Rheumatology – (M.Sc.)

Contents

The MSc course is a part-time course of two years duration. The programme consists of:

* Six 'basic' modules, each of which comprise 3-8 components for a detailed understanding of rheumatic diseases.
* Four 'advanced' modules, the training for which is based on small group tutorials, problem-based scenarios, development of critical reasoning, self-learning, and learning through the ability to provide evidence of acquired knowledge through presentations.
* Assessment throughout the two-year period, comprising a literature review, three multiple choice examinations, presentations, submission of a mock grant application and an MSc dissertation.
* A final assessment which entails viva voce examinations of the trainees on their clinical knowledge and skills.

Students will need to attend the Department (at the Nuffield Orthopaedic Centre, Oxford) for one full day (the first Thursday) of each month, with the exception of August and December. The teaching sessions for the basic modules will take place in the mornings, and the teaching sessions for the advanced modules will take place in the afternoons. Some morning sessions will combine with Regional Rheumatology Meetings to discuss case reports.

The six compulsory basic modules comprise:

* Introduction to Rheumatic Diseases
* Mechanisms of Rheumatic Diseases
* Investigation and Assessment of the Rheumatic Diseases
* Clinical Aspects of Rheumatic Diseases
* Management of the Rheumatic Diseases
* Statistics and Information Technology

Additionally, students have to choose four out of seven advanced modules they wish to study. The seven choices are as follows:

* Paediatric Rheumatology
* Cell Biology
* Bone Infection
* Sports Medicine
* Bone Tumours
* Bone and Joint Pathology
* Advanced Radiology

* Introduction to Rheumatic Diseases

This module covers the spectrum of diseases affecting the musculoskeletal system, a broad introduction to their epidemiology and frequency, their impact on global health and health in the UK, and a general introduction to their management and outcome. This module is comprised of clinical and molecular genetics, aetiology, epidemiology and pathogenesis of rheumatic diseases.

* Mechanisms of Rheumatic Diseases

This section will build on the introductory module to look at rheumatic diseases in an itemised fashion dealing with various forms of inflammatory arthritis including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and reactive arthritis, degenerative forms of arthritis including degenerative disc disease and osteoarthritis, systemic lupus erythematosus. The aetiology, the pathogenesis, clinical and radiographic outcomes of these diseases in humans will be discussed and basic mechanisms of disease in preclinical models will be introduced. This module will include genetic mechanisms, immunological mechanisms and inflammatory mechanisms.

* Investigation and Assessment of the Rheumatic Diseases

This module includes lectures on laboratory techniques for investigation and monitoring of disease and its treatment, including immunological investigations. The principles of radiological ultrasound and MRI will be introduced as well as diagnostic criteria, clinical classifications and disease scoring systems.

* Clinical Aspects of Rheumatic Diseases

This module will explore all aspects of clinical presentation, complications, management, prognosis and investigation of the rheumatic diseases in specific topics which will include the inflammatory joint diseases (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, reactive arthritis), degenerative joint disease including degenerative spinal disease and osteoarthritis, crystal deposition disease including gout and pyrophosphate arthropathy, connective tissue diseases (SLE, scleredema, vasculitides), metabolic bone disease, and heritable monogenic disorders of the musculoskeletal system and associated tissues.

* Management of the Rheumatic Diseases

Advances in our understanding of the connective tissue diseases have been considerable in the past 10 years and are leading to the development of more targeted approaches to therapy. Students will discuss the strength of evidence to support the conjecture that antibodies may mediate some forms of connective tissue disease and vasculitis. Clinical trials, evaluation measures and outcome measures will be reviewed.

Moreover, clinical pharmacology, psycho-social and economic aspects of disease, surgery of the rheumatic diseases, and basic concepts of conducting clinical trials and objective assessment of treatment efficacy, as well as physical approaches to the treatment of rheumatic diseases (physiotherapy and occupational therapy), will be addressed.

* Statistics and Information Technology

This module will inform students on how to access relevant information, and communicate it effectively through introduction to basic IT techniques for accessing databases, Pub-Med and other sources. This will be followed by sessions on basic statistical methods relevant to medicine and the understanding of meta-analysis and evidence based medicine.

* Paediatric Rheumatology

During this module students will learn about the unique problems faced by children compared to adults with rheumatic diseases, including an evaluation of the effect of disease on growth, education, the family and the wider social impact of disease in children. There will be a description of different forms of juvenile arthritis. Current concepts in aetiopathogenesis and the scientific basis for current therapeutic approaches will be addressed. The juvenile connective tissue diseases will be discussed with particular emphasis on juvenile SLE.

* Cell Biology

Building on the basic cell biology module, the students will explore the complex interaction between cells and environment in relation to cartilage breakdown in osteoarthritis, current understanding of synovial abnormalities in inflammatory joint diseases and mechanisms of bone turnover in osteoporosis.

* Bone Infection

Osteomyelitis and septic arthritis are feared complications of joint arthroplasty. The factors which predispose to infection and the mechanisms by which bacteria persist in the infected areas will be reviewed with particular reference to the development of biofilms

* Sports Medicine

This module will provide an understanding of normal physiological changes during exercise. It will explore the pathology behind common and less common sports injuries as the basis for their current and future management.

* Bone Tumours

Primary and secondary bone tumours will be reviewed in adults and children. The mechanism by which they spread will be examined and there will be an evaluation of current and future therapies

* Bone and Joint Pathology

The students will examine the pathological changes which characterise some of the rheumatic diseases; comparison will be made between different forms of synovitis; cartilage and bone changes will be explored during the natural history of osteoarthritis.

* Advanced Radiology

Techniques in musculoskeletal imaging are advancing rapidly. The module will review the use of MRI and ultrasound as diagnostic and assessment tools in rheumatology, for evaluating the severity of disease in inflammatory arthritis and ankylosing spondylitis.