Conditions - Rheumatology Service

Rheumatoid Arthritis

Rheumatoid arthritis is a condition that causes pain and swelling in the joints. Hands, feet and wrists are commonly affected, but it can also affect other parts of the body. Rheumatoid arthritis can make your joints feel stiff and can leave you feeling generally unwell and tired.

The condition is estimated to affect thousands of people in Ireland and occurs more frequently in women than men. It is most common between the ages of 40 and 70, but it can affect people of any age.

Rheumatoid arthritis is an autoimmune disease. This is when your immune system, which usually fights infection, attacks the cells that line your joints, making them swollen, stiff and painful. Overtime (if not effectively treated), this can damage the joint itself, the cartilage and nearby bone.

The symptoms of rheumatoid arthritis usually vary over time. Sometimes, symptoms only cause mild discomfort. At other times, they can be very painful, making it difficult to move around and do everyday tasks.

When symptoms become worse, this is known as a flare-up or flare. A flare-up is impossible to predict, making rheumatoid arthritis difficult to live with.


Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Fibromyalgia is a common illness. In fact it is more common than RA. People with mild to moderate cases of fibromyalgia are usually able to live life as normal.

Pain videos

Understanding pain in less than 5 minutes (Youtube video)

Tame the Beast – Lorimor Moseley (Youtube video)


People often describe vague muscle aches as "stiffness," but when doctors talk about "stiffness," they mean that a joint doesn't move as easily as it should. Stiffness may be prominent even when joint pain is not. Joint stiffness can have considerable impact on your daily life and work.

Mild morning stiffness is common in osteoarthritis and often goes away after just a few minutes of activity. Sometimes people with osteoarthritis also notice the same type of stiffness during the day after resting the joint for an hour or so. In inflammatory arthritis, however, morning stiffness may not begin to improve for an hour or longer. Occasionally, prolonged joint stiffness in the morning is the first symptom of an inflammatory condition. Joints affected by inflammatory arthritis can feel very stiff, e.g. if your hands are affected, you may not be able to fully bend your fingers to form a fist. Like joint pain, the stiffness is often worse in the morning or after a period of inactivity.

Here are some things that you can try to help ease morning stiffness:

  1. Plan ahead; Discuss with your team about timing your anti-inflammatory medications.
  2. Exercise in bed; set your alarm for a few minutes earlier than you need to be up at. Stretch gently and do some gentle range of motion exercises. It helps to warm up your muscles and loosen your joints. Discuss with your physiotherapist what exercises are suitable for the joints that are affected.
  3. Have a warm shower; the heat causes the blood to move to the surface of the skin, warming the joints in the process.
  4. Warm your clothes on a radiator or briefly in the dryer. Heat can help.
  5. Use heat packs/hand warmers/warm clothing, especially on chilly days.
  6. Move your body every day: Inflammatory conditions can make exercise difficult. While it is important not to stress or strain a joint while it is in flare, you should still try to move all the other joints. When not in flare you should aim to build up to 20-30 minutes of activity every day (more if you are able to). Keeping your body fit and strong can reduce the amount of time it takes to relieve stiffness and get going in the morning.
  7. Don’t stress, ask for help: Mornings tend to be busy anyway, but when your joints are stiff and painful, things may be even more difficult. Don’t be afraid to ask for help, family and friends are usually happy to be of assistance.
  8. Be mindful; Take time for yourself every day. Managing stress can help you cope better with your condition.

Check out the Arthritis Ireland website, under “Get Help” click on “Take control with Exercise”.

Worry and anxiety videos

The Unwanted Party Guest – Joe Oliver (Youtube video)

Struggling With Internal Hijackers (Youtube video)

90:10 What is the single most important thing you can do for your stress – Dr. Mike Evans (Youtube video)

Sleep disturbance videos

Do you practice good sleep hygiene? Mayo Clinic Minute (Youtube video)

Sleep hygiene – How to Sleep Better! (Youtube video)

11 Sleep hygiene tips by SleepZoo (Youtube video)

Additional videos

23 and ½ hours - Dr Mike Evans (Youtube video)

What’s the best diet: Healthy eating 101 – Dr. Mike Evans (Youtube video)

Are you sitting too much? (Youtube video)

Values vs Goals – Russ Harris (Youtube video)

The Sushi Train Metaphor – Russ Harris (Youtube video)

Patient Information Leaflets

Here are some really good patient information leaflets from NHS Ayrshire and Arran Trust:

  1. Understanding Pain (PDF)
  2. Managing Activity (PDF)
  3. Flare-ups and Pain (PDF)
  4. Sleep and pain (PDF)
  5. Setting Goals (PDF)
  6. Exercise and Pain (PDF)
  7. Persistent Pain Booklet (PDF)

Mindfulness Audio Tracks

Joint hypermobility syndrome

Hypermobility means your joints are more flexible than other people's joints. Flexible = able to move more or have a greater range. You may think of yourself as being double-jointed.

When this causes pain, it may be due to joint hypermobility syndrome.


While it is not urgent, you can arrange to see your GP if you:

  • often get pain or stiffness in your joints or muscles
  • are prone to keep getting sprains and strains
  • have episodes of subluxing or dislocating your joints (joints "pop out")
  • have poor balance or co-ordination
  • have thin, stretchy skin that bruises very easily
  • have digestive problems like diarrhoea or constipation
  • have weak pelvic floor muscles (the muscles that control your bladder and bowel function)

These may be symptoms of joint hypermobility syndrome.

