asked to provide a urine specimen for testing.

At the time of your appointment the Doctor or Specialist Nurse will call you into their consulting room.

You should expect to receive a clinical assessment which will usually include a range of questions and a physical examination. You may be asked to fill in a questionnaire related to your condition.

We work as a team and so you may see the Consultant, Specialist Nurse or other members of the medical or nursing staff, and this person may be different at each clinic visit, although we do try to limit this as much as possible. There may also be a medical or nursing students present as these clinics are an important part of their education.

Whilst we will try our best to keep to time, some consultations can take longer than expected, so there may be delays to your appointment time.

Further tests, for example a blood test or an x-ray may be suggested during your consultation and usually can take place after your appointment. This may add to the length of time you are at the hospital.

In some circumstances the Doctor or Specialist Nurse may recommend administering a therapeutic injection either into a joint or an intramuscular injection which may be given by the Outpatient Nurse.

We understand that sometimes it is difficult to recall all the information provided to you during your consultation, so we have a range of written material and information leaflets and resources available in the clinic area that the staff may give to you or you can help yourself.

If you need to make a further appointment this can be done at the front desk on leaving the department.

Physiotherapy

The role of the physiotherapist working in rheumatology is to help you improve and maintain your daily activities and keep independence in your work and home life. This is often achieved by increasing the joint movement and reducing stiffness and strengthening muscles that are affected by arthritis.

At the first appointment the physiotherapist will ask you some questions and physically examine your joints and muscles to find out what problems you’re having. This will help them get an understanding of what you want to achieve from the treatment and set goals. Examples of goals could be returning to work, playing with your children/grandchildren or walking your dog. It’s helpful to think of your own goals before you see the physiotherapist.

The physiotherapist will then work with you to help you understand what is happening to your joints and devise a treatment plan. This may include:

A home exercise program for your affected joints and muscles
Advice on pain relief
Advice on general exercises and improving your fitness
Walking and balance assessment and provision of walking aids, if needed.
General advice on managing arthritis including pacing and improving sleep
Flare management advice

The aims of the sessions are to give you the reassurance and confidences that you can manage your condition long-term and continue with you to do your daily activities.

Physiotherapists and occupational therapists often work closely together to provide care for people with rheumatology conditions. You may see them both at the same appointment. We try to make sure you see the same physiotherapist at every appointment.

You may see the physiotherapist when you are first diagnosed, if problems occur throughout the course, or if you simply want advice on what exercise is appropriate to do with your arthritis.

Useful patient leaflets

Greater trochanteric pain syndrome

Occupational therapy

Occupational therapy (OT) is a science degree-based, health and social care profession, regulated by the Health and Care Professions Council. Occupational therapy takes a 'whole-person approach' to both mental and physical health and wellbeing and enables individuals to achieve their full potential.

Occupational therapy provides practical support to empower people to overcome barriers preventing them from doing the activities (or occupations) that they need to do and that matter to them. This support increases people's independence and satisfaction in all aspects of life.

'Occupation' as a term refers to practical and purposeful activities that allow people to live independently and have a sense of identity. This could be essential day-to-day tasks such as self-care, work or leisure.

An occupational therapist will consider all of the patient’s needs - physical, psychological, social and environmental. This support can make a real difference giving people a renewed sense of purpose, opening up new horizons, and changing the way they feel about the future.

At the first appointment the occupational therapist will ask you some questions about how you are managing your daily activities and the impact of your condition.

They will work with you to understand what you want to achieve from the occupational therapy intervention and set goals. Examples of goals could be returning to work, managing fatigue or carrying out specific daily tasks. It’s helpful to think of your own goals before you see the occupational therapist.

Occupational Therapists will assess and provide tailored interventions in a variety of areas, such as:

Environmental adaptions
Small aids and gadgets
Splinting
Joint protection
Employment
Careering for others
Sleep hygiene
Pain management
Relaxation
Fatigue management
Pacing
Management of ‘brain fog’
Understanding your condition
Develop self-management skills including managing flairs

Occupational therapists and physiotherapists often work closely together to provide care for people with rheumatology conditions. You may see them both at the same appointment. We try to make sure you see the same occupational therapist at every appointment.

