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Rheumatology information for patients

Diagnosing and treating joint, bone and connective tissue diseases

Coronavirus: rheumatology services update

In response to the coronavirus (COVID-19) outbreak, please read our advice and information before attending the service.

Appointments

  • How do patients get referred?

    Referrals come from GPs, other hospitals or from inpatient referral.

    The team aim to give an appointment to all new patients within two weeks of referral. If you have not heard from the booking team within this time, please call 0207 188 5900. Please also check your contact details the GP holds are correct.

  • Cancelling or changing your appointment

    If you need to rebook your appointment please telephone our booking team on 020 7188 5900 or email gst-tr.rheumandlupus@nhs.net.

    We would appreciate if you could give us as much notice as possible when changing your appointment.  This will allow us to offer another patient in need, the opportunity to be seen earlier.

    We have an average 6-8 week wait for appointments.

    Failing to attend means we are not using our staff effectively and other patients are waiting longer.

  • Before your appointment

    Check your appointment details and plan your journey to the hospital. For more information please visit our helping you plan your journey page.

    If you can, it's a good idea to bring a list of medications you are taking with you to the appointment. It may also be helpful to bring a list of questions that you’d like to ask your healthcare professional so you get the most out of your appointment.

    If you need an interpreter or signer and one wasn’t booked when you arranged your appointment, please call 020 7188 8815 or email languagesupport@gstt.nhs.uk.

  • What to expect at your appointment

    We understand that it is difficult to fit medical appointments into a busy life. To give you an idea of how long your appointment may take, you may be in our department for up to 120 minutes in total.

    At your appointment you will be welcomed by our receptionist who will check you in. You may be seen by a nurse and have a blood test and some observations taken (these could include pulse, blood pressure, weight and urine tests). This can take place before or after you are seen by the doctor.  

    Patients are allocated approximately thirty minutes for a new appointment and twenty minutes for a follow up appointment. However, the doctor or nurse may decide during the appointment that the patient in front requires more or less time depending on their condition and will accommodate this. This has an impact on waiting times meaning that you may not be seen at the exact appointment time stated on this letter. The clinic team aim, however, for all patients to be seen within an hour of the stated appointment time.

  • After your appointment

    A letter will be sent to your GP detailing all the tests and results and you will also receive a copy of this.

Medication – frequently asked questions

Answers to common questions asked by our patients.

  • My new medication is a tablet

    If your medication is a non-steroidal anti-inflammatory drug (NSAID), your GP or a community pharmacist can advise you on continuing use of these medications. We do not provide repeat prescriptions for non-steroidal anti-inflammatory medication as these are readily available over the counter on the advice of community pharmacists or on prescription from a GP. If you change your NSAID medication for any reason, please inform us on your next visit.

    If your medication is a disease-modifying anti-rheumatic drug (DMARD), we will arrange the first prescription. Usually, we will monitor you for the first three months on this type of medication as you will require more regular blood tests when starting a DMARD.  If you are responding well and wish to remain on the medication, we will then arrange for the prescription to come from your GP through a shared care agreement. 

    Some of the newer medications used to treat rheumatic diseases, including tofacitinib, barictinib and upadacitinib are only prescribed by us, and not yet available from a GP.

    Some medications require you to carry a medication booklet with you to appointments. If you are given a medication booklet for recording blood tests or prescription details, please bring this with you to all hospital appointments, including blood tests.

  • What is a shared care agreement?

    Shared care is the transfer of clinical responsibility from a hospital or specialist service to your GP to continue to supply a medication and the necessary blood monitoring required.

    If your GP agrees to take on shared care responsibilities, you are advised to contact your GP surgery to find out how they intend to organise the blood tests and repeat prescriptions for you.

  • My new medication is an injection

    If your new medication is an injectable disease-modifying anti-rheumatic (DMARD) or biologic drug, we prescribe this for you.

    We will arrange for your medication to be delivered directly to your home by a homecare service. For further information, read the homecare medicines service leaflet (PDF 125Kb).

    If you wish for your medication to be delivered to an alternative address, such as place of work, you can request this directly with the homecare service so you do not need to travel to the hospital to receive your medication.

    GPs do not prescribe injectable DMARDs or biologic drugs and therefore will not be able to assist you with your prescription for this medication. 

  • What I need to know before I start my injections

    If we have recommended you start an injectable medication such as a disease-modifying anti-rheumatic drug (DMARD) or biologic drug, there is an approval process that needs to be completed before you can receive your medication. This takes four weeks on average.

    If we recommended the medication more than four weeks ago and you have not yet received it, please contact gst-tr.rheumatologynurse@nhs.net or call 020 7188 5900 (option 1).

  • Getting ready for your first injection

    When you begin your new medication you will need to learn how to self-administer the injectable medication.

