Specialist physiotherapy, occupational therapy and podiatry are all used in the non-pharmacological management of RA and are usually available via secondary care specialist teams. Patient education is important to enable them to cope with their condition. Exercise and rest have a key role to play and it is particularly important that they understand about pacing. 

Supporting self-management of RA

Pharmacy teams may see a patient that is experiencing a flare-up purchasing OTC analgesics. Advice on how patients can help themselves during a flare-up could include:

• Identifying potential triggers for a flare-up (e.g. overdoing it)
• Using cold therapy to soothe hot, red, swollen joints, or warm therapy to relieve stiff joints. Alternating between hot and cold therapy can be useful 
• Balancing activities with plenty of rest during a flare-up 
• Using gentle stretching and a range of motion exercises to help improve joint function. Movement can help keep joints flexible, reduce pain and improve balance and strength
• Considering doing stress-relieving activities such as yoga, deep breathing and meditation
• Speaking to a GP or specialist rheumatology team if the flare-up is severe or does not resolve and a prescription for corticosteroids is needed
• Assessing the frequency and severity of flare-ups and, if happening regularly, speaking to their GP or specialist rheumatology team in case a review of disease modifying medication is needed 
• Establishing how the flare-up is impacting their daily life and encouraging the patient to ask for help if a support network is available.