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Rheumatology Frequently Asked Questions

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I’m having a flare of my arthritis, what should I do?

Flare-ups are the periodic increases in your usual amount of pain, which may last from a couple of hours to a couple of days or longer.

How you manage them can have a major influence on the impact they have on your overall quality of life.

It may be helpful to think of factors that may have added to your usual day to day pressures, as it is often an accumulation of factors that can cause a flare. It can be helpful to try and notice any triggers. Keeping a record of your daily activity and level of pain or fatigue can help with this. Have you done anything differently recently, or are you coping with any additional life events that feel quite stressful, worrying or distressing?

Think of what could be helpful to self-manage your flare. Some ideas include:

  • Regular pain relief,
  • Hot and cold treatment (such as wheat bags or ice packs)
  • Pacing, prioritising, problem solving
  • Keep active – keep gentle stretches going when possible
  • Delegate or ask others for support
  • Take time out for yourself

There is additional information on managing in a flare on the website.

If you have tried your flare up plan for two weeks and you are still struggling, please call the advice line to discuss your symptoms with one of the team. Further management strategies may involve changes or additions to your rheumatology medications, and / or a referral to another specialty in the team such as physiotherapy or occupational therapy.

It will be helpful to take a photo of your symptomatic joint (s) as sometimes flare ups ease when you are seen face to face.

It may be helpful for you to record your symptoms on the Living Well with Rheumatoid Arthritis app.  We can see this information and then better advise you on how to manage your symptoms over time. Please call the advice line for us to enrol you.

If you find that one of your joints is hot and swollen, if you have a temperature or feel unwell please seek more urgent advice.

Side effects to medication

All medications can have potential side effects. It may also be worth considering other causes of symptoms, such as allergies (hay fever, known food intolerance) and new washing detergents.

Please see the film called ‘medications’ for further information. This is in the ‘information for newly diagnosed patients’ on the rheumatology website.

 

Here are some ways to help minimise potential side effects:

  • Take your methotrexate at night time to minimise feelings of nausea
  • Increase your folic acid to 6 out of 7 days to help with methotrexate side effects
  • Ask about a tablet to protect your stomach if you are taking oral steroids for a long period or a non-steroidal anti-inflammatory (ibuprofen).
  • If you are having side effects from sulfasalazine, and have just started this, it might help to increase your sulfasalazine dose at a slower rate.  Please call the rheumatology advice line to discuss this.

To help minimise injection site reactions:

Injection site reactions are different to an allergic reaction they are generally mild and resolve after a few days.  The symptoms can include mild swelling, itching, pain, redness, warmth, rash. To help with these symptoms some suggestions include:

  • Please take injections out the fridge 30 minutes before use.
  • Ensure you inject in the manner you have been taught by the nurses in your rheumatology team or home care provider.
  • Use a cold pack before and after the injection
  • Use pain relief such as a non-steroidal anti-inflammatory
  • Take an Antihistamine
  • Use over the counter hydrocortisone cream

If you feel you have side effects that have not responded to the above, or the reaction is larger than your fist, please call the advice line for further input.

If you have an all over body rash, chest tightness, severe itching, hives (fluid raised bumps), swelling of the lips, tongue or throat please seek urgent medical advice.

 

Stopping for surgery

If you are due to have a surgical procedure you should stop your biologic medication.  Please check the current guidance on when to do this with the rheumatology advice line team, as different biologic medications have different time frames to stop.

In general you should not stop your disease modifying drug as we would like for you to have stable disease, this puts you in a better place to recover from your procedure.

Travelling with your fridge items

Some medications need to be kept in the fridge and only taken out shortly before the injection is due. This means you need to take precautions when travelling.

Keeping your medication cool

  • Whilst travelling you can invest in a medications cool bag (such as ones made to transport diabetic medications).
  • You need to take your medication in the cabin as the hold can be too cold.
  • You can get a travel letter from your home delivery company (Sciensus, Lloyds pharmacy clinical homecare, Healthnet) which lets your airline know that you should be taking your injections on board a flight. Please let your home delivery company know in advance.
  • When you are at your destination you need to make sure your items are kept in a cool, dark space to ensure the integrity of the drug.
  • Please ensure you can dispose of your medication safely whilst travelling.

