Rheumatology in Surrey

Rheumatology Services

Osteoarthritis

Osteoarthritis is a common “wear and tear” joint disease. It happens when the protective cartilage that cushions your joints breaks down. This can make your joints painful, stiff and swollen. Your knees, hips and small joints of your hands are most at risk.

As you get older you’re more likely to develop osteoarthritis. To make a diagnosis your rheumatologist will perform a physical examination and sometimes blood tests, x-rays and a joint aspiration test so that they can discard other possible causes.

Osteoporosis cannot be cured but it’s symptoms can be managed. Physical activity may reduce your pain whilst also helping you keep a healthy weight. You may be advised to lose weight if you're overweight or to wear alternative footwear and use support devices. Our physiotherapy team can offer advice on the best self-help strategies for your individual circumstances.

Prescription painkillers or steroid injections may be offered if your osteoarthritis is severe. If these don’t work, for example your hip or knee osteoarthritis is too painful to allow you to continue with your daily functions, then surgery may be advised.

Inflammatory arthritis

Inflammatory arthritis is a term used to describe a group of diseases that cause your joints and other tissues to become inflamed. The main chronic conditions are: rheumatoid arthritis, gout, psoriatic arthritis (causes painful inflammation and is often linked with psoriasis) and ankylosing spondylitis (long term inflammation of the joints of your spine).

Typical symptoms of inflammatory arthritis include: pain, swelling, tenderness and warmth in your joints. Your rheumatologist will take into consideration your medical history, a physical exam and sometimes other tests including blood tests, x-rays and scans to make a diagnosis.

Your treatment will depend on the type of inflammatory arthritis you have, how severe it is and your symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) and physiotherapy may help relieve your pain. Your rheumatologist may prescribe disease-modifying anti-rheumatic drugs (DMARDs) or biologic agents to slow down or stop the disease progressing.

Rheumatoid arthritis

Rheumatoid arthritis is a chronic inflammatory condition that causes pain, stiffness and swelling most often in your hands, feet and wrists. It’s an autoimmune disease so called as your body’s immune system mistakenly attacks and damages the cells in your joints and surrounding tissues.

If diagnosed and treated early, rheumatoid arthritis can be prevented from worsening whilst also reducing the risk of other problems such as joint damage.

To monitor your condition and to diagnose the type of arthritis your rheumatologist may request imaging tests including an ultrasound or MRI scan.

Treatment often includes disease-modifying anti-rheumatic drugs (DMARDs) and biological treatments given by injection to reduce your bodies attack on your joints. Physiotherapy can help relieve some of the pain. Our physiotherapists may also offer advice to keep you mobile and able to do daily activities that are becoming difficult or are taking longer to complete. Podiatry is an option if you’ve foot problems. Painkillers may be recommended and vary in strength depending upon how much pain you’re experiencing. They range from paracetamol, through to nonsteroidal anti-inflammatory drugs (NSAIDs), to corticosteroid injections.

Despite these measures sometimes joint damage occurs and we can perform appropriate surgery including: finger, hand and wrist surgery, arthroscopy and joint replacement as required.

Gout

Gout is a type of inflammatory arthritis that can be extremely painful and, causes joints to become hot and swollen with red, shiny skin over it. Its onset is often rapid in the big toe and at night. Gout is caused by your body over making uric acid that forms crystals inside and around your joints.

It’s important to see your GP or a rheumatologist of you suspect you have gout. It’s likely your rheumatologist will take fluid from your swollen joint with a needle and examine it under a microscope to check for uric acid crystals.

You may be advised to try self-help remedies for a gout episode such as: resting and raising and keeping cool your affected joint. Over-the-counter painkillers may help or your doctor may prescribe stronger painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs), colchicine or corticosteroids.

Lifestyle changes may help prevent gout from returning, such as losing weight or changing your diet. Medications, such as allopurinol, can also lower your uric acid levels.

Osteoporosis

Osteoporosis is a gradual reduction in bone density and leads to weaker bones and an increased risk of fracture. One in two women (often postmenopausal) and one in five men over the age of fifty will break a bone due to osteoporosis. It’s a silent disease that’s often only diagnosed when a person falls and fractures their bone.

A DEXA scan is normally requested if you’ve had a fall or if you’re at risk of having osteoporosis to measure your bone density.

Treatment will be based on your DEXA scan results together with information about your age, sex, risk of fracture and previous injury history. You must ensure you're taking sufficient levels of calcium and vitamin D. There are medications that reduce your risk of broken bones by either slowing or stopping bone loss or rebuilding bone.

Regular exercise, stopping smoking and reducing alcohol consumption and, risk assessing your home may all help reduce the impact of osteoporosis and prevent fractures.

Connective tissue disorders

Your connective tissue holds your muscles, skin and bones in place. Connective tissue disorders occur when these tissues become injured or inflamed due to inherited diseases, autoimmune diseases and environmental factors. As these tissues are throughout your entire body, connective tissue disorders can be far reaching from your bones, skin, nervous system, eyes and lungs.

Treatment will depend on the type of connective tissue disorder. Heritable connective tissue disorders are less common and include Marfan’s syndrome, Ehlers-Danlos syndrome and Loeys Dietz syndrome. Autoimmune disorders are due to your body attacking its own cells and tissues. They include: scleroderma (affects your skin), systemic lupus erythematosus (SLE, affects your skin, joints, kidneys, heart, brain and red blood cells), rheumatoid arthritis (most often affects your joints), dermatomyositis (muscle inflammation and skin rash) and polymyositis (muscle inflammation and skin problems).

As connective tissue disorders cause inflammation, the most common treatments are anti-inflammatory medications to relieve swelling, redness and pain.

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