your primary care

You’ve decided to go to your GP about painful joints that may have been bothering you for some time, or you may have woken up one morning and have not been able to get out of bed. These are common scenarios for New Zealanders, who tend to wait before seeing a GP about painful joints. Most commonly, they blame their pain on an injury through work, around the home or sports. Being such an active bunch of people, it is easy to explain symptoms this way.
Patient Tips:
  • People often relate their story of symptom onset to a GP. Try not to! Be helpful when they aske questions about injury or occupational overuse, but otherwise, let the GP work through a process without a providing them with a scenario that may encourage them to go in a certain direction.
  • Work as quickly as you can to get a diagnosis. Your symptoms may remain stable, but they can deteriorate rapidly. Do go back to your GP if your condition worsens and/or if you are struggling to cope – physically or emotionally – don’t go it alone! I

You and Your GP

During your consultation, your painful joint/s will have been examined, but also other joints, and places on your body if the GP suspects inflammatory arthritis. You will have been asked questions that help in the decision-making, including how your joints feel in the morning and how long it takes for them to come right. How long they are “stiff”, “sore” and/or “painful” after sleep or other inactivity is an important factor in distinguishing IA from other reasons for your symptoms. The GP will most likely perform a simple squeeze test on sore hands or feet to help with the diagnositic process. You will almost certainly ask about your overall health and if there have been any changes to energy levels over the last few months.

Based on these investigations, the next step, if IA is suspected (or to be ruled out) is a blood test. The results from this are used to find out if there is any inflammation present in your body and if there are any markers for inflammatory disease. If these markers are negative it does not mean you do not have RA or another IA. Blood tests are only part of the diagnositic process. However, if they are highly positive for a marker called the Rheumatoid Factor (RF) of Anti-CCP, then it is very likely you have Rheumatoid Arthritis.

Your GP may prescribe a Non-steroidal Anti-inflammatory medication (NSAIDs) like prescription-only Diclofenac (similar to over-the-counter Voltaren) to help you manage the pain and discomfort of inflamed joints while waiting for the results.
The diagnostic process at the GP level may be a long, slow process. There are many diseases and conditions that have similar symptoms to an IA and often IA does not present itself with classic symptoms that the GP may expect. Be patient, but assertive if your symptoms do not improve. If your symptoms worsen treat this with some urgency. Early treatment is often the most important factor in successful management of an IA disease.

Managing IA with your GP

  • In Taranaki, not everyone with an IA is referred to a rheumatologist. People with mild disease and/or have negative RA results from blood tests might treated for a time by their GP if their condition remains stable and manageable. Your GP can prescribe the medications and refer to the allied health professionals you may need.
  • For many people, whether referred to the rheumatology clinic, or remaining under GP care, the time between the diagnosis of a suspected IA and stabilisation on a treatment plan is a distressing time.
  • If your condition deteriorates or you need extra support with personal care, home help or transport to and from appointments contact your primary care provider to discuss your needs and criteria for assistance.

Creating a management plan with your GP practice creates the best opportunity for meeting your health needs.
Creating a Management Plan
sometimes I think I'm teaching my GP as we go, J.D
All IAs, have the potential to cause health conditions beyond the impact on your joints. The medications prescribed for your IA, like most medications, have side effects. These medications require close monitoring to make sure they are doing their job and that they are not causing any problems.

Patient Tips:
  • Be proactive – recognise your condition has many variations, so even if your GP is experienced in diagnosis and management of your condition, you, as a patient, are the expert in how IA affects you. Ask questions and keep the lines of communication open.
  • Have your blood tests as recommended by your rheumatologist or GP. This will likely be once a month if you are taking any form of DMARD. The lab can give you a repeat tests card to simplify the process.
  • If your GP has ‘managemyhealth’ sign up and check the results of your tests and the doctor's notes. If you don’t have managemyhealth account, contact your primary car practice by phone or email to get the results. You don’t need to know what they are all about, but depending on underlying concerns, the CBC, Liver Function tests and CRP results (actual figures) can help you track how well you are doing on your medications.
  • Over time, there are other health conditions associated with IA. Your GP is best placed to monitor your health, to plan regular health check-ups and specifically keep an eye on heart health, infections, and bone health. There is a known relationship between RA and oral health so see your dentist regularly. Having regular check-ups with a GP who knows your overall health profile is an important anchor in your health management plan for ensuring the best outcomes for you.

As well as potentially serious complications from IA and medications there are other factors that may prevent you living a full life. Your primary health carer may be able to help you find help with some of these barriers to living a full life, or provide advice about where to get help. A
The cost of care
A major barrier to using primary healthcare as the manager of IA health is the cost of multiple appointments. The time between diagnosis and finding effective medication can be extremely difficult whether you are referred to the Rheumatology clinic or a treated by your GP. It may be that you will need to have multiple visits with your primary care providers for medication, or for assistance to cope with everyday life. In the early stages of your journey. Your GP clinic can connect you with many of the service you might need, but may not suggest them to you, don't be afraid to ask if you feel you need assistance with allied health and support services like:
  • Physiotherapy
  • Occupational Therapy
  • Green Prescriptions for subisidised activity (e.g. swimming pools)
  • Sick notes for your employer or education provider
  • Assistance with transport to appointments
  • Counselling services
  • Home help
  • Personal care
  • Childcare

If you are on a low income and have a Community Services Card there may be low or no cost options for you, but some of these options may have long waiting times. For people on higher household incomes and no medical insurance the options for cheaper services are limited. Ask your GP about integrated care through CarePlus, which is usually available to high needs patients with two or more conditions.
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Cautions apply with this information: Despite commonalities in IA processes and treatment, we're all individuals. Your unique circumstances may affect processes and appearance of your IA. Referral processes and resources available to you can also vary by area.

ALWAYS seek clarification from your medical team
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