Vaccine information

Flu vaccines, are not live vaccines, and are recommended for those who are on disease modifying medication.

Should you need a live vaccine e.g. for travel reasons please contact the rheumatology advice line as live vaccines should not be administered if you are on disease modifying medication or biologic therapy.

Live vaccines include - Shingles, varicella (chicken pox), MMR, TB, oral polio, yellow fever, rotavirus.

Altered blood tests

If you are having blood tests to monitor your disease modifying medication your GP may contact us and you to get further advice,  for example if your liver enzymes are higher than normal.

This can happen from time to time and is usually returns to within normal limits when blood tests are rechecked.

Sometimes the cause can be easily identified – such as a higher intake of alcohol than normal just before your blood test. Everyone is different and we may have different advice for different people regarding altered blood tests; within the Bristol, North Somerset and South Gloucestershire rheumatology departments we have guidelines in place to help with this process.

If your blood tests identified as being too high or too low:

  • Please stop your medication and call the North Bristol Trust rheumatology advice line
  • We will then make a plan to have further blood tests or investigations and make a plan to restart your mediation at a certain point.

Complementary and alternative medications

If you have any questions regarding over the counter supplements or herbal remedies and their place in your management plan, then please call the advice line to discuss this before taking them. Some of these therapies interact with other medications.

Biologic home delivery queries

If you have queries about you biologic delivery that has not been resolved by your delivery company then please call the advice line to see if we can help.

Patient Enquiries telephone:

Sciensus (Previously known as Healthcare At Home) : 0333 103 9499

Lloyds Pharmacy Clinical Homecare : 0345 263 6135

Healthnet: 0800 083 3060

Contact Rheumatology

Rheumatology Advice Line: 0117 4140600 (this is an answer machine service, please leave a message.)
Email: rheumatologyadviceline@nbt.nhs.uk

DXA Scan Appointments: 0117 4147874

Dr Cressida Bond - Obstetrics and Gynaecology

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Dr Cressida Bond image

 

GMC Number: 6101553

Year & location of first qualification:: Dr Bond qualified with distinction from St Bartholomew's and the Royal London School Of Medicine in 2004 and has been working in Obstetrics and Gynaecology since 2005.

Specialty: Obstetrics and Gynaecology

Clinical interests: Ambulatory and emergency gynaecology, menstrual disorders, and gynaecological and early pregnancy ultrasound.

Secretary: Cherilyn Griffiths

Telephone number: 0117 4146749

Dr Bond is a member of PROMPT Maternity Foundation, British Society for Gynaecology Endoscopy (BSGE), Association for the Study of Medical Education (ASME), HEA Fellow (Advance HE).

She is the NBT Lead for the University of Bristol Year 4 Reproductive Health and Care of the Newborn (RHCN) Clerkship.

Bond

Bristol Haemato-Oncology Diagnostic Request Form

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The BHODS request form is the most efficient way to request investigations on samples sent to the service. The laboratory can supply paper copies on request or use the editable PDF form attached: 

Regional BHODS request form Sep23 v3.pdf208.56 KB

 

Bristol Haemato-Oncology Diagnostic Sample Requirements
Blood / Bone marrow Morphology Immunophenotype Peripheral blood slides x2
Bone marrow slides x3
Peripheral blood 5ml in EDTA
Bone marrow aspirate 2ml in EDTA
Cytogenetics / FISH Peripheral blood 5ml in lithium heparin
Molecular Investigations Peripheral blood 30ml in EDTA
Bone marrow aspirate 1-2ml in EDTA
MRD studies bone marrow aspirate 1-2ml in EDTA
Tissue samples Samples for histology, immunocytochemistry,
FISH, PCR clonality & molecular investigations as needed		 Bone marrow trephine in formyl saline or block
Lymph node/Tissue: fixed lymph node in formyl saline of block
Fresh tissue - please alert the laboratory 0117 4148377
Other samples Cytospin & immunophenotype as required or fresh tissue for flow CSF/Ascites/Pleural fluid in sterile container
Fresh tissue for flow (lymph nodes or core biopsies) in PBS without anticoagulant
Single sample processing is available for agreed indications. For other cases samples will be shared between laboratory techniques when necessary and possible.

