Rheumatology Services


Osteoarthritis is by far the commonest form of arthritis and one of the leading causes of pain and disability worldwide. It occurs in your joints, most often in the knees, hips and small hand joints, when the protective cartilage breaks down at these joint margins, often due to wear and tear.

The risk factors of osteoarthritis include: genetic factors, constitutional factors (ageing, female, high bone density), biomechanical factors (joint injury, occupational/recreational usage, reduced muscle strength) and environmental/lifestyle factors (obesity).

Your doctor will undertake a physical examination and may request further tests, such as blood tests, x-rays and joint aspiration, to rule out other possible diagnoses.

Osteoarthritis cannot be cured but the symptoms (painful, stiff and swollen joints) can be relieved. You may be advised to: partake in physical exercise to reduce pain, lose weight if you're overweight, wear appropriate footwear and use supportive devices for everyday activities. Our team of skilled physiotherapists can offer individualised advice and exercise plans. We will also prescribe medications to relieve your pain if it’s severe.

If your osteoarthritis is substantially interfering with your life, surgery may be advised, for example knee or hip osteoarthritis. This can be performed by a surgeon at Berkshire Independent Hospital.

Inflammatory arthritis

Inflammatory arthritis is a generic term for diseases that cause inflammation of the joints (and sometimes other tissues). The most frequently occurring chronic inflammatory arthritis conditions are: rheumatoid arthritis, gout, psoriatic arthritis (inflammation combined with psoriasis) and ankylosing spondylitis (inflammation of the spine).

Inflammatory arthritis is associated with pain, swelling, warmth and tenderness in your joints. A diagnosis can be made based on your medical history, a physical examination and sometimes other tests such as blood tests, x-rays and scans.

Treatment will depend on the type of inflammatory arthritis as well as its symptoms and severity. Medications may be recommended including: nonsteroidal anti-inflammatory drugs (NSAIDs) that ease pain and inflammation or disease-modifying anti-rheumatic drugs (DMARDs) / biologic agents to slow down or stop the advancement of the disease and damage to the joints. Sometimes physiotherapy (massage and manipulation) may be advised. For example, it may increase your comfort and flexibility of your spine if you’ve ankylosing spondylitis.

Rheumatoid arthritis

Rheumatoid arthritis is a chronic form of inflammatory arthritis. It causes your joints, often your hands, feet and wrists, to feel stiff, painful and swollen. Often stiffness is worse in the mornings. Known as an autoimmune disease, it develops when your immune system mistakenly attacks and damages cells that line your joints and the surrounding tissues.

Early diagnosis and treatment can help prevent rheumatoid arthritis from worsening and your joints becoming more damaged.  Scans may be requested to diagnose your arthritis type and also to keep an eye on its extent.

There is no cure for rheumatoid arthritis but medications can help manage the symptoms and lessen the attack on your joints. Your rheumatologist will discuss any appropriate drug options with you. Our physiotherapists can help to keep you mobile and also advise on alternative ways of doing things that have now become difficult. If joint problems develop surgery may be required.


Gout is the most common type of inflammatory arthritis. It causes intense pain to your affected joint as well as feeling hot and swollen, with red and shiny skin. It often affects the big toe and comes on rapidly usually at night.

Gout is caused by uric acid, made by your body, forming crystals inside and around your joints as well as your tendons, ligaments and under your skin.

If you think you may have gout, it’s important to see your GP for an assessment. They may refer you to a rheumatologist if they think further tests are required such as taking fluid from your swollen joint with a needle to look for uric acid crystals under a microscope.

Treatments include: self-help remedies (rest, raising and keeping cool your affected joint), over-the-counter painkillers (paracetamol or ibuprofen) or prescription medicines (non-steroidal anti-inflammatory drugs, colchicine or corticosteroids). Lifestyle modifications such as losing weight and medications that lower uric acid levels can help gout from returning.


Osteoporosis gradually causes your bones to weaken and lose bone density. This means that your bones are more likely to break. Often this silent disease is only diagnosed when patients have a fall or sudden impact that causes a bone to fracture.

A common disorder, osteoporosis develops more often in older people, especially in post-menopausal women. If your doctor identifies you as being at risk of having osteoporosis or if you’ve had a fall, a DEXA scan may be recommended to measure the density of your bones.

Treatment of osteoporosis is aimed at strengthening your bones to reduce the likelihood of fractures. If you're diagnosed as at risk of developing osteoporosis, advice will be looking at: increasing your daily intake of calcium and vitamin D (through your diet or by supplements), a regular exercise plan, lifestyle changes (smoking or alcohol cessation) and a home risk assessment.

There are a number of medications if you have osteoporosis and the best one will be recommended based on your: age, sex, fracture risk and if you’ve had a fracture in the past due to osteoporosis. Drug treatments can help to strengthen your bones and reduce your risk of having fractures, often by slowing down the activity of the cells that break down old bone. You may require pain relief and these can include: pain-relieving drugs, physiotherapy and pain management clinics. Your consultant rheumatologist will discuss the most appropriate treatment plan for you.

Connective tissue disorders

Connective tissue disorders are a group of conditions that primarily cause the connective tissues of your body to become inflamed. Connective tissues are made of two major structural proteins: collagen (in your tendons, ligaments, skin, cornea, cartilage, bone, and blood vessels) and elastin. (major component of your ligaments and skin).

Connective tissue disorders can be caused by many factors including injury, genetics or infection. Autoimmune connective tissue disorders cause inflammation due to a dysfunction in your immune system. They include: dermatomyositis (muscle inflammation and skin rash), polymyositis (widespread muscle inflammation and weakness), rheumatoid arthritis, scleroderma (hard, thickened areas of skin) and, systemic lupus erythematosus (body attacks its own healthy cells and tissues). Less common heritable connective tissue disorders include Marfan’s syndrome and Ehlers-Danlos syndrome.

Treatment of connective tissue disorders is dependent upon the type and your health. Anti-inflammatory medications are the most common form of treatment to relieve swelling, redness and pain.

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