DEPARTMENT OF RHEUMATOLOGY

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1 Dr Steven Young Min Consultant Rheumatologist and Clinical Director Colin Beevor -Matron and Service Manager Department of Rheumatology Queen Alexandra Hospital, Cosham, PO6 3LY Telephone DEPARTMENT OF RHEUMATOLOGY Pneumococcal vaccine National guidance advises that those over 65 years of age and all those who are on immune suppressant medications (DMARDS and Biologic therapy- see attached flyer) should receive a single vaccine against bacterial pneumonia PPV23 that was introduced in Booster injections are not recommended unless you have had your spleen removed, in which case you would need further vaccine every five years Flu Vaccination please arrange through your own GP/ Doctors Surgery/ Health Center Flu vaccination is available every year on the NHS to help protect adults and children at risk of flu and its complications. Flu can be unpleasant, but if you are otherwise healthy it will usually clear up on its own within a week. However, flu can be more severe in certain people, such as: * anyone aged 65 and over *pregnant women * children and adults with an underlying health condition (such as long-term heart or respiratory disease) * children and adults with weakened immune systems this includes patients on DMARDs and Biologic Therapies- see attached information flyer Patient Feedback Why does a Rheumatology Clinic run late? The team of Doctors/ Nurses and members of the multidisciplinary team members strive to make our patients feel respected listened to and cared for. On some of the busy clinics it can be a challenge to do that well and for the clinic to stay on time. There are many reasons why rheumatology clinics may not run to time may include:- Emergency Patients- The medical and nursing team may receive or be asked to review emergency patients either in the department, other wards and departments across the hospital such as accident and emergency department. Breaking Bad News- some of the medical team may have to break bad news to a patient and their family- explaining the next steps in complex treatments/ tests and investigations

2 Supervising other Clinics- the Rheumatology Consultants will also be supervising Specialist Registrars and Clinical Nurse Specialist clinics-on some occasions the consultant s thoughts and new management plans have to be discussed and the consultant could be asked to review the patients. Patients requiring other tests and investigations- as part of their clinic appointment some patients may be required to visit x-rays for up to date x-rays which may change the course of the treatment, in this case the patient returns to clinic to hear outcome of the x-rays and agree with the patient new treatment options. Patients becoming unwell with the department- both the medical and nursing team may be called to patients take unwell in the rheumatology department, this could be in the day case suite or in another clinic room. The medical and nursing team have a responsibility to respond to these emergencies. Teaching Clinics- whilst we hope that teaching up and coming new members of the team does not take too much time during the clinic, the medical and nursing team have a responsibility to ensure that junior members have the opportunity to question things that they have seen with the person leading the equipment. Some patients take longer that the allocated time- for patients who are frail it can take time to get then undressed and dressed again as well as getting them to explain their problems, medications and past medical history. For patients where English is not there 1 st language it takes longer to ask questions through an interpreter and for the understanding of the questions to ensure that the right clinical decisions are made Computer although it s difficult to blame a computer, the complexity of using Information Technology is difficult within the NHS, we can have to access up to 4-5 different computer systems to get all the information required for clinical appointments when the patient is sitting in front of the clinician. What can YOU do to help? Turn up on time most appointments you will need to have your weight blood pressures and urine tested before you go through to see the doctor/ nurse- arrive 5 minutes before your appointment to allow this to happen bring your sample of urine with you Before you see the Dr, think about your symptoms and what you will tell him/her, e.g. how long have you had them, how severe is it, does it come and go, what makes it worse or better. Remember to bring with you, the list of your current medications If the Dr (or Nurse) is running late, please be patient and understanding as they may have been dealing with complex patients or called out to a seriously ill patient. Ask the Health Care Support Workers check with the team how the clinics are running and let them w I you are waiting longer than 15 minutes than your appointment time. They can then give you an update on the clinic waiting time. Rheumatoid Arthritis Coffee/ Tea and Chat session Some of our patients are getting together for coffee/ Tea and chat sessions, if you are interested in attending please colin.beevor@porthp.nhs.uk / Telephone and I will forward dates, times and places to meet

