Click on one of the names of conditions below to learn more.
Osteoarthritis
Rheumatoid arthritis
Shoulder pain
Neck pain
Back pain
Fibromyalgia
Ankylosing Spondylitis
Psoriatic arthritis
Systemic lupus erythematosus
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Osteoarthritis

 Osteoarthritis (OA) is generally thought of as a condition affecting old people and while it is true that all elderly individuals do have osteoarthritis somewhere (whether or not they are aware of it) it may also occur in relatively young persons under certain circumstances. OA is often described as a 'wear and tear' phenomenon affecting the joints so that they are envisaged as simply wearing out. While it is true that there is an element of accelerated wear, it not always so simple as that and, for instance, heredity is known to be important. Click on this button to see a picture of knobbly fingers in hereditary OA.
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Rheumatoid arthritis

 Rheumatoid arthritis (RA) is the commonest form of inflammatory arthritis which occurs in the UK and in other developed countries in the Western World. It is said to affect approximately 1% of the population and women are affected 3 times as commonly as men, at least before the menopause. Although it is often thought of as a crippling disease and although it is responsibe for much of the disability due to arthritis generally, its severity varies enormously and many sufferers have the condition quite mildly. It is incurable but treatment is steadily improving and there has been a tendency to treat the condition more vigorously in the early stages in recent years.
Diagnosis relies on accumulating information from the history, examination and investigations, especially certain blood tests and X-rays. Some patients develop characteristic nodules, particularly on the elbows. (Click on the button below to see a picture) They are not usually painful unless traumatised.
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Shoulder Pain

Shoulder pain can result from arthritis but other soft-tissue problems are actually rather more common. The most frequent problem is rotator cuff tendonitis which may often result from trauma to the tendons. This may be repeated minor trauma resulting from a repetitive activity. The pain is usually experienced in the shoulder or in the upper outer arm. Pain may restrict movements of the arm to some extent, but not usually as much as in the case of the other fairly common shoulder problem, 'frozen shoulder' or adhesive capsulitis. In this condition, whose cause is not known, the shoulder becomes extremely stiff and painful (usually worst at night) and the condition may take many months (not infrequently up to 2 years) to resolve completely. Injection may be helpful in either condition but the response is less predictable in the case of frozen shoulder. (Click the button below to see this illustrated)
Arthritis may affect the shoulder though. The shoulder may be involved in RA for instance. In the elderly, osteoarthritis may occur and degenerative change may also occur if the rotator cuff tendons become damaged.
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Neck Pain

Neck pain is very common. As with pain which arises spontaneously in any part of the spine, the precise cause or origin of the pain is often unknown but degenerative change affecting the joints between the vertebrae and also the discs is often believed to be the problem. (Cervical spondylosis - click on button to see an X-ray) A slipped disc may sometimes occur and give rise to pain or disturbance of sensation in the arm due to a 'trapped nerve'. Neck pain may also radiate to the shoulder area or towards the shoulder-blade without an actual nerve having become trapped. Trauma to the neck is another common cause of pain, as in road traffic accidents which may cause a 'whiplash injury'.
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Back Pain

Back pain is a very common complaint and is also socio-economically very important because of the disruption to work which it causes each year. This has been addressed to some extent by the introduction of some regulations related to certain working practices in the UK for example but there is a long way to go before the problem will be solved. 'Back strain' or soft tissue problems are the commonest cause of pain in younger patients along with intervertebral disc prolapses. With increasing age, this kind of problem becomes less frequent and degenerative change (lumbar spondylosis) takes over as a more important cause of pain. It's probably partly because we are so ignorant about the mechanism whereby the pain is generated that makes treatment so difficult. Many sufferers go to practitioners of various types of physical treatment to gain relief - hence the numbers of chiropractors and osteopaths who practise in this field. Physiotherapists also see many back pain sufferers. Click on the button to see lumbar traction underway in an individual with sciatica due to a slipped disc.
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Ankylosing spondylitis

Ankylosing spondylitis usually presents with low back pain. Back pain is generally very common, so how can we ensure that this diagnosis is not missed? The doctor must always be aware of the condition and remain on the lookout for certain diagnostic clues - otherwise the true diagnosis can be overlooked for years, as has been the state of affairs in the past.
A history of morning stiffness or pain and stiffness in the night is typical. The pain may radiate down the back of the thigh (but not beyond the knee) which sometimes results in a mistaken diagnosis of sciatica. There may be pain at other sites - the neck, the rib cage, joints or at points of tendon attachment (click button for picture). There may be a family history of the condition or related disorders such as psoriasis or inflammatory bowel disease. It is important that the diagnosis is made at an early stage to permit treatment to prevent loss of mobility of the spine.
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Systemic lupus erythematosus

Systemic lupus erythematosus (SLE, Lupus) is the commonest of a group of less common rheumatic disorders known as connective tissue diseases. They are also often referred to as 'autoimmune diseases' because they are characterised by evidence of autoimmunity which is mainly evident on blood-testing. Virtually any organ in the body can be affected by lupus but the contition most commonly affects joints and skin. Joints pains are very common and there may not appear to be very much wrong with them on examination which may suggest to the doctor that there is not very much going on when the patient first consults with the problem. Other relatively common problems are a rash induced by sunlight(photosensitivity), hair loss, mouth ulcers and simply feeling unwell. Kidney involvement may occur and is sometimes associated with more serious disease but the condition overall has a much better outlook than seemed to be the case in the past. Clicking on the button will enable you to see an example of alopecia.
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Psoriatic arthropathy

About 5% of individuals with psoriasis develop an arthritic problem at one time or another. Psoriasis is itself a common condition, affecting about 1% of the population in the UK. There is no relationship between the severity of the skin complaint and the severity of the rheumatic disorder and the two may arise at quite different times but in many cases the two start within months of each other. The rheumatic symptoms occur in a variety of forms ranging from a type which resembles rheumatoid arthritis through to ankylosing spondylitis. In most cases, the arthritis has a better outlook overall than RA but there is much individual variation in severity. Some of the clinical features overlap with ankylosing spondylitis. Click on the button to see what psoriasis looks like.
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Fibromyalgia

This condition is characterised by pain which is often diffuse and widespread and associated with tenderness which occurs typically at certain sites. Sleep disturbance is a characteristic symptom and indeed may contribute to pain. It has been shown that artificial sleep deprivation may cause fibromyalgic symptoms. Another characteristic feature is that laboratory investigations are normal and are of no positive help in making the diagnosis although they can help in excluding certain other conditions. Fibromyalgia may be either Primary, or not associated with anything else or Secondary, in which case there seems to be some pre-existing problem, for instance some other rheumatic disorder. The frequency with which the diagnosis is made varies among doctors and it is a condition which is more often diagnosed in the USA. Treatment can be difficult. Restoring a normal pattern of sleep may help and tricyclic antidepressants have been shown to be beneficial, perhaps partly due to this action
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