Consent and sample processing
It is the responsibility of the clinician involved to ensure that the patient understands the reason for taking a tissue sample, making the request for an examination and the range of tests that may be involved. It is advisable to obtain the patient’s valid consent for testing and to remember that the initial consent is likely to involve a request to investigate what is wrong, rather than to perform a specific set of analyses. Clinicians must also consider whether or not to document the consent they have obtained. On receipt of a sample, the laboratories assume that the referring clinician has obtained valid consent. Since the field of haematopathology is changing so rapidly, it may be prudent to include consent for subsequent research investigations where possible. Biopsy samples and material produced from them may be stored with the laboratory facility within accepted operating procedures. The Genetics laboratory stores fixed material (including DNA/RNA) from new diagnostic leukaemias and patients with equivocal diagnoses. This material will be made available on request to clinical trials in which the patient has been entered.

Sample transport
The laboratories accept samples for both routine and urgent processing. Transport of urgent sample may require special transport arrangements to be made by the sender. The laboratory should be advised of the dispatch of an urgent sample.

For further information see Royal College of Pathologists: A brief guide on consent for pathologists, January 2005 & Guidelines on inter-departmental dispatch of samples from patients sent to another hospital or centre for assessment and/or treatment (2nd edition), September 2006. Professional guidance and local standard operating procedure should be followed for sending samples by post or courier.

Bristol Haemato-Oncology Diagnostic Request Form

Patient Information - Delirium

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What is delirium?

Delirium is a state of mental confusion that can happen if you become medically unwell.

It affects about 2 in 10 hospital patients but is more common in older people who may have some decline in their thinking skills. 

It can be frightening - not only for the person who is unwell, but also for those around them.

What is it like to have delirium?

You may:

  • Be less aware of what is going on around you.
  • Be unsure of where you are or what you are doing there.
  • Have vivid, frightening dreams, which may continue when you wake up.
  • Hear noises or voices when there is nothing or no-one there to cause them.
  • See people or things which are not there.
  • Worry that other people are trying to harm you.
  • Be acutely confused and agitated, have fluctuating cognition, or be sleepy/drowsy. Some people may
    fluctuate in symptoms.
  • Sleep during the day, but be more wakeful at night.

Who is at risk of developing delirium?

  • Older people.
  • People with memory problems/ dementia.
  • People who have poor hearing or eyesight.
  • Severely ill people.
  • People who have had surgery.
  • People with an infection.
  • People who are dehydrated.
  • People who are terminally ill.
  • People who have suddenly stopped drugs or alcohol.
  • People who take certain medication such as painkillers and steroids.
  • People who have constipation.

How can I help someone with delirium?

  • Stay calm.
  • Talk to them in short, simple sentences.
  • Offer support, reassurance, and reorientation if they are confused. Listen to what they have to say and give people time to respond.
  • Make sure they can see a clock or a calendar and remind them of date and time.
  • Make sure they have glasses or hearing aids that they normally use.
  • Help them to eat and drink.
  • Try to make sure someone they know well is with them. This is most important during the evenings when delirium often gets worse.
  • Bring in some familiar objects from home.
  • Have a light on at night so that they can see where they are when they wake up and what time it is.

How is delirium treated?

To treat delirium, you need to treat the underlying cause of which there are many. Common causes include infection,
dehydration, constipation, and pain. Each person may have more than one cause, for example a urinary infection,
constipation, and dehydration.

Causes will be treated accordingly and may include antibiotics, intravenous fluids, encouragement to eat and drink, along with use of medications to reduce agitation and distress if needed.

Personalised care plans will be needed and in North Bristol NHS Trust (NBT) we use the ‘This is Me’ document to gather information about the person so staff can support the person when family/ carers are not available.

We use this document for people with cognitive impairment, delirium and/or dementia so please don’t be alarmed if you are asked to complete this on behalf of someone.

