Rheumatology Services


Many people suffer from osteoarthritis especially as they get older as their risk increases when they reach 50 years and above.

Osteoarthritis is a degenerative joint disease which involves the breaking down of the cushioning cartilage between your joints, often due to wear and tear. This results in your joints becoming painful, stiff and swollen. Your knees, hips and small joints of the hands are the most susceptible.

Your consultant rheumatologist will examine you and may request other tests such as blood tests, x-rays or a joint aspiration test to rule out other possible causes.

Osteoarthritis cannot be cured but it can be managed effectively. Physical activity can help manage your pain. If you’re obese it’s a good idea to lose some excess weight. You might also benefit from wearing appropriate footwear and using supportive devices to relieve pain. Our chartered physiotherapists can offer advice in these areas and develop individual plans.

Your rheumatologist may prescribe pain killing medications. However, if the pain is so severe that it’s significantly affecting your daily life then surgery may be an option. This can be performed at Ashtead Hospital by a fellow surgeon if required.

Inflammatory arthritis

Inflammatory arthritis encompasses many diseases that cause your joint and other tissues to become inflamed. Common types include: rheumatoid arthritis, gout, psoriatic arthritis (develops in some people with psoriasis) and ankylosing spondylitis (inflammation of joints in the spine).

If you’ve inflammatory arthritis you’ll most likely feel pain, warmth, tenderness and swelling in your joints. Your consultant rheumatologist may be able to diagnose your condition on your medical history and a physical exam alone. They may need further tests such as blood tests, x-rays and scans.

Treatment is particular to the type of inflammatory arthritis you have whilst also taking into account your symptoms and its severity. You may be advised to take drugs to relieve your pain, stiffness and inflammation (over the counter or prescription). Your rheumatologist may prescribe disease-modifying anti-rheumatic drugs (DMARDs) or biologic agents to slow down or stop the progression of the condition. Our physiotherapists can also support you in moving safely and effectively whilst maintaining your ability to perform daily tasks.

Rheumatoid arthritis

Rheumatoid arthritis is a chronic condition that causes inflammation in your joints and results in stiffness, pain and swelling usually in your hands, feet and wrists. You may have prolonged joint stiffness in the morning. Rheumatoid arthritis is an autoimmune disease that develops when your body’s immune system starts to attack and damage the cells that line your joints and the surrounding tissues, by mistake.

It’s important to diagnose rheumatoid arthritis quickly. Early treatment can help prevent it getting worse as well as reducing the risk of further problems such as joint damage.

Your rheumatologist may suggest imaging tests such as ultrasound or MRI scan to determine the type of arthritis and to monitor your condition.

Unfortunately, there isn’t a cure for rheumatoid arthritis but we can offer options to relieve your symptoms such as medications that can offer pain relief and they can work on your immune system to reduce the attack on your joints. Our physiotherapy department can help keep you mobile and offer you advice on other ways of doing daily activities that have become more difficult or take longer to complete. We can also perform surgery to correct any joint problems that may develop.


Gout is a common form of arthritis that causes pain and inflammation in your joints. It occurs when you have too much uric acid in your body that forms crystals mostly in your joints. Most people with gout experience acute attacks every now and then, that often begin at night or in the early morning with sudden, very painful joint swelling often at the base of the big toe that’s red, overheated, shiny and sensitive.

Your rheumatologist will make an assessment and may take some fluid from your affected joint with a needle to look for uric acid crystals under a microscope.

Over-the-counter painkillers, such as paracetamol or ibuprofen may help when you have a gout attack. You can try self-help treatments for gout such as resting, raising and keeping cool your affected joint. Your doctor may prescribe medicines to ease an attack of gout such as non-steroidal anti-inflammatory drugs (NSAIDs), colchicine or corticosteroids.

To prevent gout returning you can make lifestyle changes such as losing weight, changing your diet and avoiding trigger foods. You may need medication to reduce your uric acid levels over the long-term such as allopurinol. Medication is a good option if your attacks become more frequent or there is a risk of complications.


Osteoporosis means porous bones, so if you have osteoporosis your bones are gradually losing bone density and becoming more fragile, increasing your likelihood of breakage. Osteoporosis is very common, especially as you get older and in post-menopausal women. It can cause pain and disability.

If you’ve had a fall or you’re at risk of osteoporosis, then your doctor may recommend a bone density scan to confirm if you have osteoporosis. Often people don’t know they have osteoporosis until they fracture or break a bone.

There are many treatments for osteoporosis and to prevent fractures. Self-help measures such as increasing your daily intake of calcium and vitamin D in your diet or by supplements, taking regular exercise, stopping smoking or alcohol consumption and risk assessing your home.

Drug treatments for osteoporosis can help strengthen your bones and reduce your risk of a fracture. Most work by slowing down the activity of the cells that break down old bone and are known as ‘antiresorptive’ drugs. Pain management options include pain-relieving drugs, physiotherapy and pain management clinics. Your consultant will discuss the best options for your individual circumstances.

Connective tissue disorders

Connective tissue holds your muscles, skin and bones in place throughout your entire body. Connective tissues can become injured or inflamed due to inherited diseases, autoimmune diseases and environmental exposure. Connective tissue disorders can affect many parts of your body including your bones, eyes, skin, nervous system, and lungs.

There are many types of connective disorders and treatment depends on the type of disorder and your health. Anti-inflammatory medications are most frequently given to relieve inflammation, swelling, redness and pain.

Less common heritable connective tissue disorders include Marfan’s syndrome, Ehlers-Danlos syndrome and Loeys Dietz syndrome.

Autoimmune disorders cause your body to attack its own healthy cells and tissues and includes: scleroderma (hard, thickened areas of skin), systemic lupus erythematosus (SLE, affects your skin, joints, kidneys, heart, brain and red blood cells), rheumatoid arthritis (affects your joints), dermatomyositis (muscle inflammation and skin rash) and polymyositis (widespread muscle inflammation and skin problems).

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