3 Patient Advice and Information Line- latest update Our Patient Advice and Information line remains busy, we are pleased to say that 96% (August 2017 data) of our Patient Advice and Information Line calls are responded to within 48 hours which is our standard for this service. As we now have two options for the Patient Advice and Information line (telephone and ) as of the 1 st May 2017 we will now only try to return your call within 2 days - If we are unable to get through we will write to you and let you know that we have not been able to contact you. Please ensure that you leave the correct information * Full Name * Date of Birth * Hospital Number *Telephone Number * Brief information about what the call/ is about Rheumatology.pail@porthosp.nhs.uk Telephone Something new for 2017/2018 Flare Rollercoaster - patient/family and carer work shop 1 st Work Shop - Saturday 2 nd December 2017 Arthritis and Connective Tissue Disease flares are normal but do have an impact on every aspect of your life. In simple terms a flare can be described as a sudden increased severity in symptoms that can hit at any time. For many patients having a flare is disheartening, they feel that they have been managing their arthritis/connective tissue disease well and doing all the right things by taking their medication regularly and maintaining a healthy balance of exercise and activity, then one day they wake up and feel like it was all for nothing. For many the symptoms can be mild and for others the symptoms of joint pain, stiffness and swelling and fatigue are the worst that they can remember in a long time. It s important to remember arthritis and connective tissue diseases even when on effective treatments can have acute periods of time with pain, inflammation and fatigue this is known as flares. Thankfully for many these troublesome and unpredictable, flares are short lived, unfortunately for a few the flares may continue for a few days or even weeks. Colin Beevor - Matron Flares can be alarming, not only because of the pain, but because of their unpredictability, patients are often fearful that the flare will spiral out of control and how the flare is disrupting their work family and own quality of life. We are therefore pleased to announce a new Flare Rollercoaster patient, family and carer workshop, the programme is open to anyone with inflammatory arthritis (Ankylosing Spondylitis, Rheumatoid arthritis,

4 Psoriatic Arthritis and Connective Tissue Diseases (Lupus, Sjogrens, Scleroderma, Vasculitis and Myositis) The Department of Rheumatology is pleased to announce the first Flare Rollercoaster work shop on Saturday 2 nd December 2017 registration 09:15 - start 09:30 - finish 1:00pm To register to attend Write to Rheumatology Conferences/Education Programmes Rheumatology Department Queen Alexandra Hospital Southwick Hill Road Cosham, Portsmouth PO6 3LY Telephone rheumatology.conference@porthosp.nhs.uk Department of Rheumatology- What s Going On Supporting Patients- more dates announced No Time for Pain No Time for Pain Patient- Partners/Family/carer work shop We are holding four- Patient workshop- No time for pain on Saturday 7 th October Winton House, 18 High Street, Petersfield GU32 3JL 1:30 start Saturday 25 th November :30-12:30- Hip and Knee School, Queen Alexandra Hospital, Cosham Saturday 13 th January :30-12:30- Hip and Knee School, Queen Alexandra Hospital, Cosham Saturday 17 th February :30-12:30-1 st floor meeting room, Fareham Library 7 Thackeray Mall, Fareham PO16 0PQ- meeting room 1 st floor What does "No Time for Pain- Workshop" have to offer that is different from other things you have tried, and future date will be announced in the coming weeks so please look out for these. Firstly- unfortunately the current programmes are only for people under the care of Portsmouth Hospitals NHS Trust Department of Rheumatology (Queen Alexandra Hospital, Petersfield and Gosport clinic) living with Arthritis and Connective Tissue Diseases in the Portsmouth Area Secondly, our workshop includes time to re think your own strategies for managing chronic and persistent pain associated to your Arthritis and Connective Tissue Disease Thirdly, we show how you can put into practice the new knowledge and skills that you have gained from attending our No Time for Pain - workshops Fourthly, we encourage you to bring one guest - partner, family member or carer with you to help build your self-management programme - pain management toolkit For more information or to book a place on either of the workshops- please Valerie.robins@porthosp.nhs.uk

5 Tired of Being Tired Fatigue - an overwhelming tiredness - is one of the most common symptoms of Inflammatory Arthritis and Connective Tissue Diseases. Fatigue in Arthritis and Connective Tissue Diseases is not just an ordinary tiredness, like you might get at the end of a hard day's work. It's as an overwhelming sense of tiredness that often occurs after very little activity. Fatigue affects people in different ways, and it may change daily or hourly. Some people find that it is the symptom that affects them most, but there are ways to manage it and minimise its effects on your life. This can make it complicated to explain fatigue to others. The Department of Rheumatology is currently offering a 7 week programme entitled Tired of Being Tired, previous attendees report that the programme has given them the opportunity to explore different self-management and relaxation techniques and improved their quality of life. If you would like to know more about the programme or would like to register- please contact Department of Rheumatology by Rheumatology.TOBTEducation@porthosp.nhs.uk or telephone Patient Feedback- I recently attended the Tired of Being Tired course at Q.A. for arthritis and connective tissue diseases. My husband also came along with me and we both found the evenings very informative and helpful run by excellent, caring and understanding people. John, Sandy and Audrey are a great team. John and the Team certainly understood the various problems. The difficulties of dealing with flare ups of symptoms, the 'you don't look ill attitude', pain control, massage and mindfulness were all addressed in plain language. All questions were answered and encouraged This was a great example of a Health Service that goes beyond diagnosis and treatment and offers care and advice to help the patient feel more in control in coping with long term illness. I have found the course has helped me accept how I am now and has also given me renewed enthusiasm for finding alternative means of coping with symptoms. It is not always easy to remain positive and I will always try to remember the advice given on this course. I cannot thank you and the team enough. Kind regards RN To watch the introduction video- visit Keeping Active with Arthritis Scottish Dancing- join us for classes starting Wednesday 14 th February 2018 for 6 week Queen Alexandra Hospital- Cosham Anyone who has ever been to a Scottish Country Dancing knows just how much fun a Dashing White Sergeant can be. It is likely, too, that anyone who has attempted the Gay Gordons or Strip the Willow, also knows the physical effort needed for a full night of traditional Scottish dancing. Did you know- just an hour can use up nearly 400 calories and work just about every muscle in the body. This explains why there is a new wave of interest in Scottish Country dancing as an alternative to aerobics classes or body combat for men and women.