How long does it take to get better?

Once the cause is treated, delirium can take several days or weeks to resolve fully. It is important to see whether the person recovers more quickly at home before making important decisions about future care.

Medical staff will let the GP know that someone has had delirium in their hospital discharge letter, so that the GP can assess this after discharge and refer on to other services if further investigation is needed. It is important that you know what has been said / sent to the GP so that you can ask for a review appointment with the GP.

Useful contacts

Ward staff should always be the first people you ask for more information.

Carers Support

CarersLine: 0117 965 2200

www.carerssupportcentre.org.uk

Alzheimer’s Society

National Helpline: 0300 222 1122

www.alzheimers.org.uk

Royal College of Psychiatrists

Web based information on delirium.

Delirium Royal College of Psychiatrists 

Delirium prevention, diagnosis and management (National Institute for Health and Care Excellence)

www.nice.org.uk/guidance/cg103/

Reference

In developing this information for local use in North Bristol Trust, the Royal College of Psychiatrists delirium leaflet accessed at the web address above was used as a basis.

© North Bristol NHS Trust. This edition published August 2023. Review due August 2026. NBT003161

It's okay to ask

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Find out about shared decision making at NBT. 

Support your local hospital charity

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See the impact we make across our hospitals and how you can be a part of it. 

SWNODN - Get Involved (Professional Membership)

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A major remit of the South West Neuromuscular Operational Delivery Network (SWNODN) is to involve our health and social care colleagues in developing services around the region. We therefore encourage you to register your interest by emailing swneuromuscularodn@nbt.nhs.uk  to take part in Project Specific Working Groups – this could be around respiratory, cardiac, genetics, disabled services, etc., depending on the priorities set by the SWNODN Executive Board.

The SWNODN team are highly specialised in neuromuscular conditions and we would encourage colleagues to utilise their skills and knowledge whenever it is felt that extra support is required. Please see Training and Development for further information on how the Network can help.

BSLTRU Research Participants

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Here at Bristol SLTRU we are regularly looking for people with speech, language and communication needs, their parents, family and/or carers, to take part in our research projects. 


Research participants may be involved in a variety of ways:

  • Completing questionnaires

  • Being interviewed by one of the research team

  • Attending focus groups with other patients

  • Pilot-testing new technology or providing feedback on new websites or apps

  • Working with the researchers to develop new projects, advising on all aspects of research development and process

If you have a child with speech, language and communication needs or experience communication difficulties yourself as a result of injury, illness or a life-long condition and would be interested in being a participant in a future research project please register your interest by emailing info@speech-therapy.org.uk. 

Trust Strategy

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North Bristol NHS Trust Strategy

A triangle-shaped graphic with four tiers. From the top it reads "Our aim: Outstanding patient experience. Trust objectives: Deliver great care, healthcare for the future and anchor in the community. Improvement Priorities: High quality care - better by design, innovate to improve - unlocking a better future, sustainability - making best use of our limited resources, people - proud to belong, commitment to our community - in and for our community. NBT values: caring, ambitious, respectful and supportive."

Our new Trust strategy launched in February 2023. An overview can be seen in the plan on a page image to the right.

Our reason for existing as an organisation is to put the patient first by delivering outstanding patient experience– and that’s the focal point of our strategy, Our Aim. 

How we deliver that is so important and the NBT Cares ‘Values and Positive Behaviours Framework’ which we launched in Autumn 2022 underpin this.

Through our NBT Cares ‘Values and Positive Behaviours’ we are committed to being:

  • Caring.
  • Ambitious.
  • Respectful, and
  • Supportive.

We will continue to maintain overall focus on our three Trust objectives:

  • Delivering great care.
  • Healthcare for the future, and.
  • Being an anchor in the community.

To support us to achieve our three Trust Objectives, we have new Improvement Priorities, which have the potential to transform what we do as a Trust on behalf of our patients.

