Description of specialty

Musculoskeletal (MSK) diseases have a major impact on health and society in the UK: over 17 million people are affected, with around 30.8 million working days lost each year. The estimated cost to the NHS of MSK disease is around £4.7 billion per year. Versus Arthritis (a merger of the two charities Arthritis Research UK and Arthritis Care) has useful data on prevalence.

Rheumatology deals with the investigation, diagnosis and management of more than 200 rheumatic musculoskeletal disorders (RMDs) affecting joints, bones, muscles and soft tissues. These include:

  • inflammatory arthritis and other systemic autoimmune disorders
  • vasculitis
  • soft-tissue conditions
  • spinal pain
  • metabolic bone disease.

About 17 million people in the UK have a RMD. A significant number of RMDs also affect other organ systems such as the lung, kidney, skin, eye, nervous system and gut. Many of these disorders need to be diagnosed by a rheumatologist as knowledge of RMDs is not extensive among non-specialist doctors.

Rheumatology is a multidisciplinary specialty and rheumatologists work in close liaison with other medical specialists and healthcare professionals. Care is delivered by the team. Work takes place either in a hospital or community setting, though most work usually spans both. Rheumatology services need to link closely with orthopaedics and other musculoskeletal services. However, strong links with other medical specialties and their support services are also required for patients with inflammatory and autoimmune diseases receiving rheumatological care. Training for paediatric and adolescent rheumatology is based within paediatrics, although adult rheumatologists should be aware of the conditions that affect children in order to take part in the transitional care of older adolescents and young adults.

Most rheumatological illnesses are subacute or chronic problems, and care is usually delivered in an outpatient or ambulatory setting. However, acute rheumatological emergencies do occur (eg acute arthritis, multisystem disease or infective complications of treatment) and it is essential that general medical teams have prompt access to rheumatological expertise.