Patients with inflammatory arthritis should be treated by a multidisciplinary team rather than by an individual clinician. The exact make-up of the team will differ between units depending on a range of local circumstances [3]. Key members of the team include rheumatologists, specialist nurses, physiotherapists, occupational therapists and podiatrists. Patients are often involved in making decisions about the care they receive and therefore may sometimes be considered part of the team. Ideally primary care clinicians and surgeons would also be involved. Although many clinicians are involved in the team, one member needs to have overall responsibility for coordinating care between the various health professionals involved. Often this role will be taken by a specialist nurse.

The diagnosis of inflammatory arthritis has a negative impact on patients. They need support and advice to deal with their anxieties about their condition and its management. Most often this is provided by rheumatology specialist nurses. Education can be provided for individual patients or groups of patients. The approach chosen reflects patient preferences and local custom and practice. It is also possible to incorporate education within clinic visits by providing structured support from clinicians; one example of this approach is collaborative goal-setting with patients. An expert review of the area [4] highlighted that information is a prerequisite to education and that appropriate education can empower patients to take an active part in managing their disease. It will also improve coping and enhance adherence with treatment regimens.

It is essential to help patients deal with their arthritis. A range of approaches can be used. These include promoting self-management approaches and attempting to instil a readiness to change. Cognitive-behavioural approaches, which can be employed by a range of clinicians, can help promote health behaviour change. Other psychological therapies may also be useful. These include relaxation training and stress and mood management as well as formal cognitive behavioural therapy. Promoting coping can usually be combined with patient education and exercise programmes [5].

Equally important is to promote mobility and enhance function. This can be achieved in several ways. Supportive information can underline the benefits of exercise and joint protection and promote lifestyle physical activity. Historically clinicians advised patients with arthritis to rest. This approach has now been reversed. Patients should be given advice and training to improve general and musculoskeletal fitness. Examples include individualised walking and fitness programmes and group or individual joint protection training, which include hand exercises and fatigue management.

General advice should be supported by specific therapy to help individual needs. Physiotherapy can help by providing exercise programmes, balance training, hydrotherapy and mobility aids. Occupational therapy can help by providing work advice and rehabilitation, training for activities of daily living, environmental modifications, orthoses, a range of social and leisure rehabilitation methods and some psychological therapies. Finally, podiatry can help by giving foot care and footwear advice, foot orthoses and custom shoes.

Physiotherapy uses a range of physical approaches with the aim of reducing pain, preventing deformity and maximising function. These aims are achieved by using a range of interventions. Some are active interventions and others are more passive (Table 11.1).