Rheumatology: frequently asked questions about appointments, flare-ups, and medications
Information for patients from Rheumatology
This information sheet lists some of the questions our rheumatology patients ask us most often. It covers:
appointments
conditions
flare-ups, and
medications.
We hope this answers some of your questions. If you have any further questions or concerns, please speak to your GP or a member of the Rheumatology team.
Contact details
Rheumatology Advice Line, Kent and Canterbury Hospital, Canterbury
Telephone: 01227 783156
Rheumatology Advice Line, Queen Elizabeth the Queen Mother (QEQM) Hospital, Margate
Telephone: 01843 235047
Rheumatology Advice Line, William Harvey Hospital, Ashford
Telephone: 01233 616032
Appointments
To cancel or amend an appointment, please phone 01227 868686.
To book a blood test, please go to the Trust web site or phone 01227 206739.
Conditions, flare-ups, and lifestyle
Where can I find out more about my rheumatic condition?
For more information, please go to the Arthritis UK web site.
What should I do if I have a flare-up of my rheumatic disease?
You can often manage mild flare-ups for a few days with:
rest and gentle stretches
heat / cold packs
over-the-counter medications, such as paracetamol or ibuprofen (creams or tablets). Only take these if they are safe for you
Please contact the helpline, if your symptoms:
are severe
do not improve within 3 to 5 days
are affecting your daily activities
We may suggest short-term management with steroids (tablets or injections). If your flare-ups are persistent or happen regularly, we may need to change your treatment.
Call 111 or go to the Emergency Department, if you develop the following symptoms:
chest pain,
severe breathlessness, or
sudden swelling or fever.
Can I drink alcohol with my rheumatology medication?
Limit how much alcohol you drink to no more than 14 units per week. Drinking more than this can increase your risk of developing liver problems. Especially with medications such as methotrexate or leflunomide, which are processed by the liver. For more information, please go to the NHS web site.
Why have I been advised to stop smoking?
We strongly encourage all patients to stop smoking. Smoking makes rheumatic disease worse, increases symptoms, and raises your risk of heart disease and stroke.
For free friendly support and medication to help you stop smoking, contact One You Kent.
One You Kent
Telephone: 0300 123 1220
Email
I need advice about work, time off work, and PIP?
If possible, all patients should remain at work with adaptations. Adaptations include flexible working hours, ergonomic adjustments, or reduced physical demands. Discuss these with your employer or the Occupational Health team.
If you are unwell and unable to work, you can self-certify for up to 7 days without needing a Fit Note. If you need a Fit Note beyond 7 days, please contact your GP. If you have been admitted to hospital, some wards can issue Fit Notes, but not all.
If you need help with Personal Independence Payment (PIP) paperwork, please contact your GP. The Rheumatology team cannot help with PIP forms, but can provide necessary medical reports. More information on available benefits is listed on the government web site.
Can I exercise with a rheumatic disease?
We highly recommend exercises for all of our patients. Use a mixture of aerobic, stretching, and strengthening exercises. Exercise can help reduce your weight, improve your cardiovascular and mental health, and strengthen joints and muscles.
The UK government recommends 150 minutes of moderate intensity activity, spread over the week. We understand that this might not be possible for everyone.
Start slowly, and gradually build up your activity level. Find activities that do not cause pain or discomfort. Aim for a balanced approach between rest and exercise. Some types of exercise that you can try include low-impact activities. These activities include Pilates, yoga, Tai Chi, walking, swimming, cycling, and warm water pool exercises.
For more information on exercising with arthritis, please go to the Arthritis UK web site.
You can access a free 6-month programme on the Nuffield Health web site.
If you need more guidance or advice, please speak to your GP. You can ask for a referral to a physiotherapist, either from your GP or the Rheumatology team.
Do I need to follow a special diet?
A healthy diet is recommended for people with rheumatic diseases. There is no strong evidence that a specific diet is better for patients with rheumatic disease. More information on healthy eating is available on the NHS web site.
Some patients report that certain foods can make their symptoms worse. If this happens, remove that particular item from your diet. You should still have a balanced diet without too many restrictions.
Medications
Where can I find out more about the drug that I have been prescribed?
You will have been given information about your medication when it was prescribed. For more information, please go to the Arthritis UK web site.
These are the types of medication you may have been prescribed.
Steroids such as prednisolone, and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as naproxen. Both of these are usually used short-term, to help with symptoms.
Disease Modifying Anti-Rheumatic Drugs (DMARDs). DMARDs include Methotrexate, Hydroxychloroquine, Leflunomide, Mycophenolate, and Sulfasalazine.
Biologics treatment include Adalimumab, Etanercept, Rituximab, Secukinumab, Tocilizumab, Filgotinib, and Upadacitinib.
How do I ask for repeat prescriptions?
Patients taking DMARD. The hospital will prescribe medication for at least the first 6 months. Once your condition is stable, your GP can take over the prescription and blood test monitoring. This is called 'shared care'. If your GP is unable to take over the prescription, please contact the Rheumatology Advice Line. Their contact details at the start of this leaflet. For more information, please read the Information on shared care medicines for patients and carers leaflet.
Patients taking biologic medication. Biologic medications cannot be prescribed by your GP. They are managed by the Rheumatology team and a specialist delivery company. These prescriptions will be automatically renewed if you have:
responded well to the treatment
had no serious side effects
have been attending your appointments and having blood monitoring tests
If you have any problems with the delivery of your biologic medication, please contact us. Our details are listed on the 'Contact us' leaflet.
Will I need regular blood tests to monitor my medication?
