• Smoking: check that patients are aware that smoking increases the risk of RA, can exacerbate the condition and also make some RA treatments less effective. 
• Diet and weight: obesity is a risk factor for RA and puts more strain on joints. Pharmacy teams are well-placed to discuss weight management with patients who may also want advice about potential trigger foods for joint symptoms and the food types and supplements that may have a protective effect.  There is no strong evidence for the benefits of a particular diet in RA but patients should be advised to follow a healthy, Mediterranean diet rich in healthy oils, fish and vegetables. Patients should also include foods rich in calcium and vitamin D (e.g. dairy and green leafy vegetables) due to the risk of osteoporosis. It is important that a patient keeps well within the national recommended limits for safe alcohol intake, although some specialist teams recommend a lower limit for patients on csDMARDs, particularly methotrexate. 
• Exercise: Regular exercise is beneficial as it can help ease stiffness, improve joint movement and strengthen muscles, as well as improving general fitness. Patients should consider a combination of stretching, strengthening and cardiovascular training and can be guided by a specialist physiotherapist. Hydrotherapy may also be beneficial. Low impact or gentle activities such as swimming, tai chi, Pilates or other gentle exercise are also beneficial to keep joints moving. 
• Mental wellness: living with a chronic health condition such as RA can affect a patient’s mental health, not just their physical health. Information resources are available to help with this and specialist teams often have a health psychologist and run patient groups.

Reflective exercise

Think about what you have learnt in this module and how it applies to your own practice:

• Is there a particular change you can make to help support patients living with inflammatory arthritis?
• If so, how might you go about achieving this?
• What impact do you think this might have on patients?