6 Colin Beevor- Matron and Clinical Nurse Specialist "Everyone loves the fun side of the dancing, but more and more people have been talking about the fitness element of it, too. It is something quite different which is also entertaining. It is also a great way to meet new people because there has to be a certain amount of interaction. Claire Jefferies Rheumatology Specialist Physiotherapist People often avoid exercise as they view it as a chore, so the trick is to find an activity that you enjoy so you are experiencing the benefits of exercise almost without realising it. "This is why ceilidh dancing is a great way to keep active. Classes are fun and sociable, but also have the added advantage of helping to maintain general fitness levels. To find out more about our Scottish Dancing 14 th February 2018 programme and to register you interest in attending rheumatology.conference@porthosp.nhs.uk or telephone Department of Rheumatology- What s Going On Fund Raising Saturday 9 th December 2017 Christmas Tea Dance- St Coleman s Church If you re looking for a fun way to work out with big benefitsconsider dance as a form of exercise and activity. A study published in the 2014 studied adults who took a 45-minute dance therapy class twice a week, those participating reported less knee and hip pain and were able to walk faster after three months. Claire Jeffries - Physiotherapy Manager and Clinical Specialist in Hydrotherapy and Rheumatology said Dancing strengthens muscles, and the music stirs happy thoughts, we know that people are more likely to keep up with an exercise program that s enjoyable and dancing is great exercise at any age Ballroom Dancing such as waltz and some tangos can be done in ways that avoid stress on the joints- just wear comfortable shoes instead of the high-heeled ballroom shoes. Are you experience or would you like to try ballroom dancing- if yes then join the Department of Rheumatology on Saturday 9 th December 2017 for our Christmas Tea Dance. Colin Beevor Matron we are so luck that Pauline Peskett who runs P.P.Dees Dance Club is going to join us and take us through the steps FLASH Funky Sale in aid of Department of Rheumatology Wednesday 7 th February Atrium, A Level Queen Alexandra Hospital Cosham PO6 3LY The Department of Rheumatology is looking for celebrities to donate a pair of gloves for our Flash Funky Celebrity Glove Raffle on the 7 th February 2017.

7 The event will be part of our Wear your gloves campaign to raise awareness of Raynaud s - Raynaud s phenomenon is a common condition that affects the blood supply to certain parts of the body usually the fingers and toes. Raynaud s is usually triggered by cold temperatures, anxiety or stress. The condition occurs because the blood vessels go into a temporary spasm, which blocks the flow of blood. This causes the affected area to change colour to white, then blue and then red, as the blood flow returns. People with Raynaud s also experience numbness, pain, and pins and needles. Symptoms of Raynaud's can last from a few minutes to several hours. We are looking for donations of home knitted gloves, mittens and arm warmersplease drop off into the Rheumatology Department- any time leading up to and on the 7 th February Sunday 4 th March 2018 Afternoon of light music and cream tea- Mountbatten Centre Portsmouth- details to follow Sunday 22 nd April 2018 Cream Tea and Craft Sale- Wheelhouse, Hillhead, Farehamdetails to follow Friday 29 th June 2018 Quiz Night- Wheelhouse, Hillhead, Fareham- details to follow Saturday 18 th August 2018 Cream Tea and Craft Sale- Wheelhouse, Hillhead, Farehamdetails to follow Coming up- Patient Meetings Getting To Grip Meetings Rheumatology OPD Patient Education Programme Getting to grips - Staying in Control - Queen Alexandra Hospital, Cosham, PO6 3LY- Spaces are limited so please book in advance- By Phone: Alex Fletcher Ext Rheumatology.conference@porthosp.nhs.uk Date Venue Talk Saturday 18th th November Lecture Theatre E- Level- Queen Managing your disease led by Sr Long

