Hi, my husband has had RA for around 10 years. After a few years of severe symptoms, it's now generally under control with Sulfasalazine, with occassional flare ups every year/two years. His rheumatologist is in London where we used to live, 2 hours away. The care is excellent and he's happy to travel there every 6 months for check-ups. He is currently suffering badly with a severe flare up, and his specialist has previously confirmed with his GP he should have a steroid injection in this circumstance (as long as they don't become more regular). He has had 2 previously from GP (in 4 yrs), and both times it was made difficult for him and GP wasn't keen/said the drug wasn't in stock etc). He phoned last week asking if he could arrange this, and got a message back via a receptionist that they GP won't give this, despite his specialist advising this treatment. He was in severe pain and couldn't drive or get to work, so he phoned the GP to see if he could get more info about this decision. Instead of calling back, the GP again sent a message via the receptionist saying he can't help...see the specialist. We're wondering if it has a connection to the GP being a homeopath as well as regular GP....an objection to steroids perhaps?
Just wondered if this is a common response by a GP. He's slightly better now but feels a bit helpless, given appointments with his specialist aren't available until April 18 and he would struggle to travel that far when at his worst. Would appreciate to hear of any similar experiences /solutions. Sorry for the long post!! Thanks.
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toramm1
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Hi. Sorry you're in this position. From what I've gathered since I was diagnosed once you're under the care of a Rheumatologist, GP's don't like to get involved with your medication. I've experienced this situation myself, even though my Gp has a Rheumatology nurse. They did give me the option to transfer my care to them and there's a document that has to be signed and approved. However I have a good relationship at the hospital and decided to stay put. They did relent on one occasion when I was flaring badly and hospital couldn't fit me in for a fortnight. But as in your case they don't keep the Depo Medrone. I was given a prescription and had to collect it from the chemists then back to the nurse to give me the shot. A bit of a faff but better than waiting for a hospital appt. If I was you I'd call your Rheumatology dept and ask them to call your Gp. As in my case I'm sure they'd relent...maybe they just need the ok to do so? I'm guessing the only thing that can stop it is if they haven't got a nurse who is IM trained.
My GP has given me two IM shots fairly recently. She contaced rheumatologist the first time, then the second one GP just gave me. I was in a pretty bad way, and no hope of see rheumatologist earlier.
Hiya torram1, welcome. I've only ever had steroid injections from my Rheumy & Rheumy nurse but I am also on oral steroids, albeit low dose. I am sure though would it be necessary my GP wouldn't hesitate to give me a steroid injection if it were appropriate. My oral steroids along with my other RD meds are prescribed by my GP, I take it your husband's are as well, if so like my GP he must have signed a shared care agreement. This will state that the prescribing & monitoring of his RD meds will be undertaken by him at the request of the secondary provider, his Rheumy. Your husband's steroid injections, whilst an acute med not one of his repeat meds, should still be supplied & administered by his GP if needed. If he's in any doubt, for example if your husband has had x number within x period he should consult with your husband's Rheumy, he's not in a position to decide whether it's appropriate or not them having been initiated by his Rheumy. If he's not had an injection for some time & it's appropriate then it should be given, it's simple isn't t it? As you say his Rheumy has previously confirmed with his GP that he should administer them in these circumstances, so that's exactly what he should do. My bet is it's due to prescribing costs, he doesn't want acute meds coming out of his prescribing budget.
What I would do in this situation is ask him directly the reason he won't prescribe & administer the injection & remind him he signed a shared care agreement. There is an alternative way if his GP has a valid reason, contact his Rheumy nurse & ask if she will do it.
I'm sorry he's having such difficulty, you don't need it when in flare.
My GP never actually signed a shared care agreement...she just did what was necessary. I ended up ferrying blood tests results and so on too and fro, but since she was a good GP I didn't object. But she did do general steroid shots when needed (not into joints tho').
In your situation I think I'd just change my GP. Life's too short to do battle with unwilling people. As presumably your rheumy nurse is also 2 hours away...
Thanks for the advice, I think he may end up changing GP if that’s possible. Good to know there are helpful ones out there who will provide this treatment.
Yes...I had a GP years ago who said he "didn't believe" in steroid injections....I had thought GP's had got over that by now! I often wondered if that GP had had a bad outcome from giving a steroid injection & wouldn't chance it again?