Our Improvement Priorities which will help us to deliver our ultimate aim of delivering outstanding patient experience are:

  1. high quality care – we’ll make our care better by design.
  2. innovate to improve – we’ll unlock a better future.
  3. people – our people will be proud to belong here.
  4. sustainability – we’ll make best use of limited resources.
  5. commitment to our community – we’ll be in our community, for our community.

Our Clinical Strategy

Our Joint Clinical Strategy

Bristol NHS Group Summary Benefits Case

Our Patient Experience and Carer Strategy

Easy Read version:

Volunteer Services Strategic Plan

Our Clinical Research Strategy

Clinical Research Strategy 2022-27.

Our Digital Vision

Our Patient Safety Strategy

The referenced media source is missing and needs to be re-embedded.

Our People Strategy

Risk Management Strategy and Policy

Our Mental Health Strategy

Healthier Together

Healthier Together is the name given to our Bristol, North Somerset and South Gloucestershire Integrated Care System.

The Bristol, North Somerset and South Gloucestershire (BNSSG) Integrated Care Board (ICB) was established on 1 July 2022. We’re responsible for developing plans to meet the health needs of our population, managing the NHS budget and arranging for the provision of health services in our area.

Our work is focused on four key aims:

  • Improving outcomes in population health and healthcare.
  • Tackling inequalities in outcome, experience and access.
  • Enhancing productivity and value for money.
  • Helping the NHS support broader social and economic development.

The Annual Review for 2022 to 2023 can be viewed on the BNSSG website.

Hidden Disabilities

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Sunflower Lanyard scheme

North Bristol NHS Trust is now proudly participating in the Hidden Disabilities Sunflower Lanyard scheme.

Sunflower logo

This means that those with a hidden disability can wear a sunflower lanyard or wristband to make their disability visible to those around them while in hospital. Staff should help you with any support or adjustments you may need.

You can find lanyards and wristbands in the main receptions of the Brunel building at Southmead Hospital and of Cossham Hospital.

What are hidden disabilities?

Some disabilities don’t have physical signs so we cannot always tell if someone has one. Hidden disabilities include autism, mental health, acquired/traumatic brain injury, sensory processing, multiple sclerosis, epilepsy, partial sight and hearing loss.

For instance, those with autism may need some extra time and space to process what is around them. People with partial sight may need help reading signs and other information.

You can learn more on the Hidden Disabilities website.

​What if I have additional needs?

The Learning Disabilities team are taking extra care of patients with additional need. Carers can also complete a COVID Passport for the patient.

The Sunflower scheme at NBT was kindly provided for by donations to Southmead Hospital Charity. 

Accessibility Statement for North Bristol NHS Trust Website

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This accessibility statement applies to the NHS website for North Bristol NHS Trust, www.nbt.nhs.uk. 

This website is run by North Bristol NHS Trust. We want as many people as possible to be able to use this website. For example, that means you should be able to:

  • Change colours, contrast levels and fonts using browser or device settings.
  • Zoom in up to 400% without the text spilling off the screen.
  • Navigate most of the website using a keyboard or speech recognition software.
  • Listen to most of the website using a screen reader (including the most recent versions of JAWS, NVDA and VoiceOver).

We’ve also made the website text as simple as possible to understand.

AbilityNet has advice on making your device easier to use if you have a disability.

How accessible this website is

We know some parts of this website are not fully accessible:

  • You cannot modify the line height or spacing of text.
  • Most older PDF documents are not fully accessible to screen reader software.
  • Live video streams and videos do not have captions.
  • You cannot skip to the main content when using a screen reader.
  • There’s a limit to how far you can magnify the map on our ‘Our Hospitals’ pages.

Feedback and contact information

If you find any problems not listed on this page or think we’re not meeting accessibility requirements, contact: NBTCommunications@nbt.nhs.uk.

If you need information on this website in a different format like accessible PDF, large print, easy read, audio recording or braille:

We’ll consider your request and get back to you in 10 days.

If you cannot view the map on our ‘Our Hospitals’ pages, call or email us for directions.

Please email NBTCommunications@nbt.nhs.uk. We’ll consider your request and get back to you in ten days.