    You can either watch a video, have a demonstration in a video consultation or, if necessary, attend the rheumatology department to perform your first injection.

    You will require regular blood tests in order to monitor your response to the medication and to keep you safe. Your medication will need to be stored in a fridge between two and eight degrees Celsius. It will be your responsibility to store your medication safely as it may not be replaced by us if your fridge stops working. Please take care to ensure the medication is not frozen or left out of the fridge.

    When you receive your first delivery of medication, please contact the nursing team to arrange for your training on gst-tr.rheumatologynurse@nhs.net or call 020 7188 5900 (option 1).

  • Why are blood tests important?

    Blood tests are essential for you to continue to receive your prescriptions of disease-modifying anti-rheumatic (DMARD) or biologic medication. The most common reason for an interruption of medication supply is a lack of a blood test result or a blood test which has been performed too long ago to be reliable.

    It is important to plan ahead for your blood test appointments, either if you have these performed at the hospital or at your local surgery. If you are unsure when your next blood test is due, please email the nursing team on gst-tr.rheumatologynurse@nhs.net or call 020 7188 5900 (option 1).

  • Which blood tests do I require?

    The standard rheumatology blood tests required for a disease-modifying anti-rheumatic drug (DMARD) and biologic medication includes a full blood count (FBC), ALT and Creatinine

    The frequency of these blood tests will depend on what medication you are on and how long you have been on it. We recommend you keep a diary of your blood tests to help you plan ahead.

    If you would like a booklet to record your blood results, please speak to your specialist nurse.

    If you are unsure what frequency of blood tests is required for your medication, please contact the nursing team on gst-tr.rheumatologynurse@nhs.net or call 020 7188 5900 (option 1).  

  • Will the hospital remind me I need a blood test?

    If you have not had a blood test, we will text you or if necessary write to you to recommend you have a blood test.

    This is to make sure you receive your next prescription on time. If you are unsure when your next blood test is due, please email the nursing team on gst-tr.rheumatologynurse@nhs.net or call 020 7188 5900 (option 1).

    The most important thing you can do is plan ahead to avoid any interruption in medication supply.

  • I need to have a blood test for my next prescription

    We will inform you if you need to have blood tests when you are taking certain medications. Please ask if you are not sure.

    If your medication is a disease-modifying anti-rheumatic drug (DMARD) you will usually have your blood tests performed at Guy's Hospital in the first 12 weeks of treatment. Following this, your GP will arrange these through a shared care agreement.

    If your medicine is an injection which is arranged by the hospital you will also need to have a regular blood test at Guy's Hospital. 

    To arrange a blood test at Guy's Hospital, please call 020 7188 5900 (option 2) or email gst-tr.rheumandlupus@nhs.net to make an appointment.

    If you would like to have a blood test locally with your GP, please ask your GP if they would be happy to perform the tests and send the results to the hospital. Results should be sent by email to gst-tr.rheumatologynurse@nhs.net

  • How to arrange a blood test at the hospital

    To arrange a blood test at Guys Hospital, please call 020 7188 5900 (option 2) or email gst-tr.rheumandlupus@nhs.net to make an appointment.

  • Will I receive my blood test results routinely?

    Your blood test results will not routinely be sent to you, but we will contact you if we are concerned that the results are abnormal.

    If you would like the results of your tests, please email gst-tr.rheumandlupus@nhs.net and request this or call 020 7188 5900 (option 2).

  • Can my GP do my blood test?

    If your medication is a disease-modifying anti-rheumatic (DMARD) drug and we are happy for you to continue with your medicine after three months use, we will send a shared care agreement to your GP to ask them to continue giving you the medicine on a repeat prescription.

    If your medication is a biologic drug and your GP has agreed to perform the blood tests, the results will need to be sent to us to ensure your prescription is arranged by the hospital. This can take up to three weeks from the date of your last blood tests so we recommend you plan ahead to avoid any delays to the supply of your medication.

    The standard rheumatology blood tests required for DMARD and biologic medication includes a full blood count (FBC), ALT and Creatinine. You will need to arrange for your GP practice to send the results to gst-tr.rheumatologynurse@nhs.net.

  • I had my blood test last week and I haven’t had my delivery

    If your medication is usually delivered to you by a homecare company this will usually take up to three weeks to be processed following your last blood test.

    For oral medication it will take seven to 10 days to be processed and ready for collection from the hospital. Please allow up to 14 days if this is being posted to you.

    Please make sure you have contacted the nursing team to request a prescription via email on gst-tr.rheumatologynurse@nhs.net or telephone 020 7188 5900 (option 1) if you have any concerns regarding your next prescription.

  • My new medication is an infusion

    If your medication is a drug that is delivered by an intravenous infusion (given directly into your vein), you will need to come to the infusion suite at the hospital for this medication.

    What is an infusion?