Yes. Regular blood monitoring tests are important. The tests make sure that you are safe while on your medication.
Patients taking DMARD. Blood tests are usually needed every 2 weeks for the first 6 weeks. After that, they are monthly for 3 months, and then every 3 to 4 months.
Patients taking biologic medication. Patients usually have blood tests every 6 months.
Your rheumatologist may advise you to have more frequent tests. Missing blood monitoring tests might cause delays in getting your medications.
What should I do if I have side-effects from my medication?
If the side effects are mild, continue taking your medication. The effects often improve after a few weeks. Mild side effects include slight nausea (feeling a bit sick) or headaches.
Stop the medication if side effects continue after a few weeks, get worse, or feel severe. Contact the helpline for advice. Do not restart the medication until you have spoken to us.
Call 111 or 999, or go to your nearest Emergency Department, if:
your face, throat, or lips swell,
you have chest pains, or
are short of breath.
These symptoms may mean that you are having an allergic reaction to your medication.
I have been on a new medication for a few weeks, but have not noticed any changes in my symptoms. What should I do?
Patients taking DMARD. Most patients notice a difference between 6 to 12 weeks.
Patients taking biologic medication. Most patients notice a difference after 3 to 4 months.
Please continue taking your medication until your next clinic appointment. At this appointment, you can discuss your progress and, if needed, make changes to your treatment plan.
What should I do if I miss a dose of my medication?
If you take your medication daily, take your next dose as normal. Do not take 2 doses to catch-up.
Missing a dose should not cause any issues. If you regularly miss doses, discuss this with your GP or pharmacist. They will discuss ways to help, such as using dosette boxes.
If you miss a dose that you take weekly or monthly, take it as soon as you remember. You will need to take your next dose on this new day next week / month. For example, if you forget to take methotrexate on Tuesday but remember and take it on Thursday, you would need to change your methotrexate day to Thursday going forwards.
I am unwell with an infection, should I still take my normal medication?
If you feel unwell with symptoms of infection or are prescribed antibiotics, stop taking rheumatology medication:
until you feel better
the antibiotics have finished
you are free of infection
Symptoms of infection include fever, a wet or chesty cough, and pain when urinating (peeing). You do not need to stop hydroxychloroquine or sulfasalazine.
If you are taking long-term prednisolone or any other steroids, do not stop them suddenly. This can lead to a life-threatening condition called adrenal crisis. Depending on how bad your infection is, you might need to increase your steroid dose. For more information on adrenal crisis, please read this Society of Endocrinology leaflet.
What should I do if I have surgery planned?
Patients taking DMARD. Continue to take your medication before and after:
minor procedures, such as biopsies, endoscopies, or drains; and
elective procedures, such as joint replacements and other orthopaedic procedures.
If you are having emergency or abdominal surgery, please tell your surgeon about your medication. Also, contact us via the helpline for further advice.
Patients taking biologic medication. Stop taking these before surgery. You must tell your surgeon and contact us via the helpline for specific advice. The exact stopping times for biologic medications before surgery are drug-specific. Only restart your biologics 14 days after your operation, if you are infection-free and your wound is healing well.
Are vaccines safe with my medications?
We recommend that all rheumatology patients have the following vaccines if offered and are eligible.
Flu vaccine (yearly).
COVID vaccine (yearly).
Pneumococcus vaccine (one-off).
Shingles / Shingrix only (2 doses as a one-off).
Patients on biologics and some DMARDs: do not have live vaccines, as you are immunosuppressed. Examples of live vaccines include Varicella, MMR, TB, oral polio, yellow fever, and rotavirus. Do not have these vaccines without discussing it with your Rheumatology team.
*If you are treated with Rituximab, we recommend you have vaccines 2 to 4 weeks before your next Rituximab.
*Stopping methotrexate for 2 weeks after your COVID-19 or flu vaccine may increase the vaccine's effectiveness. Please discuss this with us if needed.
What should I do if I am travelling with medications?
Take all your medication with you. If you need it, request extra medication in good time.
If you are taking injectable medication, ask your home delivery company or Rheumatology for a travel letter. Tell your airline that you need to carry your injections on board. This is not needed if you take tablet medication.
Carry your medication in the cabin in its original, labelled packaging. The hold can be too cold and could damage your medication. If your medication needs to be refrigerated, you will can buy an insulated travel bag.
At your destination, make sure your medication is stored the same way you would store it at home. For example, keep it in the fridge if needed.
If you are using injectables, make sure you can dispose of your used medication safely. You may need to carry a sharps bin.
To reduce your risk of a flare-up, do not stop taking your medications when travelling.
If you are going to miss your routine blood monitoring tests, re-schedule your appointment before you travel. For extended trips, discuss alternative arrangements with your GP.⚠️Always get health insurance before you travel, in case you fall ill.⚠️
I am planning to have a baby, what should I do with my medications?
Please discuss pregnancy plans with your Rheumatology team at least 6 months before you try to conceive. This is important because:
Some drugs used to treat rheumatic conditions can harm an unborn baby. Your treatments may need to change before you try for a baby.
Your rheumatic disease needs to be well-controlled before you try for a baby. A better-controlled disease is linked with more successful pregnancies.
If you have an unplanned pregnancy, please contact your GP and Rheumatology team as soon as possible.
For fathers, most medications are considered safe. Only cyclophosphamide will affect a baby. Sulfasalazine may reduce male fertility. Please speak to your GP or Rheumatology team if you have not conceived after a year of trying.
We hope this information sheet answers some of your questions. If you have any further questions or concerns, please speak to your GP or a member of the Rheumatology team.
[Web sites last accessed 25 June 2026]
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