Enforcement procedure

The Equality and Human Rights Commission (EHRC) is responsible for enforcing the Public Sector Bodies (Websites and Mobile Applications) (No. 2) Accessibility Regulations 2018 (the ‘accessibility regulations’). If you’re not happy with how we respond to your complaint, contact the Equality Advisory and Support Service (EASS).

Technical information about this website’s accessibility

North Bristol NHS Trust is committed to making its website accessible, in accordance with the Public Sector Bodies (Websites and Mobile Applications) (No. 2) Accessibility Regulations 2018.

Compliance status

The website has been tested against the Web Content Accessibility Guidelines (WCAG) 2.2 AA standard.

This website is partially compliant with the Web Content Accessibility Guidelines version 2.2 AA standard, due to the non-compliances listed below.

Non-accessible content

The content listed below is non-accessible for the following reasons.

Non-compliance with the accessibility regulations

1.1    Text Alternatives

1.1.1 Non-text Content
Cause of error: Alternative (alt) text on non-decorative images describe the image and say it is a link, how to action the link, but not what the link is. 
Action to remediate: Correct alt text to describe the link the image is linked to as well as the image. For example, image of heart in hands is link to further support page, opens in same window.

1.3 Adaptable

1.3.1 Info and Relationships
Cause of error: Bullet headings are not announced and mentioned in the voice over. 
Action to remediate: Format bullet headings using integrated heading styles in CMS.

1.3.2 Meaningful Sequence
Cause of error: Content skips to links, missing main text and drop-down headings.

1.4 Distinguishable

1.4.1 Use of Colour
Cause of error: Where colour is used to distinguish text (telephone numbers and links) there is no additional text explanation included in the main wording or description. 
Action to remediate: Ensure the presence of telephone numbers, email addresses, links etc is included in the text description. For example, the telephone number for the helpline is…

2.4 Navigable

2.4.1 Bypass Blocks
Cause of error: no obvious way to bypass blocks of regular content e.g. page footer.

2.4.3 Focus Order
Cause of error: Cannot access the drop-down headings using the tab key alone. Must use a pointer (digit or mouse). 
Action to remediate: Include a section header and introduction for pages with drop-down (FAQ format) content describing the content as drop-down. For example, the following information provides answers to frequently asked questions. Use the cross to drop down each section for more information.

2.4.4 Link Purpose (In Context)
Cause of error: not all links on page provide context, explanation or hover text e.g. Our Hospitals. 
Action to remediate: Add hover text, supporting text and alt text so this can be picked up through screen readers. For example, Home Help - visit the home help pages of our website for more information on how this service works. Hyperlink - opens in same window.

3.2 Predictable

3.2.1 On Focus
Cause of error: Not all links describe what is going to happen. Heading for online letters opens new page in same window. 
Action to remediate: Hyperlinks should describe that it will open in the same window telling the user they will have to navigate between pages to continue reading.

3.2.6 Consistent Help
Cause of error: the helpline (telephone number) listed is not interactive or describes as a telephone number. It is also difficult to find. 
Action to remediate: The content should announce that it includes a telephone number. For examples, call our telephone number for more information on … and the number should be consistently formatted throughout the website to be an interactive hyperlink.

We’re working with our suppliers to resolve these issues as soon as possible. We will make another assessment when the supplier contract is up for renewal, likely to be in May 2026. 

We plan to resolve these by the end of 2026

Content that’s not within the scope of the accessibility regulations

PDFs and other documents

The accessibility regulations do not require us to fix PDFs or other documents published before 23 September 2018 if they’re not essential to providing our services. 

All new PDFs and Word documents we publish will comply with the built-in accessibility standards of Adobe Acrobat Pro and Microsoft Word.

Live video 

We do not plan to add captions to live video streams because live video is exempt from meeting the accessibility regulations.

Preparation of this accessibility statement

This statement was prepared on 24 August 2020. It was last reviewed on 24 July 2023, 4 August 2023 and 2 June 2025.

This website was last tested in May 2025 against the WCAG 2.2 AA standard.

The test was carried out by North Bristol NHS Trust’s Communications Team. 

The most viewed pages were tested against the DWP’s WCAG manual checks testing template using automated testing tools.

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