    Infusion therapy is the administration of medications through a needle or a catheter directly into your bloodstream. To speak to a nurse in the infusion suite about your treatment call 020 7188 5900 (option 3).

    If you require hospital transport to attend your infusion appointment, please call 020 7188 2888 (option 1) to arrange this with the patient transport service (PDF 345Kb). Extra measures will be taken to ensure your safety whilst you travel to and from the hospital with us. Please discuss any concerns with the infusion suite staff before your appointment.

    What if I am unwell on the day of my infusion?

    Do not travel to the hospital or attend your appointment if you are feeling unwell on the day. Please contact the infusion suite with as much notice as possible.

    Do I need blood tests before the infusion?

    We will inform you if you require a blood test before your infusion. If you are unsure, please email gst-tr.rheumatologynurse@nhs.net or book a telephone appointment to speak to a nurse.

    How do I book a date for the infusion?

    We will send a request for a new infusion to the team. They will contact you directly to book the appointment. Please contact the infusion suite on 020 7188 5900 (option 3) if you have an appointment query or if you need to change the date of your infusion.

    How do I know when my next infusion is next due?

    Some infusions are given on a regular basis and some are given as and when needed. Please contact the infusion suite on 020 7188 5900 (option 3) if you have a query about your infusion regime.

  • What to do if I need advice about my medication between appointments?

    If you have any concerns about your medication, develop side-effects or have any questions, please book a telephone appointment to discuss this with our rheumatology team, email gst-tr.rheumatologynurse@nhs.net or call 020 7188 5900 option 1.

  • I wish to travel overseas with my injection medication

    If you are planning an overseas trip, please contact the homecare delivery company which supplies your medication in the first instance.

    They can usually provide you with appropriate guidance and a letter to travel with your medication. If you require any further guidance, please book a telephone appointment to speak to a member of the nursing team.

    If your medicine requires regular blood tests and you are planning to be overseas when the next blood test is due, you may need to obtain the tests when you are abroad. If you are unsure, please contact us on 020 7188 5900.

  • Who do I contact if I am running out of medication?

    The most important action for you to take is to plan ahead. We know that running out of medication can bring worry and distress. If your first prescription was provided by the hospital you may need a review in the rheumatology clinic before a repeat prescription is arranged to ensure it is safe to continue with the medication.

    If your medication was a non-steroidal anti-inflammatory (NSAID) medication, your GP or a community pharmacist can advise you on continuing use of these medications. Our rheumatologists do not provide repeat prescriptions for NSAID medication as these are available over the counter or on prescription from a GP.

    If your medication is a disease-modifying anti-rheumatic (DMARD) and the rheumatology team are happy for you to continue with your medicine they will send a shared care agreement to your GP to ask them to continue giving you the medicine on a repeat prescription.

    If you have been unable to receive your DMARD medicine from your GP for any reason, in urgent situations you may ask our team to provide the prescription. Allow at least seven to 10 days for the prescription to be done and processed by the hospital pharmacy. Please email gst-tr.rheumatologynurse@nhs.net to request the prescription. It is important to include your full name and either your date of birth, NHS number or hospital number and the prescriptions you require to avoid delays. We are only able to supply your rheumatology drugs, not all of your usual medicines.

    If your medicine is an injection, please contact the homecare delivery to arrange your next delivery.

    If you only have one or two injections remaining and no scheduled delivery you may require a blood test in order to receive your next delivery. The most common cause for an interruption of medication supply is a lack of blood test results or a blood test which has been performed too long ago to be reliable.

    An exception to this is if you are on a biologic medication which you take only once every three to six weeks. If you are unsure, contact the department on 020 7188 5900 (option 1) or email gst-tr.rheumatologynurse@nhs.net for advice regarding your blood test regime.

  • I have stopped my injection treatment – what do I do with the extra injections?

    Medication cannot be returned and has to be disposed of in the sharps bins. Please do not dispose of them unless you are certain that you will not be continuing treatment.

  • What do I do with used sharps bins?

    The homecare delivery company who supply your sharps bin will collect this from you. Let them know when they next call to organise a delivery and they will bring you a replacement.

Useful links

  • National Ankylosing Spondylitis Society – for information on all forms of axial spondyloarthritis (including ankylosing spondylitis and non-radiographic axial spondyloarthritis), what it is, how it’s managed and living with the condition. It can help you find local support groups in your area and its helpline (020 8741 1515) provides callers with up-to-date information, work support and help people understand more about the disease and the treatments available.
  • Arthritis Research UK – leading charity in arthritis research and information.
  • Mindfulness leaflet (PDF 136Kb) – a short guide to mindfulness for people living with a long-term health condition.
 

Contact us

To book, amend or cancel appointments (including blood tests) in the rheumatology department, please call 020 7188 5900.