However....although it seems a simple procedure, lots of GP's are not used to giving these injections& if they should make a mistake it could be very serious......it is now recommended Depo injections are made in the thigh, not the buttock...but when I was discussing different injections with my GP practice nurse she did not know that. Your GP has maybe signed a Shared Care Agreement for SSZ, but not for DEPO injections?
Personally I will only have Depo injections given by my rheumy, or his rheumy nurse who does it all the time...but thankfully since I have been on RTX I haven't needed one.
Have you thought of asking at your local hospital if a rheumatologist there might inject for you if you had a letter from the London Rheumy?
Do hope your husband manages to get the injection soon,
Interesting to hear of your similar experiences, thanks. It may be an option to get a more local rheumatologist to do it, or perhaps even change his care.....he’s just unsure about this as has a really excellent one.
What was perhaps more unclear was the continuation ...that GPs had gotten over it by now". Since my thought would be more in the line that GPs in fact are more aware of the bad effects of steroids and may in fact have been told to cut off on them after studies have shown that the use of steroids is much more common than thought when new recommendations now try to reduce the use of them.
Living abroad, I had (approx) two steroid injections a year for 3/4 yrs, in the bum. Immediate relief for 4-8 weeks. My now UK Rheumy simply said ‘we don’t do that here’. How often is it ok to have steroid jabs?
Agree .. A lot of GPs aren't experienced in giving steroid injections even into the top of the buttock. All my GPs have said they would not attempt to do one into the joint but my consultant, Registrar or senior physio have done them in the injection clinic and in my review clinic in the past when needed.
Getting a steroid injection wrong in the hip can result in a dead leg which could be irreversible....wouldn't let a GP near me with a Depo injection unless I knew he knew what he was doing....my rheumy always injected my thigh......
As you say unless a GP has taken special courses in these injections it's advisable to wait for a rheumy or Nurse experienced in giving them.
That would be horrendous and I'd only let the rheumy do the hip too. We had one GP who could do them as he had been working during his training in rheumatology for several months but I had no need for one at the time he was with our practice.
My GP surgery wouldn’t give steroid injections and I only have this done by the rheumatologist himself. Not sure I’d trust my GP to do it properly anyway! Definitely get in touch with your rheumatology dept and ask for one, or get them to arrange your GP to give you one. You sound in a bad way so you must be helped.
Hi I have trouble with my knees swelling up the first two lots of steroid injections I had at the hospital and waited many months it was ridiculous I could hardly walk by then, I was given a letter to give to my doctor to say I had had it done, when I went to the doctor about something else I handed it to him and he said oh I can do these for you here, so now I go about every 4 months or so and it is just across the road I can walk there instead of getting a lift to the hospital who say they only offer 2 lots anyway I am in Wigan
What a shame to have this extra situation to deal with.
I have had a lot of problems with shared care. It takes about 6 months for the Gp to agree with any medication even after signing the shared care agreement. My rheumys secretary always ends up faxing jnformation over after letters have been sent out etc etc. However ive always had injections done by rheumy.
Really hope you / your husband get sorted very soon
I have shared care between my rheumatologist at the hospital and my gp. I see my rheumatologist every six months. I have blood tests at my gps and if the results are unusual he emails my rheumatologist who says what action, if any, should be taken. My gp doesn’t change my meds but he does give steroid shots if it is too far to my next hospital appointment. I have seen the same gp and consultant since I was first diagnosed with RA in 2004.
My GP stopped giving general steroid injections a couple of years ago but is happy to do it into a joint. Check if they will do that and then pick a joint (any joint) and go for it. You do get referred benefit in all other joints so it's worth it.
I would change my GP, as my GP says, ‘if a Consultant tells me that’s what you need, it is not in my power to go against them’. Sounds to me like your GP doesn’t have the same opinion. I’m these days of different trust funding, your GP should arrange anything that a consultant tells them you need. I have this happening all the time, from physiotherapy, to experimental drugs usually used for another condition. As my GP also says, they are the specialist in their field of medicine and who is he to argue!
Here in California a GP cannot prescribe methotrexate over 2.5 in a pill form. My Rheumy can prescribe shots at 25mil. A pharmacy delivers the shots to my house. I inject once a week.
Change your GP! Mine would be more than happy to. Ideally you should be able to get one from the nurse in the rheumatology department as they are usually much better at giving them!
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