The rheumatology multidisciplinary team
Rheumatology employs a team approach to helping people with their conditions. Doctors diagnose and supervise plans for treatment with each patient, but other team members give advice and help based on their own knowledge and skills. A key member of the Rheumatology Team is the Rheumatology practitioner. Typically the practitioner has a nursing background but some were initially trained in Physiotherapy or Occupational Therapy. Whichever background the practitioner has, they are all ‘specialist’ in Rheumatology.
Rheumatology practitioners specialise in the care of patients with a variety of conditions particularly conditions requiring long term Rheumatology care. Owing to the complexity and number of conditions, the role of the practitioner can be very varied and may include disease assessment, education about diseases or treatment, disease and treatment monitoring. Some practitioners can also prescribe, arrange tests and inject joints, like doctors.
Rheumatology practitioners help you to understand your condition, medications and treatment plan, ensuring that decisions made about your care is based on informed, shared decision making. Practitioners may be pivotal helping you manage your illness at home and explain what to do if you have any problems. Practitioners often act as coordinator of your care within the team, making sure that you see the right people, in the right place, at the right time for you.
Rheumatology practitioners will undertake assessments that may include taking a detailed history, physical examination (in some cases including the joints, skin, chest, heart, or circulation) and assessment of how you are coping generally. This will help ensure that your treatment plan meets all your needs and is based on your informed choices and shared decision making.
Physiotherapists supervise physical /exercise therapy to restore movement and function when someone is affected by injury, illness or disability to help improve or maintain a person’s independence and quality of life.
Physiotherapists help you to manage and cope with your condition initially asking you about how your symptoms affect you. They will discuss with you what you would like to achieve, and can achieve, in terms of improving your physical functioning and quality of life. This could include what you can do to help yourself, your posture, how to exercise and keep as active as you can; positioning to help you sleep well and tackle fatigue; and how to manage daily tasks, including work.
Physiotherapists may offer suggestions of activities or exercises to help with pain relief, joint protection and ways to keep supple and strong. Their range of treatments may also include hydrotherapy (exercising in warm water), manual (handson) therapy, acupuncture or electrical treatments.
Podiatrists are health professionals that specialise in treating foot problems, particularly advising on foot orthoses (support insoles) that provide more comfort or realign mechanical problems in the feet causing problems.
A podiatrist will help you to care for your feet by completing assessments that may include checking your circulation, nerve function and overall health of the structures in your feet. The assessment may also include a review of your footwear and the way you walk in addition to requests for specific imaging or review of your latest blood tests. They will let you know about any potential risks to your foot health and how these can be reduced.
If needed, podiatrists can offer a wide range of treatments depending on your specific needs. The treatment given by podiatrists ranges from assistance with wound care, the prescription of medication or orthoses (insoles), the administration of steroid injections or minor surgery to education and advice about more general foot care. The Podiatrist will work along with the rheumatology team when planning and giving treatment.
Occupational Therapists (OT)
Occupational therapists (OT) are trained to work as part of multidisciplinary teams within hospitals and help to improve or maintain a person’s ability to carry out their activities of daily living, leisure or work despite a patient’s (often chronic) condition.
At your first meeting, the OT will need to understand how your condition impacts your ability to carry out daily activities and, based on your priorities, they will identify with you some achievable treatment goals. In order to achieve your goals, the OT may provide treatments that include the use of aids and adaptations, splinting, hand and upper limb exercise programmes, selfmanagement education, and psychological support, such as counselling and cognitive behavioural therapy approaches.
It is important to start looking after your joints as soon as you are diagnosed with a musculoskeletal condition as making early changes will help you to avoid problems in the future. The OT will teach you joint protection techniques to reduce strain, which should also ease any pain you may have. If you have problems at work as a result of your condition, an OT can also assess your needs at work and devise a work rehabilitation programme to help tackle these problems.
Pharmacists are experts in drugs and medicines - how they work, their regulation, their interactions with other medicines etc. A pharmacist’s job is to ensure the safe supply and best use of medicines by the public. Your pharmacist will double check the prescriptions written by your Doctor ensuring there are no final problems with the prescription. Pharmacists are very knowledgeable and a good source of information if you have any questions regarding your prescription, drugs or medicines, whether it be about side effects or how you take medicines (e.g. with or without food etc).
Psychologists are health professionals who diagnose and treat conditions based in the mind or brain such as depression and help patients cope mentally with the stress and frustration of having a chronic rheumatological condition. For example people may experience different emotional reactions to living with a long-term medical condition - perhaps worrying about the future, becoming anxious, developing low mood or feelings of loss or anger and having relationship or work related problems as a result.
Coping with and adjusting to living with a chronic musculoskeletal condition can be challenging and stressful. This may involve a number of changes for you and your family. There are a number of different problems a psychologist can help with in order to support you to live as well as you can with your condition.
Psychologists can also help if a person finds they need some extra support with coping with some of the symptoms, including fatigue, pain, anxiety about taking prescribed medications, or struggles to make lifestyle changes which may be helpful in the longer term. A Psychologist can work with you, or if you and the psychologist feel it’s helpful, with your partner or other family member.