The Rheumatology Department is based in the Churchill Unit at Weston General Hospital.

This can be found by entering the hospital through the main entrance and immediately following the corridor to your left. Follow this corridor to the very end where you will find the Churchill Unit.


What is Rheumatology?

It is a division of medicine that involves the evaluation and treatment of the rheumatic diseases and conditions. They are characterised by symptoms involving the musculoskeletal system. Many of these diseases also feature immune system abnormalities.


What is a Rheumatologist?

A Rheumatologist is a doctor who is qualified by additional training and experience in the diagnosis and treatment of arthritis and other diseases of the joints, muscles and bones.


What kind of training do Rheumatologists have?

After four or five years of medical school and a number of years of training in general medicine, Rheumatologists devote an additional four years to specialised rheumatology training.


What do Rheumatologists treat?

There are over 100 rheumatic diseases. Some of the most commonly treated are as follows:

  • Rheumatoid arthritis
  • Osteoarthritis
  • Fibromyalgia
  • Vasculitis
  • Systemic lupus erythematosus
  • Scleroderma
  • Spondyloarthropathies
  • Gout
  • Polymyositis
  • Infectious arthritis
  • Polymyalgia rheumatica
  • Psoriatic arthritis
  • Bursitis
  • Tendinitis
  • Osteoporosis


What might the treatment involve?

Most rheumatic diseases cannot be cured but effective treatment can allow people who have these conditions to live pain-free and active lives.

Treatments include pain relief, medication, exercise, dietary control, rest and relaxation, and education on how to best manage the condition. Other treatments may include the use of appliances, such as splints or braces.

It is important that the doctor and the patient work together to develop a treatment schedule that helps each patient maintain or improve his or her lifestyle. In some difficult conditions a combination of treatments may be required.


Drug treatments in Rheumatology

  • Analgesics (painkillers) - such as paracetamol. These help to relieve pain.
  • Anti-inflammatory drugs – such as ibuprofen. They help relieve pain, stiffness and swelling in joints.
  • Disease Modifying Drugs – such as Methotrexate. They help to suppress the activity of the Arthritis and prevent or reduce damage to the joints. These drugs require medical supervision, and blood tests to monitor patients safely.
  • Steroids - are powerful, natural anti-inflammatory agents and can be used both in injection and tablet form. They are used with care as they can have side effects.
  • Biologic Drugs - are a new group of drugs used for various rheumatic diseases.


When should you see a Rheumatologist?

A lot of musculoskeletal pains are temporary and self-limiting. But sometimes, pain in the joints, muscles or bones is severe or persists for more than a few days. At that point, you should see your doctor.

Many types of rheumatic diseases are not easily identified in the early stages. Rheumatologists are specially trained to do the detective work necessary to discover the cause of swelling and pain. It's important to determine a correct diagnosis early so that appropriate treatment can begin early. Some musculoskeletal disorders respond best to treatment in the early stages of the disease.

Rheumatic diseases can be complex, chronic disorders and therefore long-term follow up may be necessary. These diseases often change or evolve over time and changes to the treatment plans are common. Rheumatologists work closely with patients to create plans that are acceptable to both parties.


Who else may I see as part of my treatment?

Rheumatic diseases are best managed with the help of the multi-disciplinary team. Team work is important, since musculoskeletal disorders can be chronic. We often rely upon the help of many skilled professionals including specialist nurses, physiotherapists, occupational therapists and podiatrists. Health care professionals can help people with musculoskeletal diseases and their families cope with the changes the diseases cause in their lives.

Rheumatologists may also need to work closely with other doctors such as:

  • Orthopaedic surgeons (who perform joint replacements, soft tissue reconstruction and repair and nerve decompression).
  • Radiologists (who report on X-rays, CT, MRI and ultrasound scans).
  • Dermatologists (who diagnose and treat skin diseases).
  • Respiratory physicians (who diagnose and treat lung problems).
  • Gastroenterologists (who diagnose and treat disorders of the gastrointestinal tract).
  • Neurosurgeons (in particular for neck and back problems).

