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Rheumatology Harley Street
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At RHS, we aim to provide the best standard of care for patients with rheumatic conditions. All Consultants in the practice have strong Academic backgrounds and apply evidence-based medicine to diagnose, treat and manage joint and connective tissue disorders.
We provide a multidisciplinary approach tailored to meet individual patients’ needs.Rheumatology
Harley
StreetT E A M
Doctor
Elisa Astorri
Doctor
Michele Bombardieri
Doctor
Francesco CarlucciRead moreRead moreRead more -
Dr Elisa Astorri MD PhD is the founder of Rheumatology Harley Street ©, a private practice specialising in the cure of inflammatory joint disorders and autoimmune rheumatic conditions. She concentrates in all aspects of Rheumatology ranging from Rheumatoid Arthritis, Osteoarthritis, Back Pain, Gout, Lupus, Sjögren’s Syndrome, Ankylosing spondilytis, Fibromyalgia, Osteoporosis. Dr Astorri is an Academic Physician Rheumatologist working at Barts Hospital, Queen Mary University, London since 2007. She is also Senior Investigator in several Clinical Trials that involve the use of new Biologic treatments in connective tissue autoimmune diseases. She completed her Specialty training in Rheumatology with Queen Mary University, Barts and The London School of Medicine, London, UK as well as at La Sapienza University of Rome, Italy, magna cum laude.D r E l i s a A s t o r r i
T E A M
Dr Astorri previously completed a PhD in Rheumatology on Sjögren’s Syndrome at the Experimental Medicine & Rheumatology Department, John Vane Science Centre, William Harvey Research Institute. During her medical career she also trained in French Universities such as the Centre Hospitalier Universitaire de Bretonneau, Tours and Le Service d’Urgence de la Fondation Vallée, Paris. Dr Astorri graduated in Medicine at University Campus Bio Medico, Rome, Italy, magna cum laude. Dr Astorri has published several scientific articles in peer-reviewed journals with high impact factor and she is a Member of the IDF. Dr Astorri is fluent in English, French, Italian and Spanish. Send me an emailback -
Dr Michele Bombardieri, MD, PhD, FRCP is Reader in Immuno-Rheumatology at the Centre for Experimental Medicine and Rheumatology at the William Harvey Research Institute at Queen Mary University of London and Consultant Rheumatologist at Barts Health NHS Trust.
He completed his specialist training at the University of Rome “La Sapienza” and completed a PhD in Experimental Rheumatology at Kings College London in 2007. He has been recipient of consecutive prestigious fellowships from the Arthritis Research UK, including a Clinical Research Fellowship (2005-07) and a Clinician Scientist Fellowship (2007-2010). He was awarded a NIHR/HEFCE Senior Clinical Lectureship in 2010 and was promoted to Reader in 2016.
D r M i c h e l e B o m b a r d i e r i
He is an internationally recognised expert in the field of autoimmunity, inflammatory arthritis and connective tissue diseases and has authored over 80 publications in distinguished peer-reviewed Journals. He leads on national and international clinical trials with novel biologics in Sjogren’s syndrome for which he received a NIHR Principal Investigator Recognition Award in 2016.
Dr Bombardieri has been on the GMC specialist register since 2007 and his clinical practice encompasses the whole spectrum of rheumatological conditions. His specialist clinical interests focus upon the diagnosis and management of patients with autoimmune rheumatic diseases such as Sjogren’s syndrome, lupus, overlap syndromes and all forms of inflammatory arthritis. Send me an emailT E A M
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Dr Francesco Carlucci MD PhD FRCP is Rheumatologist specialist in the diagnosis, treatment and management of Rheumatology conditions. In particular, he has acquired extensive experience in the treatment of Inflammatory Arthritis, such as Rheumatoid Arthritis, and Connective Tissue Disease, such as Lupus.
