Write to us at: Inspire, 1 Cambridge Technopark, Newmarket Road, Cambridge, CB5 8PB, or email inspire@versusarthritis.org Ask the doctor Whether its a health niggle or emotional problem, DR SARAH JARVIS gets straight to the point Q I havent had a hospital appointment for almost a year. Has the treatment for rheumatoid arthritis changed much? Dr Sarah Jarvis answers: Many people with long-term conditions have missed out on appointments since COVID-19 burst onto the scene. However, the National Institute for Health and Care Excellence (NICE) has worked on assessing the evidence and producing recommendations for improved treatments throughout the pandemic. In June 2021, it produced new guidance on the use of several biological medicines for treating moderate rheumatoid arthritis. Biological medicines block chemicals in the body that lead to inflammation. In different conditions, different chemicals are involved for instance, in rheumatoid arthritis, tumour necrosis factor alpha (TNF-alpha) plays a major part in inflammation and damage to joints. Treatment for rheumatoid arthritis aims to reduce pain and damp down inflammation, helping to reduce joint damage. The mainstay of treatment for this is DMARDs disease-modifying anti-rheumatic drugs. The first DMARD offered is often methotrexate: this can be really effective, but doesnt work for everyone, and some people cant take it because of side effects. A group of medicines called anti-TNFs, which help block the action of TNFalpha, have been recommended for some years for people with severe rheumatoid arthritis, if their condition has not responded to other treatments. In medical terms, whether you have mild, moderate or severe rheumatoid arthritis will depend on assessments by your doctor. NICE has now recommended that people with moderate rheumatoid arthritis can be considered for treatment with three anti-TNFs adalimumab, etanercept and infliximab if their symptoms havent been controlled adequately by at least two other DMARDs. Unless theres a medical reason you cant take methotrexate, the anti-TNF would be prescribed in combination with this drug. Ask the expert CATHERINE HASTINGS is a helpline advisor for Versus Arthritis Q How do I prepare to get the most from my GP appointment? Catherine answers: Perhaps jot down the main things you want to ask, and think about the most important questions first. Try to give the GP a picture of all the symptoms you have been having, and for how long. This can help your GP to make a comprehensive diagnosis. You could ask your GP if, based on your symptoms, you need to have any further tests, such as blood tests or X-rays, or a referral to a specialist. Blood tests can help rule out or confirm the inflammatory types of arthritis. If you are given medication, ensure you know for how long you are meant to take it, how long it is likely to be before it will work, possible side effects, and what to do if you experience any. Your GP might also give you information about exercise, or refer you to a physiotherapist. If they suggest this, you could ask about self-referral, which can sometimes speed up the process. It can be a challenge getting an appointment at present, but if you need medical attention, dont put it off. Your GP will assess the risks and triage you as to whether you need a face-to-face or telephone appointment.