Your consultant will always keep your own GP fully informed of your clinic reviews.


What services do we offer?

We run a variety of clinics including:

  • General Rheumatology clinics (Mon am/pm, Wed pm, Thurs am, Fri am)
  • Early synovitis clinic (Monday am)
  • Connective Tissue Disease clinics (1st Thursday of the month am)
  • Joint Injection clinics (Wednesday am)
  • Ankylosing Spondylitis clinic (2nd Friday of the month am)
  • DEXA scan reporting and Osteoporosis case review
  • Medical Student Teaching clinics (Some Thursday's am)
  • Nurse-led Osteoporosis clinics
  • Nurse-led General Rheumatology clinics (Monday and Friday)
  • Nurse-led Blood monitoring clinics (Wednesday)


We have access to a number of radiological investigations on-site including:

  • Plain X-ray
  • Ultrasound
  • CT scanning
  • MRI scanning
  • Bone densitometry scans (DEXA)


We offer day-case care in the Hospital's ATC unit for certain drug infusions (bisphosphonates, biologic drugs, methylprednisolone).

Any patients requiring in-patient care or certain types of day-case care (cyclophosphamide infusions) are admitted to Trym ward at Southmead Hospital (Bristol). Our Consultants/Registrar visit the ward weekly on a Tuesday morning.


Rheumatology Helpline

The telephone helpline is well established and has been available for a number of years now. It is run by our Specialist Nurses. Patients with rheumatic diseases use the advice line for different types of reasons, but the majority of calls are for:

Medical issues that the Nurse Specialist can provide information and advice about. Blood test enquiries. Flare up of arthritis and the need for an earlier appointment to review their treatment. Medication advice or information. Emotional and psychological support. Information related to local services or access to other organizations related to their disease.


The role of the Rheumatology nurse specialist

Specialist Nurses have a patient and carer centred approach to care, and the services that they provide are described below.


Patient Education and Information

Relating to the disease process and treatment options available. About specific drugs that you may be prescribed and the monitoring required. Pain management and coping with flare ups. How to cope with disease and life style issues.


Nurse Run Clinics

The nurse will be able to spend time with you answering any questions that you have related to your disease. During these clinics the specialist nurse will be able to offer the following services:

  • Physical assessments of your joints.
  • Monitoring of the safety and effect of your drug treatments.
  • Review of your blood tests.
  • Rapid access to emergency clinic appointments following a helpline enquiry.
  • Liaison between your GP and other members of the Rheumatology Team.
  • Referral onto other members of the team, for example occupational therapists, physiotherapists, and podiatrists.
  • Request the opinion of a Consultant Rheumatologist if a particular problem arises that the Nurse Specialist is unable to deal with.


Anti - TNF Drugs and Monitoring

The Nurse Specialist is responsible for assessing people who might be suitable for Anti-TNF medication and providing information about the medication. Once patients have been assessed and found to fit the criteria for Anti-TNF medication, the Nurse Specialist ensures that patients are monitored regularly in order to assess their response to treatment and any possible side effects.


The role of the Physiotherapist

Physiotherapists are health care professionals who help people resume an active and independent life both at home and at work. They are experts in assessing movement, addressing individual needs, helping to improve function, and managing pain.

Some of our physiotherapists specialise in treating people with arthritis, which affects people in different ways. They can provide you with appropriate aids, such as a walking stick, and teach you how to use these. They also teach you how to protect your joints.

Exercise is an important part of your treatment. The Physiotherapists will help show you how to exercise appropriately and safely. Exercise can help you to:

Have less pain Have more movement in your joints Have strong muscles Prevent deformities in your joints Maintain good posture Feel fitter Do your daily activities more easily.

You should try to perform your exercises at least once every day, even if your joints feel stiff (you may need to take painkillers beforehand if necessary).

If you are having a flare of your arthritis, reduce the number of exercises you do but continue to exercise each joint at least once to prevent you 'seizing up'.


