Rheumatology is a medical specialty which focuses patient management and research on the manifestations of musculoskeletal disease. Given the origin and aetiology of musculoskeletal disease, the subject matter is necessarily wide.
Conditions which are managed and researched by rheumatologists include autoimmune connective tissue and joint diseases (for example: rheumatoid arthritis, systemic lupus erythematosus), mechanical and degenerative joint diseases (for example: osteoarthritis and disorders of articular cartilage), muscle and tendon disorders, sports injuries, disorders manifest by pain and conditions of bone (for example: osteoporosis).
Rheumatologists have the opportunity to develop sub-specialist interests, in addition to undertaking General Medicine duties, through dual accreditation in Medicine and Rheumatology.
Rheumatology attracts basic science immunologists and cell biologists interested in (chronic) inflammation research. Arguably, the most frequent clinical manifestation and major clinical consequence of chronic inflammation is either autoimmune joint or connective tissue disease. Similarly, bone biologists can appropriately develop relevant clinical links through Rheumatology. Inflammation and bone research scientists wishing to train in a clinical specialty might reasonably choose to train clinically in Rheumatology within the National Clinician Scientist Training Scheme.
Rheumatology out-patient work is extremely varied. There are opportunities to practice a variety of practical skills including joint and soft-tissue and epidural injections. Rheumatologists invariably need to be skilled clinicians, keen on diagnostic dilemmas and stimulated by complex medical disease. They are often the most appropriate medical specialists to 'orchestrate' the long-term holistic care of patients with challenging multi-system disorders.
- Completion of a core medical training programme or equivalent.
- Documented evidence of achievement of level 1 competencies in general internal medicine (acute) and generic curricula.
- A broad general medical interest and knowledge base
- Knowledge and interest in the pathophysiology of auto-inflammatory diseases and metabolic bone disease as well as in biomechanics
- Ability to communicate effectively with patients
- Ability to communicate effectively with medical colleagues and paramedical specialists (for example physiotherapists, occupational therapists, specialist nurses)
- Capacity for working effectively within a team of professionals
- Capacity to be cognisant of the consequences of chronic disease and show sufficient empathy with that situation in applying knowledge and skills
- A commitment to life-long education
Rheumatology Curriculum https://www.jrcptb.org.uk/sites/default/files/Rheumatology%202022%20Curriculum%20FINAL.pdf
Internal Medicine Stage 2 Curriculum
British Society for Rheumatology (BSR) http://www.rheumatology.org.uk/
European League against Rheumatism (EULAR) http://www.eular.org/
American College of Rheumatology http://www.rheumatology.org/
Arthritis Research UK http://www.arthritisresearchuk.org/
National Osteoporosis Guideline Group (NOGG) https://www.shef.ac.uk/NOGG/
'My decision to do Rheumatology was fortuitous – great things happen by chance! The reason why I chose East of England was purely because my mum only knows two places in the UK – Cambridge or Oxford. Hence you can imagine my surprise when I was told that I would spend most of my time in Luton! However what a great decision that was. The rotation prepared me for all eventualities as I had the opportunity to see a wide range of pathology, take OOP time to undertake research, learn from great mentors and had relative freedom to choose the area for sub-specialisation. Though the rotation could be over a large geographical area, all my jobs were outlined in advance with focus on easy commuting and sufficient time to plan ahead. All these benefits manifested with final placement at Luton where the department was keen to expand providing consultant job at the right time for me to apply. I'd thoroughly recommend EoE rotation as I feel it complements a wide variety of job interests and provides plenty of opportunities to excel whilst keeping work life balance.’
Muhammad Nisar - Consultant in Rheumatology and General Medicine, Luton and Dunstable Hospital
Below are some highlights of research projects being undertaken or recently completed by our trainees;
Max Yates, Academic Rheumatology trainee and clinical lecturer
PhD in 'Epidemiology of polymyalgia rheumatica and giant cell arteritis' completed at University of East Anglia Jan 2018.
''My PhD investigated risk factors for onset and progression amongst individuals diagnosed with polymyalgia rheumatica (PMR) and giant cell arteritis (GCA)''
Jobie Evans, ST7 Rheumatology Trainee, currently out of programme for research
Currently undertaking MD Research Project in 'The effectiveness of small bowel MRI imaging as a screening tool for the presence of axial spondyloarthritis.' Undertaken at Addenbrookes Hospital on behalf of Cambridge University.
''My MD project is assessing the effectiveness of looking for incidental sacro-iliitis on MRI small bowel imaging to detect undiagnosed axial spondyloaarthritis. My aim is to increase the diagnostic rate and thereby referral rate from Gastro. There is good evidence long term structural damage and functional impairment can be prevented for early intervention in this patient group. However there is often a long time between first presentation to health care professional and a diagnosis being made, often over 5 years. I hope help improve the early referral of these patients from gastroenterology to rheumatology.''
Jagtar Nijjar, Academic Trainee and National Institute of Health Research Clinical Lecturer
Creating a national registry of CRMO (Chronic Relapsing Multifocal Osteomyelitis) and SAPHO (Synovitis Acne Pustulosis Hyperostosis and Osteiitis) as part Clincal Lecturer Role.
''Following a chance meeting with a mother of a teenage girl suffering from CRMO I wanted to do more to help patients with these two rare, possibly overlapping conditions. As these condition are so rare, in order to do this we need a formal register of patients with these conditions. This will help us identify potential causative factors and enable us to easily recruit patients to clinical trials to gather robust evidence for the most effective treatments.''
The Annual Review of Competence Progression (ARCP) takes place each year. This normally covers both rheumatology and general medicine, with the only exception being the Penultimate Year Assessments (PYAs) where the appraisals are separated. Trainees should ensure that their e-portfolio is up-to-date with the required number of assessments at least 2 weeks prior to the ARCP to enable the panel to review the evidence before the meeting.
Rheumatology ARCP Decision Aid
Internal Medicine Stage 2 ARCP Decision Aid https://www.jrcptb.org.uk/sites/default/files/IMS2%20ARCP%20Decision%20Aid%202022%20150921.pdf