Rheumatology deals with the investigation, diagnosis and management of patients with musculoskeletal conditions. It is a multidisciplinary complex specialty incorporating over 200 disorders affecting joints, bones, muscles and soft tissues, including inflammatory arthritis and systemic autoimmune disorders. Musculoskeletal conditions can be debilitating and socio-economic consequences severe: 20% of people with chronic physical health problems have depression known to be associated with poor treatment adherence and diagnostic overshadowing, adversely affecting treatment and health status. Diseases are often treated in isolation but there is increasing recognition of the complex relationships between diseases and treatments in patients with multiple chronic diseases, and growing evidence of the detrimental effect poor mental health can have on physical health outcomes. There is little formal acknowledgement of the impact of mental health on those with musculoskeletal conditions. With the management of arthritides largely based in secondary care, the rheumatology team could be best positioned to provide psychological support for those with mental health issues as co-morbidities. The European League against Rheumatism (EULAR) recommends that the role of the rheumatology practitioners should include provision of psychosocial and self-management support for patients with inflammatory arthritis (IA). This discussion advocates syndication of a registered mental health nurse (RMN) embedded within the Rheumatology outpatient department (OPD). This will require the support of clinical leaders and policy makers but could bring significant patient benefit