The role of the Occupational Therapist

An Occupational Therapist, or OT, is a trained health professional who works with people of all ages, helping them to carry out everyday activities and lead fulfilling lives.

Occupational Therapy is a way of helping individuals to do the things they want and become much more independent. In this context 'occupation' means any way in which people spend their time, from personal care (getting dressed, cleaning their teeth, shopping); to productivity (paid or unpaid work, housework or school); to leisure (sports, games, hobbies, social life).

OT's can help by

  • Giving practical advice on how you can overcome everyday problems
  • Making everyday activities easier Providing or advising about specialist equipment
  • Offering advice about employment and leisure activities
  • Discussing your condition and what you can do to help yourself Providing splints to rest or support painful or unstable joints
  • Providing joint protection advice
  • Providing advice on fatigue management
  • Preventing loss of function Improving / maintaining psychological status
  • Providing advice about relaxation techniques

Our OT has developed specialist skills in treating people with arthritis.


Medical Student Teaching

Staff in the Rheumatology Department are involved in teaching third year medical students from the University of Bristol about musculoskeletal problems. We usually have a group of 5-6 students at any one time. All students understand the need for confidentiality and have had lectures and seminars on its importance.

If you are happy to have students present then we are thankful to you. The best way for them to learn is to see patients with problems that they may have to treat in the future. It is hoped you will find this an enjoyable and interesting experience.

The students will generally sit in with the doctors/nurses during the clinics to learn more about musculoskeletal problems. There will not usually be more than 2 students with each doctor/nurse.

On some Thursday mornings we run medical student teaching clinics. These are slightly different in that you will be seen and assessed by the student/s initially. The students will ask questions about your illness and other medical conditions you may have. They may ask to examine your joints. The appointments generally take longer (up to an hour). A doctor will then come in and see you with the student to decide on an appropriate plan of action.

Please feel free to give the students any feedback if you feel it is appropriate.

If you do not wish to have medical students present during your consultation then please inform the staff in the unit. This will not compromise your care in any way.


What to expect at your appointment

If you are unable to keep your appointment please call 01934 647151 to inform our receptionist as soon as possible so that your appointment time can be offered to someone else.

Please bring a list of all your current medications and dosages. If you have had a previous rheumatology appointment and have been given a drug monitoring booklet please bring this too. You should also bring a sample of urine for routine testing.

It may also be helpful to write down any specific concerns which you wish to discuss at your appointment.

Each time you come for a rheumatology clinic you will be booked in by our receptionist. You will then be seen by a health care assistant (HCA) or nurse, who will weigh you, check your height, body mass index (BMI) and blood pressure and test your urine sample.

At your first clinic appointment you will be seen by a member of the rheumatology team; this will be one of the medical team. You will be asked about your general health, previous medical history, what medication you take and if you have any drug allergies. Any relevant family history will also be noted. If a physical examination is necessary you may be asked to partially undress. If you need assistance, one of our staff will be available to help you, and a chaperone will be available if you wish. Further investigations such as blood tests or x-rays may be needed before a further appointment is arranged.

Following your clinic appointment you may need to start new medication. You will usually be given a prescription which can be dispensed by any pharmacy, or you may be advised to consult your own doctor for this. You will generally only be issued with a small supply of medication and will need to obtain further prescriptions from your GP.

Regular blood tests are often required when taking many of the disease-modifying treatments used in rheumatology and it is important that you have these tests – you will be told how often tests are needed for your treatment program. The blood tests are usually arranged at your GP practice.

Sometimes conditions will not require further follow-up from the rheumatology team and if this is the case you will be discharged back to the care of your own GP. More often, a further appointment will be arranged.



The Weston Rheumatology Department is active in research and currently has a number of projects in progress, all of which help to further our understanding of rheumatological conditions and may lead to the development of new treatments.

You may occasionally be asked if you would like to take part in a research study and we appreciate your help in this: patient participation is extremely important, not only locally, but nationally and internationally. However, there is absolutely no pressure to participate if you prefer not to do so.