Your GP will usually test the flexibility of your joints using the Beighton score.
They may refer you for a blood test or X-ray to rule out any other conditions like arthritis.

Treating joint hypermobility syndrome

There's no cure for joint hypermobility syndrome.The main treatment is learning to manage your symptoms by improving muscle strength and fitness so your joints are protected.

Ask a GP to refer you to a physiotherapist or occupational therapist for specialist advice. You can also arrange to go to see them privately.

They can help you:

  • understand your pain
  • self manage your risk of subluxations/dislocations
  • improve muscle strength and fitness
  • improve posture and balance

Treating joint pain

Paracetemol or anti-inflammatory painkillers (like ibuprofen; tablet, gel or spray) may help ease your pain. Talk to your pharmacist about the best treatment for you.

To help ease joint pain and stiffness, you can:

  • have warm baths,
  • use hot water bottles,
  • use heat-rub cream.

Joint care you can do yourself

If you have joint hypermobility syndrome, there are things you can do to improve joint and muscle strength, and reduce strain.


  • gentle low-impact exercise like swimming or cycling (not doing any exercise can make your symptoms worse),
  • maintain a healthy weight,
  • buy good, firm supportive shoes,
  • if you have flat feet, use special insoles (support arches) in your footwear.

Do Not

  • do high-impact exercise especially if it impacts your symptoms,
  • overexercise,
  • grip things too tightly,
  • overextend your joints just because you can.

What causes joint hypermobility syndrome?

Joint hypermobility syndrome usually runs in families and cannot be prevented.

Usually, the joints are more flexible because the tissue (collagen), that should make them strong and support them, is more stretchy than normal, allowing for greater movement. This is why it is very important to strengthen the muscles around the affected joints, as they act to support the collagen in reinforcing/protecting the joint.

You really don’t need weak muscles around a flexible joint that is symptomatic.

Adapted from NHS webpage 08/2020

Joint Hypermobility Information Booklet (PDF)


Axial Spondyloarthritis (axial SpA) is an inflammatory arthritis where the main symptom is usually back pain. Axial spondyloarthritis is an umbrella term and it includes:

  • Ankylosing Spondylitis (AS): Where changes to the sacroiliac joints or the spine can be seen on x-ray.
  • Non-radiographic axial spondyloarthritis: Where x-ray changes are not present but inflammation is visible on MRI or you have symptoms.

Typical symptoms of axial SpA (AS):

  • Slow, gradual onset of pain and stiffness in the back over weeks or months.
  • Early-morning stiffness and pain, which generally reduces during the day with movement or exercise.
  • Symptoms lasting for more than 3 months.
  • Feeling better after movement and worse after rest.
  • Fatigue or tiredness.

If left untreated it can be a painful, progressive form of inflammatory arthritis. It mainly affects the spine but can also affect other joints, tendons and ligaments. It can be associated with inflammatory bowel disease, inflammatory eye conditions and psoriasis.

The Occupational Therapist (OT) can assist you by supporting you to stay in work, or get back to work. Ask for nurse or doctor for a referral to OT if this is something you need. 


Symptoms can sometimes interfere with your ability to perform your duties at work. Pain and fatigue can have a significant impact on what you want and need to be able to do at work.

Work is good for your health – as well as improving financial security, it can boost health and happiness.

For more information, click on the links below:


Osteoarthritis (OA) is the most common joint disorder. It is a clinical syndrome of joint pain accompanied by various degrees of functional limitation and reduced quality of life. While it generally affects the elderly population, it should not be considered a consequence of aging.

In OA, the bottom of the thumb, and the small joints of the fingers are often affected. This can cause pain, weakness and problems with your grip. You may find that some of your regular daily activities become difficult and painful. There are many different options that can help, including:

  • Strengthening the muscles that support the joints
  • Changing the way you do things, modifying your grip
  • Using equipment such as jar openers, and tools with larger handles
  • Using splints and gloves to support painful joints
  • Pain relief, such as anti-inflammatory gels and paracetamol

The knee is one of the most commonly affected joints. Osteoarthritis causes the cartilage in your knee joint to thin and the surfaces of the joint to become rougher, which means that the knee doesn’t move as smoothly as it should, and it usually feels painful and stiff. Osteoarthritis can affect anyone at any age, but it’s more common in women over 50. The genes we inherit from our parents can also increase the risk of the condition developing. Being overweight is also linked to osteoarthritis, as this causes extra strain on weight-bearing joints, such as your knees. A rehabilitation programme for people with chronic joint pain of the knees or hips that integrates educational self-management and coping strategies with an exercise regimen.

Foot Problems

Feet have a complex structure consisting of 26 bones, more than 30 small joints (where bones meet) and many muscles, tendons, ligaments and nerves.

Pain or problems in the foot and ankle are often, but not always, associated with arthritis.

Most feet have an arch shape that spreads the body's weight evenly over many bones and joints. The structure of the foot changes as we get older or if arthritis affects the foot joints, and many people will notice changes, particularly in the arch of the foot.

Even if you don't have any significant health conditions, you should still seek help if there is:

  • Ulceration of the skin (a break in the skin), or if it is infected.
  • Poor circulation/blood flow to the area.
  • Pain for more than three months.
  • A change whereby symptoms are noticeably worse.
  • A change in the colour of your skin, especially if it's dark blue or black.
  • Progressive changes in the shape of your foot.

You should also seek help from your GP if you:

  • suddenly develop foot problems
  • have increased swelling
  • are taking drugs which suppress your immune system (including steroids or biologics), or if you have a history of poor skin healing