General practice

Getting a diagnosis

 

If you have any pain, stiffness or swelling in your joints,
it is important that you visit a GP as soon as possible.

 

It is possible that your GP will be able to diagnose you
right away, but, in some instances, they may need to refer you to a
rheumatologist or orthopaedic surgeon at your local hospital.  A diagnosis will be made on the basis of your
symptoms, a physical examination and medical tests (if necessary).

 

When you visit your GP be ready to give a full description
of any pain, stiffness or other problems. You will be working together with
your GP to manage your condition so don’t be afraid to ask questions. Make a
list before the appointment so that you don’t forget anything or take a family
member/friend with you.

 

Osteoarthritis (OA)

 

The National Institute of Health & Social Care (NICE) have produced a national guideline on osteoarthritis care and management and the care you should expect to receive:

 

https://www.nice.org.uk/guidance/cg177/ifp/chapter/Osteoarthritis

 

This information is very useful and includes a list of questions
you might like to ask your health providers.

 

Diagnosis:

 

The majority of patients who are 45 or above receive a
diagnosis of OA without the need for tests (clinical osteoarthritis).

 

This diagnosis is based on their age, whether there is joint
pain with activity and when and for how long they experience stiffness in the
joints.

 

However, GPs must be aware of other possible diagnoses and
this, in some cases, may require further investigations such as blood tests or
X rays.

 

If you are diagnosed with OA, your GP will be your main
contact for managing your condition. They may also refer you to a
physiotherapist for advice on keeping your joints mobile. If your arthritis is
severe, the GP can refer you to a rheumatologist, orthopaedic surgeon or pain
specialist.

 

Assessment and management

 

NICE recommends that the GP:

 

  • Assesses the effect of osteoarthritis on the
    person’s function, quality of life, occupation, mood, relationships and leisure
    activities.
  • Agrees a plan with the person for managing their
    osteoarthritis, taking into account comorbidities (other illnesses) that impact
    on the effect of osteoarthritis.
  • Discusses the risks and benefits of treatment
    options with the person, ensuring that the information provided can be
    understood.
  • Offers advice on – access to information; activity
    and exercise; weight loss if the person is overweight or obese.

 

NICE recommends that GPs support patients with osteoarthritis
with self management (see Self management on this website) including strategies
such as exercise, weight loss, use of suitable footwear and pacing.

 

For more details on the management of OA see “Managing
arthritis” on this website or see the NICE guidelines https://www.nice.org.uk/guidance/cg177/ifp/chapter/Osteoarthritis

 

Rheumatoid arthritis (RA)

 

The National Institute of Health & Social Care (NICE)
have produced a national guideline on the management of RA:      https://www.nice.org.uk/guidance/ng100/chapter/Recommendations

 

This includes some information for patients: https://www.nice.org.uk/guidance/ng100/informationforpublic

 

Rheumatoid arthritis is usually managed by rheumatology specialists
however GPs may be involved in the initial diagnosis.

 

Your GP will:

 

Examine your joints and skin, and test your muscle strength

 

Carry out blood tests looking for inflammation

 

Do X-rays to find early signs of damage to joints and bones

 

If you are diagnosed with RA, your GP will refer you to
other healthcare professionals including a rheumatologist and physiotherapist.
You will also be prescribed drugs to control the disease and reduce the
inflammation.

 

 Help with
long-term pain

 

GPs are very well trained in exploring all aspects of
medical problems, including both physical and emotional parts, and usually know
how to treat problems related to pain. Your GP should know how to correctly
understand what symptoms mean and whether they’re caused by ‘new’ pain or a flare-up
of long-term pain. They’ll know when to react, for example by ordering further
tests.

 

GPs can  work with you
to draw up a plan, which is important with long-term conditions. Living well
despite pain is a skill which takes time to master. Your GP will be crucial to
how you deal with long-term pain, so it’s important that you try to build a
relationship where you can speak openly and be listened to, ask questions and
trust the advice you’re given. Ask them to make the information clearer if
you’re worried or unsure.

 

What types of treatment can my GP prescribe?

 

In addition to simple painkillers, GPs often prescribe
non-steroidal anti-inflammatory drugs (NSAIDs) or opioids. Occasionally
medicines that aren’t traditionally used to treat pain can be prescribed, for
example anti-seizure medication like gabapentin, which was originally developed
to treat epilepsy, can be effective for neuropathic pain. Anti-depressants are
also commonly used to treat long-term pain, whether you have depression or not.

 

 Who can GPs refer
me to?

 

GPs are good at knowing where to refer you to if you need
other treatments. They can help you get access to other medical professionals
and the following services:

 

Exercise to maintain fitness and general health

 

Occupational therapy to help with daily living and
functionality

 

Psychology to help optimise coping strategies and living
well

 

Physiotherapy for specific musculoskeletal problems

 

Other doctors for second opinions.