Musculoskeletal Pain
Often patients will present with symptoms, which they perceive to be ‘arthritis’. Actually, there are many different reasons why you may have pain around a joint or the spine, which are not due to arthritis, but the pain mimics the symptoms. In many cases, the pain is due to soft tissue rheumatism. Here, the problem lies within the soft tissues such as ligaments, tendon insertions, muscles and fascia. Here are a few typical examples, which the Rheumatologist recognises and treats all the time.
1) Pain in the hip / lateral thigh pain
Trochanteric bursitis; in this case the hip pain is coming from around the widest point of the femur (greater trochanter), where there is a fluid filled sac (bursa) which may be inflamed and cause pain which radiates down the leg, typically at night, as far as the knee. Other structures, which may be inflamed and cause pain around here; the gluteus medius tendon insertion called gluteus medius tendinosis (often give pain going up and down stairs and sitting in the car), the ilio-tibial band (iliotibial band syndrome) causing pain down the lateral thigh into the knee 
The above problems may be misdiagnosed as osteoarthritis of the hip, sciatica and osteoarthritis of the knee. These are problems, which are due to a mechanical imbalance of the feet (usually pronation) or sometimes there are also co-existing back problems or a leg length difference. Patients, who have had unremarkable hip x-rays but continue to have hip pain, should seek a specialist referral to a Consultant Rheumatologist to make the correct diagnosis and to treat the condition.
An MRI scan may be useful to confirm the diagnosis, in some cases. The treatment is aimed at correcting any positional or postural imbalance of the feet or spine, working with a podiatrist and a physiotherapist. One (or sometimes two) low dose corticosteroid injections (from the Consultant Rheumatologist) to the inflamed areas will reduce inflammation and abolish the pain.
2) Plantar Fasciitis ‘Policemans heel‘
This is a very painful condition of the heel. The pain is worse on standing up, first thing in the morning and on weightbearing throughout the day.
The problem is due to inflammation of the thick tissue overlying the heel bone (plantar fascia) and may be caused by loss of the medial arches of the feet, combined with walking excessively in unsupportive/non-cushioned footwear.
The treatment consists of a steroid injection to the heel (following a local anaesthetic) followed by calf stretching exercises and orthotics (to provide proper foot alignment and heel cushioning).
For further information visit Arthritis Research Campaign website
3) Back Pain
This condition, may be simple or more complex. Rheumatologists will see patients with many types of back pain. It is useful to see a Consultant Rheumatologist to determine which sort of back pain you have, so that the treatment may be very specifically targeted to abolish or alleviate the pain.
Ankylosing Spondylitis
This condition is a form of inflammatory arthritis (starting from the immune system), mainly in the spine and particularly involving the sacroiliac joints but it may spread throughout the spine, causing stiffness and, sometimes, deformity.
Patients are particularly stiff in the mornings and sometimes woken up at night, with the pain.
It is a complex medical condition, usually diagnosed by a rheumatology specialist, through taking a careful patient history, examination, blood tests and x-rays or MRI.
There are a number of very effective treatments for this condition now. Physiotherapy is also extremely helpful to maintain mobility of the spine.
For further information visit Arthritis Research Campaign website
Mechanical Back Pain
In this case, there is no underlying inflammatory cause, and this kind of pain is generally worse on weight bearing, or as the day goes on.
There are many possible underlying causes such as degenerative / protruding discs which may be pressing on exiting nerve roots (giving sciatic type symptoms), degenerative changes of the vertebrae or facet joints. There are also muscular attachments to the spine, which may become tender or painful. A careful history, examination and radiology investigations will help to determine the cause, and treatment will follow. Rheumatologists work closely with spinal surgeons, physiotherapists, and pain consultants to treat this kind of back pain.
Other causes of back pain
These will be investigated by your specialist from the patient history, examination, blood tests and radiology.
It is very important to exclude other serious causes of back pain, such as malignancies and osteoporotic collapse of a vertebra.
