is the division of internal medicine that deals with diseases of the musculoskeletal system including joints, bones and soft tissues. The commonest joint problem and the one with which everyone is familiar is Osteoarthritis which is usually described as wear and tear and becomes increasingly common with age, after the menopause or after injury to individual joints. However, there are said to be around 200 ‘Rheumatic’ diseases involving diverse mechanisms including infection, metabolic disturbance (such as Gout and Osteoporosis) and importantly diseases due to abnormal function of the immune system. These are referred to as Autoimmune (AI: auto here means “self”) disease reflecting the concept of the immune system reacting to the bodies own or ‘self’ tissue causing ongoing inflammation.

Rheumatoid Arthritis (RA) is the commonest AI arthritis and affects up to to 1% of the population. Information is available at the NRAS website  Other, less common conditions include Systemic Lupus Erythematosus (SLE) http://www.lupusuk.org.uk/and spinal inflammatory diseases such as Ankylosing Spondylitis (AS) (http://nass.co.uk/) or read more here ( http://www.arthritisresearchuk.org/arthritis-information/conditions/ankylosing-spondylitis.aspx.) Likewise, Psoriaisis is an autoimmune disease of skin and is associated with various forms of immune inflammatory arthritis some resembling AS, others resembling RA (psoriatic arthritis: PsA. (Read more about it here.) Less common conditions sharing a genetic relationship with psoriasis and AS include examples like Behcet’s disease (http://www.behcets.org.uk) and arthritis associated with inflammatory bowel disease. Vasculitis refers to autoimmune disease of the blood vessels. Most forms are rare and many can be serious, but two types: Polymyalgia Rheumatica (PMR) and the related Temporal Arteritis (TA) are fairly frequent in the European population (http://www.arthritisresearchuk.org/arthritis-information/conditions/polymyalgia-rheumatica.aspx.)

Joint hypermobility can present a number of challenges often complex, the HMSA provide advice.

An important concept with AI disease is that these conditions, while often presenting primarily as joint diseases can affect any or most of the bodies organ systems (skin, kidney, brain, lung etc) and are also called multisystem diseases to reflect this. Accordingly a strong grounding in general medicine is an important aspect of the training of a rheumatologist and for that reason trained throughout in general medicine and practiced as a consultant general physician for over 10 years after appointment at Maidstone.