You may see the occupational therapist when you are first diagnosed, if problems occur throughout the course, or if you simply want advice on how to do certain activities.

Pharmacy

The pharmacy departments at York and Scarborough hospitals employ over 180 staff members, providing comprehensive services and support to patients, wards, clinics and departments within the Trust, as well as several community hospitals and units in the locality.

Click here to access more information about the pharmacy department and the services provided across both s ites.

Contact us

If you have a question or query about your medicines you should contact the pharmacy your prescription was supplied from.

You can contact the appropriate Pharmacy reception by using the numbers below; our trained staff will transfer you to an appropriate member of the pharmacy team.

York Hospital Pharmacy Reception: 01904 725736
Scarborough Hospital Pharmacy Reception: 01723 342448
Lloyds Pharmacy Reception: 01904 721991

Prescription payments

If you have received a hospital outpatient prescription and have received a prescription payment reminder, you can access the online payment portal here.

Location

Services are provided at:

York Hospital Pharmacy Department and Lloyds Pharmacy, both can be found via the main entrance to York Hospital, on the ground floor.
Scarborough Pharmacy Department, which can be found via the south entrance to the hospital, on the first floor.

Information about your medicines

We understand that coming into hospital or attending an appointment can be daunting and, once you get home, it may be difficult to remember important information about your medicines.

If you have a question about your medicines or need further information about a medicine following a recent outpatient appointment or stay in hospital, please contact the pharmacy medicines information team by calling 01904 725960.

The medicines information team is available Monday to Friday between 9am and 4:30pm.

Find more information about your medical conditions or the medicines you are prescribed here.

Help us to help you: bringing your medicines to hospital

If you come to hospital for an appointment, a planned procedure, or even unexpectedly, you should always bring any medicines you're currently taking with you.

Bringing all of your current medicines with you helps the staff looking after you get the most accurate and up-to-date picture of your current medication regime. It also helps you stay in control of your own medicines and medical conditions and saves wasting valuable resources.

For more information on why it's so important to bring your medicines with you to hospital, please click here.

cartoon medicines pictured walking in the direction of a sign that says 'to hospital'

Pregnancy and parenthood

Planning for pregnancy

It’s completely normal to feel concerned about the effect of the pregnancy on your condition and the effect of your condition on the pregnancy.

It’s never too early to start the conversation with your doctor so that you can get on the right treatment plan.
If you have a type of inflammatory arthritis you may be referred to an obstetric rheumatology clinic. They can advise on everything from fertility, to the pregnancy and the medications available. This may be something your local hospital offers or you may be referred to a nearby specialist centre.

If you’re already on a pregnancy friendly drug, you won’t have to worry about coming off it or switching medications when you decide to start trying for a baby.

But we know that it’s not always possible to plan ahead. In which case, it’s important to let your rheumatology team know as soon you become pregnant. They can check everything is fine and make sure you’re on the right medication. There are some medications which are safe during pregnancy and breastfeeding, and some which are not recommended.

Where should I look for information?

There are many very helpful websites which have a wealth of information regarding your condition and pregnancy, including:

Information, resources and links

Useful websites

Articles

Frequently asked questions

Information leaflets can be obtained from the Arthritis Research UK, Arthritis Care websites, or the York Hospital Rheumatology clinic.

The Rheumatology advice line can be contacted via 01904 721854.

How many people have arthritis?

There are 10 million people living with arthritis in the UK. One in five of the adult population in the UK has arthritis.

Does arthritis affect young people?

Arthritis affects people of all ages. There are 12,000 children in the UK with arthritis and approximately 27,000 people living with arthritis are under the age of 25.

Do many people visit their GP because of their arthritis?

One in five GP visits involves the symptoms of arthritis, such as joint pain, stiffness, fatigue and impaired mobility.