8 Saturday 16 th December Alexandra Hospital PO6 3LY Christmas Event with Sr Ingall and Sr White Getting to Grips- Petersfield We are pleased to announce that we will now be bringing the Getting to Grips with Arthritis and Connective Tissue Disease to the Petersfield and surrounding area. The meetings will all take place at the Petersfield Community Hospital - Swan Street - see programme below:- Spaces are limited so please book in advance- By Phone: Alex Fletcher Ext Rheumatology.conference@porthosp.nhs.uk Date Time Theme 21/11/2017 Willows day room 13:30-for 13:45 start 15:30 finish Managing the Christmas and New Year Flare - Living well with Arthritis and Connective Tissue Diseases over the festive period Portsmouth and South East Hampshire Group National Osteoporosis Society- Local Branch Meeting- Portsmouth and South East Hampshire- Our meetings are held at Cosham Baptist Church, Havant Road, Cosham at 2pm. We ask for 2 for each meeting to cover expenses. A drink and biscuits will be provided. We also hold a Bring and Buy sale to help our funds 9th November Preparation for Winter Falls Prevention & Home Exercises Adi Phillips, Falls Prevention Co-ordinator, Southern Health Trust. 7th December Medical Update Dr Steven Young-Min, Clinical Director, Rheumatology Dept. Queen Alexandra Hospital 2018 Talks 8 th March 2018 Pets as therapy 12 th April 2018 Sleep clinic 10 th May 2018 Health watch Hampshire 13 th Sept 2018 Dietitian 11 th Oct 2018 Stroke 8 th Nov 2018 Pharmacy Issues 13 th Dec Medical Update Dr S Young Min NASS- National Ankylosing Spondylitis Society- new videos! NASS released our first video, 'What is Ankylosing Spondylitis?' on World AS Day in May. It's a simple video designed to explain AS. We hoped it would raise understanding and awareness of the condition. Now we've produced the follow up video, 'Ankylosing Spondylitis - Not just back pain' which talks in more detail about all the extra-articular manifestations. You can find both videos on the NASS You Tube Channel which can be reached from the bottom of the NASS Homepage (ww.nass.co.uk) or by searching National Ankylosing Spondylitis Society on You Tube.

9 NASS- 4 Albion Court Hammersmith W6 0QT 'What is Ankylosing Spondylitis? 'Ankylosing Spondylitis - Not just back pain' National Rheumatoid Arthritis Society (NRAS) launches new booklet: 'Medicines in Rheumatoid Arthritis' NRAS is delighted to unveil its latest initiative that will help those with the debilitating condition Rheumatoid Arthritis (RA) understand more about the medicines that are used in the treatment and management of this incurable condition. RA is a complex disease and not everyone with RA can be treated in the same way; the disease is more akin to a syndrome than a disease, i.e. many different subtypes and levels of severity. That is why the medicines used in managing the condition are also complex and diverse it is not a one size fits all! Having a wide range of treatments to utilise is essential and understanding how and why they may be used is important for patients and their healthcare professionals. Up until now patients will have received information about their treatment in the form of varying different leaflets on each treatment what this new NRAS booklet does is bring all that information together in one easy to read resource. The Medicines in Rheumatoid Arthritis booklet covers treatments used for managing pain, bridging therapy used during flare ups of the disease, use of steroids, disease modifying anti-rheumatic drugs, biologics and biosimilars, as well as what is in the pipeline for future treatments. Love Your Heart' - Coming Soon NRAS is delighted to announce its upcoming initiative called 'Love Your Heart' - an online programme that will help those with RA understand the risk of cardiovascular disease. Love Your Heart is an interactive online programme that will enable people with RA to assess their cardiovascular risk and set personal goals to improve their cardiovascular health. NRAS has collaborated with Dr Holly John, Consultant Rheumatologist at Dudley General hospital to create this programme. It is currently in testing phase and we hope to be able to launch fully in November If you have RA, the programme will enable you to: understand the reasons why RA increases risk of cardiovascular disease (CVD) calculate a QRISK2 score a prediction algorithm for CVD, recognised by GPs.

10 learn how to reduce the risk of CVD log progress through a series of behavioural goals NRAS is really excited to be working with Dr. John and hope that the Love your Heart Programme will help all those with RA to lead a longer and healthier life by addressing those risk factors that are within our own control. Keep your eyes and ears peeled here for latest developments and information on how you can access the program.