What is rheumatology?

30 minutes

Rheumatology is a branch of medicine that deals with the investigation, diagnosis and management of people living with rheumatic and musculoskeletal diseases. These diseases are usually caused by problems in the immune system, inflammation, infections, or the gradual deterioration of joints, muscles and bones. Rheumatic and musculoskeletal conditions affect soft tissues, joints, bones, cartilage, tendons, ligaments and muscles – also known as connective tissues. Within rheumatology, the two abbreviations MSK (musculoskeletal) and RMD (rheumatic and musculoskeletal diseases) are often used interchangeably, although MSK conditions are, technically, one subset of RMDs.

30 minutes

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Need-to-know: rheumatic conditions

Rheumatic conditions can affect people at any age. Those under 16 are generally treated in paediatric and adolescent rheumatology services, before starting to transition to care within adult rheumatology settings. Common conditions affecting children and young people treated in paediatric and adolescent rheumatology services include juvenile idiopathic arthritis, connective tissue diseases and other musculoskeletal problems, such as joint hypermobility.

The facts

Every year, about 1 in 5 people visit their GP with MSK symptoms. These consultations amount to about 30% of GP appointment and attendances at NHS walk-in centres

There are more than 200 different rheumatic and MSK diseases

80% of people with rheumatoid arthritis have at least one additional condition (known as a comorbidity)

More than 400,000 adults have rheumatoid arthritis in the UK, amounting to about 1% of the population. 20,000 new patients present every year. 18,200 have lupus and 6,500-8,000 have scleroderma

1.8 million people have gout

Risk factors for MSK and rheumatic conditions include: smoking, excess weight, inactivity, some work-related activities, genetic factors and increasing age

12,000 children in the UK have juvenile idiopathic arthritis (this most commonly occurs in children under 5 or secondary school-aged children). Many do not have any symptoms as adults: only about 30% of cases continue into adulthood

The typical multidisciplinary team includes consultant rheumatologists, rheumatology nurse specialists, occupational therapists and physiotherapists

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Common rheumatic and MSK conditions

The three most common forms of inflammatory arthritis are rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis.

Rheumatoid arthritis

Rheumatoid arthritis causes pain, swelling and stiffness in the joints due to inflammation. In rheumatoid arthritis, the immune system sends extra fluid and blood to the joints unnecessarily. Most people are diagnosed with rheumatoid arthritis between 40-60, although it can affect adults of all ages. It's 2-3 times more common among women than men. A combination of genetic and environmental factors cause rheumatoid arthritis; smoking and being overweight can significantly increase risk.

Psoriatic arthritis

Psoriatic arthritis develops in some people with psoriasis, a skin conditions causing red flaky patches of skin with silvery scales. It causes affected joints to became inflamed, stiff and painful.

Osteoarthritis

Osteoarthritis is the most common condition treated by rheumatologists. It affects the smooth cartilage lining of the affected joints, making movement more difficult than usual and causing pain and stiffness. Nearly 9 million people in the UK are affected by it; almost everyone will develop it in some form as they get older. Severity varies from person to person, and among affected joints.

Ankylosing spondylitis

Ankylosing spondylitis is a condition where the spine and other areas of the body become inflamed, causing back pain and stiffness. 200,000 people have it; while it can affect anyone, it's most common in young men, starting in their late teens and 20s.

Every year, about 1 in 5 people visit their GP with MSK symptoms. These amount to c.30% of GP appointments and attendance at NHS walk-in centres

British Society for Rheumatology

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The rheumatology multidisciplinary team

The typical multidisciplinary team (commonly referred to as the MDT) varies between departments, but ordinarily includes the following roles as a minimum: consultant rheumatologists, rheumatology nurse specialists, occupational therapists and physiotherapists. There is great variation in the availability of allied health professionals across the UK

Primary care

When someone first develops symptoms, primary care will be the first point of contact in the care pathway. Primary care clinicians and advanced nurse practitioners will refer patients to consultant rheumatologists, and may later help to manage care and any medicines.

Rheumatology specialist nurse

Rheumatology nurse specialists help deliver and monitor treatment and provide practical advice on how to live with rheumatic conditions.

Consultant

A consultant rheumatologist diagnoses patients, develops treatment plans and monitors care. Nurse consultants may also undertake these tasks.

Occupational therapist

The occupational therapist helps people with rheumatic conditions to find better ways of doing things that accommodate any symptoms and prevent further injury or disability. An occupational therapist may advise a patient on how to continue to do their hobbies and leisure activities, and help enable them to stay in work if their symptoms impact on how they go about these activities.

Physiotherapist

Physiotherapists help people to maintain function and strength in their joints and muscles. Physiotherapists use a variety of techniques and therapies including manipulation of body tissues, massage and exercise programmes.

There are further members of the MDT depending on the particular needs of a condition. They include nurse consultants, orthopaedic surgeons, pharmacists, podiatrists, clinical psychologists and social workers

What is rheumatology?