How do I know if I have arthritis?

For most people, arthritis causes discomfort or pain, stiffness and perhaps swelling in one or more joints. If your arthritis is causing significant symptoms, getting worse or you are worried about your joints you should visit your GP who will be able to make a further assessment. You may then be referred to a specialist consultant if necessary.

Is there a cure for arthritis?

At the moment, there is no cure for arthritis. However, there are many ways of treating the symptoms of arthritis. There is also much you can do to protect your joints and keep mobile with drugs, therapies and self-management techniques, such as by maintaining a healthy diet, weight control and taking regular exercise.

Is arthritis hereditary?

There are over 200 types of arthritis. The majority are not hereditary and you will not pass it on to your children. However some types of arthritis can affect members of the same family. Recent evidence suggests that certain types of arthritis such as osteoarthritis in the hands can be hereditary, but further studies are needed to confirm this. Some people may have a genetic predisposition to certain types of arthritis (e.g. lupus, ankylosing spondylitis), but this is not the same as a type of arthritis being hereditary.

Do arthritis symptoms go away during pregnancy?

Many women who have arthritis find that their symptoms lessen when they are pregnant. However, once the pregnancy is over, the arthritis returns. If a woman has Axial Spondyloarthropathy (a type of inflammatory arthritis of the spine) pregnancy does not usually help and may worsen symptoms in the last phase of pregnancy.

How long do I have to stop taking my arthritis medication before I start a family?

Women and men taking stronger medication for their arthritis such as methotrexate or other disease modifying anti-rheumatic drugs (DMARDs) will have to consult their doctor or consultant about the best course of action. Those on anti-TNF therapy can continue to take the medication whilst pregnant (until the third trimester) but we would like to know if you are planning a pregnancy to discuss this further with you. Some medications such as hydroxychloroquine can be continued throughout pregnancy.

The amount of time taken for a drug to leave the body can be very variable. However, it is recommended that if you are taking drugs such as Methotrexate then you should allow at least 3 months from stopping this medication before trying for a pregnancy.

Do I need to stop my medicines if I am having an operation?

If you need to have an operation, it is likely that you will need to stop your rheumatology medication a few weeks before the surgery. You will be able to re-start your medication a few weeks after the operation so long as the wound is fully healed and you are well. This is because there may be an increased risk of infection if you are taking some rheumatology medications such as methotrexate or biologic therapies. You should ask your surgeon or contact the Rheumatology Department if you require further information on this.

Some doctors or dentists may advise additional antibiotic medicines for certain surgical or dental procedures if you are taking certain rheumatology medication such as methotrexate or biologic therapies.

Do I need to stop my medicines if I develop an infection?

If you develop mild infection symptoms, you should monitor how you feel and be prepared to stop your rheumatology medication if your infection symptoms get worse. If you are unsure what to do, you should contact your GP or the Rheumatology Department for advice.

You should stop your rheumatology medication and seek advice from your GP or the Rheumatology Department if you develop any moderate or severe infection symptoms.

If you are prescribed antibiotics for an infection, you should stop your rheumatology medication and only restart them when you have completed the course of antibiotics and your infection symptoms have fully improved.

Do I need to stop my medications if I develop side effects?

All medications have the ability to cause side effects. In the majority of cases these are mild and with rheumatology drugs often settle a few weeks after starting them. If your side effects are mild our usual advice would be to continue the medication. If the side effects continue, worsen or are severe you should stop the medication and either contact the rheumatology department if you have recently started the medication (less than 3 months ago) or contact you GP. You will have been told about more common or serious side effects of medications that the rheumatology team have started and you can also refer to the drug information leaflets and the information that you receive from the pharmacist.

Further information about the drugs used in rheumatology and possible side effects can be found in the medication leaflets on the arthritis research UK website.

What if my arthritis flares?

Sometimes your arthritis may flare despite being on medication. The majority of these are short-lived and can be self-managed.

The following websites may be helpful.

