On the basis of efficacy, safety and cost, leflunomide should be considered in patients with RA who have failed first-line DMARD drug therapy. In refractory cases, leflunomide may be used in combination with, for example, methotrexate before biological agents. Therapy should be initiated by a specialist, but repeat prescribing in general practice on a shared care basis is acceptable using agreed protocols. Clear mechanisms are required to monitor toxicity, with good communication between the patient and rheumatologist to manage nuisance side-effects and avoid unnecessary discontinuation of leflunomide.

The symptoms associated with fibromyalgia had a negative effect on sexual enjoyment. The questionnaire appears to be useful in addressing sexuality in patients with fibromyalgia.

People with OA and RA wanted nurses and AHPs to listen, empathise and help them to manage their condition, especially the pain. Participants with RA would value psychological support. We need to ensure that nurses and AHPs have the knowledge and skills to address these needs.

Objectives: To examine the role, acceptability, and cost effectiveness of a telephone helpline organised and run by specialist nurses in a district general hospital outpatient rheumatology department. Material and methods: Patients accessed the telephone helpline by leaving a taped message on an answer phone with a 24 hour response time. Assessment included an audit of the nature and outcome of helpline calls, patient satisfaction with the helpline, and a health economic analysis of the helpline operation. A postal questionnaire was used to assess patient satisfaction; this was sent to the 87 patients who called the helpline during one month, and overall satisfaction with the helpline was assessed. The nature and outcome of all calls was analysed retrospectively using a helpline record book for February and October of one year and February of the following year. From the results of the retrospective analysis and an estimate of the number of general practitioner consultations avoided by provision of the helpline, the cost effectiveness of the helpline was calculated. Results: Of those returning questionnaires, 61/63 (97%) were satisfied with the response time, 63/63 (100%) with the courtesy, and 60/63 (95%) felt that their questions were answered directly and to their satisfaction in 62 (98%) of cases. Had the helpline not been available, 38/63 (60%) patients would have made an appointment with their GP. When these figures were extrapolated to an annual estimation, a basic cost analysis showed that the helpline produced a cost saving to the NHS, largely as a result of GP consultations avoided. Conclusion: Clinical advice and support can be provided by a rheumatology helpline set up as an adjunct to a standard outpatient service. The results of a postal questionnaire suggested more than 95% satisfaction with all aspects of the helpline service and that 99% of callers would call the helpline again. The provision of the helpline service contributes to the quality of care provided by an outpatient department and provides benefit to the NHS.

The nurse consultant's role was pivotal in the implementation of the chronic pain service.

Objective. To characterize provision of telephone helpline services in rheumatology units in England and Wales. Methods. A questionnaire study of rheumatology nurse specialists (RNS) providing advice by a designated telephone helpline in England and Wales. Results. Responses were obtained from 164/185 rheumatology units (89%). Of the responding units, 154 (94%) employed RNS and 146 units provided telephone advice either by Allied Health Professionals or RNS. A total of 135 units confirmed that only RNS gave telephone advice via a designated helpline. Completed questionnaires were analysed from 126 RNS working in 121 rheumatology units with a designated telephone helpline. Most RNS implemented both a manned and answerphone helpline service. The average number of calls varied from <10 to >100 per week. Fifty-six percent of RNS had performed an audit of the service. Twenty-four percent possessed helpline protocols or standards. RNS' rheumatology experience ranged from 4 months to 25 yrs. Seventy-five percent had undertaken post registration study. Three out of 126 RNS reported having specific training in giving telephone advice and 25% had received in-house training or supervision. Seventy-eight percent had not been assessed in providing this service. Conclusions. The telephone helpline is an established service in many rheumatology units. Provision varies throughout England and Wales and a lack of protocols, formal training and assessment in giving telephone advice is common. This prompted the Royal College of Nursing Rheumatology Forum to form a working party to compile a guidance document for nurses and practitioners providing telephone advice.

The NC role had impacted on service development and culture in the instigation of a chronic musculoskeletal pain service and leadership and education activities. Patients experienced the holistic nature of the role.

The symptoms associated with fibromyalgia had a negative effect on sexual enjoyment. The questionnaire appears to be useful in addressing sexuality in patients with fibromyalgia.