If your symptoms continue or you feel they are severe please initially contact your GP and then the advice line if needed.

Does the weather affect my arthritis?

The links between arthritis and the weather are inconclusive. There is no overwhelming evidence to support this and information has been anecdotal and subjective. Many people with arthritis say that their joints ache before a storm, and, according to experts, this is due to a drop in pressure and a rise in the humidity causing pain and stiffness in the joints. However, a change in the weather will not cause arthritis.

Does diet affect my arthritis?

There are no diets or dietary supplements proven to cure arthritis. However, some people find their symptoms improve as a result of changing what they eat or taking some dietary supplements. Some people do find that certain foods and beverages make their arthritis worse. If this is the case you should avoid these foods/beverages. If you have been diagnosed with gout you should follow a more prescriptive diet and this will be discussed with you. Generally everyone should try to eat a well-balanced and varied diet. If you are overweight, losing weight will reduce the strain on your joints.

Are complementary and alternative therapies helpful for people with arthritis?

Complementary medicine uses therapies that work alongside conventional medicine. Alternative medicine includes treatments not currently considered part of evidence-based Western Medicine.

Some herbal medicines are not recommended for people with arthritis and some may interfere with your Rheumatology medications. You should not start any new complementary or alternative therapies without first discussing with your Rheumatologist or Rheumatology Specialist Nurse.

What vaccinations are recommended if I have arthritis?

If you are taking immunosuppressive medications or have a long term condition such as arthritis, you should receive regular vaccinations against Pneumococcus and Influenza. Your GP can arrange for you to have these.

If you are taking immunosuppressive medication, including moderate to high dose steroids for more than two weeks, you should not have live vaccines or oral vaccines. Examples of live vaccines include yellow fever; measles, mumps and rubella (MMR); BCG (against tuberculosis); chicken pox vaccine.

If you are taking immunosuppressive medication or moderate to high dose steroids, you should stop these at least three months before receiving a live vaccine.

If you have a live vaccine before starting immunosuppressive medication, you should wait at least 2 weeks, and preferably four weeks, before starting the medication.

Should I have the shingles (herpes zoster) vaccine (Zostavax) if offered it by my GP?

There is currently an immunisation programme for the shingles vaccine in those age 70-80. If you are eligible the GP surgery will be in contact with you. If you are >50kg (7st 12Ib) and taking DMARDS including methotrexate and sulfasalazine you can have this vaccine. If you are on steroids of 10mg prednisolone or less per day you are also able to have this vaccine.

Those on high dose steroids (greater than 10mg prednisolone a day) or more a powerful immunosuppressant such as anti-TNF or rituximab should not have the vaccine.

If you are unsure please check with your GP or one of the rheumatology team.

When will I find out my test results from clinic?

You will be informed of any investigations that need to be acted upon. All the rest of the investigations can be discussed at your next clinic appointment. If you are waiting for a routine MRI, CT or DEXA scan and have not received an appointment through the post within eight weeks of being seen in clinic please contact your consultant’s secretary via switchboard. If you are unsure and wish to discuss this please contact the rheumatology department.

How do I change or cancel an appointment?

If you need to change or cancel an outpatient appointment or telephone appointment, please phone York Hospital Contact Centre – Tel: 01904 726400. Please ensure that you do cancel your appointment if you cannot attend so other patients can be contacted to take your appointment slot.

How do I order a new prescription for my rheumatology medication?

When you start a new rheumatology medication, the rheumatology department is responsible for monitoring your blood results and providing your prescription (this can be requested via the helpline). Once you are safely established on your new medication, responsibility for monitoring your blood results, and providing the prescription, is handed to your GP (this is called Shared Care). For hydroxychloroquine, this usually occurs by four weeks.

For other medications such as methotrexate or sulfasalazine, your GP will be asked to take over at approximately eight weeks. Some medications, such as biologic therapies or mycophenolate mofetil are prescribed solely by the rheumatology department. You will be advised accordingly at your appointment.

Shared care guidelines

Homecare contact details