After obtaining his specialist training certificate at the University of Rome “La Sapienza”, he moved to the Imperial College London where he completed a PhD in Rheumatology. He was then awarded a three years Clinician Scientist Fellowship by Arthritis Research UK after which he moved to the Botnar Research Centre, Oxford University, where he was Senior Investigator in several Clinical Trials in RA, psoriatic arthritis and ankylosing spondylitis.D r F r a n c e s c o C a r l u c c i
Dr Carlucci is now a Rheumatology Consultant at Croydon University Hospital. He previously worked at Hammersmith Hospital, Imperial College NHS Trust, at Barts Hospital, Queen Mary University London, and more recently at the Nuffield Orthopaedic Centre, Oxford University Hospitals.
Dr Carlucci has years of experience in musculoskeletal ultrasonography (MSK US) having had years of training and attended several national and international courses. He is currently registered with Canterbury Christ Church University for a Diploma in MSK US. Dr Carlucci has published several scientific articles in peer-reviewed journals with high impact factor. Send me an emailT E A M
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Inflammatory
joint disordersRheumatoid ArthritisCrystal ArthropathiesAnkylosing SpondylitisConnective
tissue diseasesLupusSjogren’s SyndromeRaynaud’s phenomenonVasculitisPolymyositis/DermatomyositisPain
syndromesFibromyalgiaOsteoarthritisBack painOsteoporosisPaget’s diseaseW E T R E A T
Degenerative
joint disordersBone
disordersD I S O R D E R S
Carpal tunnel syndromePsoriatic arthritis -
Inflammatory
joint disordersD I S O R D E R S
Rheumatoid arthritis (RA) is the most common chronic inflammatory arthritis. In this condition white blood cells attack multiple joints causing inflammation, which results in joint pain and swelling. If untreated, RA leads to permanent joint damage and disability. Early diagnosis and treatment with synthetic disease-modifying anti-rheumatic drugs (DMARDs) is critical to control inflammation and prevent joint damage: also known as disease remission. However, around 40% of patients with RA do not respond to or cannot tolerate synthetic DMARDs; in these patients a biologic treatment (i.e. anti-TNF) should be started without delay.Rheumatoid Arthiris
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Inflammatory
joint disordersD I S O R D E R S
In Crystal Arthropathies, joint inflammation is caused by deposit of crystals in the joints. These crystals can be mainly formed by urate in gout and by calcium pyrophosphate (CPP) in CPP disease (CPPD) or sometime known as “pseudo-gout”. Gout can happen as an acute attack of joint pain and swelling (gout attack) or a persistent inflammation of the joints (chronic gout). The underlying cause is raised uric acid levels in the blood, which may be present for years without acknowledgement. Treatment involves lifestyle changes, tablets to reduce uric acid levels and anti-inflammatories to control joint pain. Differently from gout, no drugs can modify CPP deposition and thus CPPD management is still purely symptomatic with the use of anti-inflammatory drugs and intra-articular or parental corticosteroid.Crystal Arthropathies (Gout and CPPD)
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Inflammatory
joint disordersD I S O R D E R S
Ankylosing spondylitis (AS) is a progressive, disabling inflammatory condition that affects mainly the spine (spondylitis meaning spine inflammation). This condition causes severe low back and neck pain, typically at night time. If untreated, AS reduces the flexibility of the spine leading to profound disability. Thus, early diagnosis (i.e. with an MRI scan) and treatment are critical to prevent disease evolution.Ankylosing Spondylitis and Spondyloarthropathies
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Inflammatory
joint disordersD I S O R D E R S
Psoriatic arthritis is a form of chronic joint inflammation associated with a skin condition called psoriasis (a red, scaly skin rash frequently affecting elbows, knees, scalp and fingernails). The arthritis can develop before the psoriasis, without psoriasis or in patients with a close relative affected by psoriasis. Symptoms of psoriatic arthritis can be diverse and include stiff, swollen and painful joints with sausage-like swelling of fingers or toes, involvement of the spine with low back pain and pain in the tendons (i.e Achilles tendons).Psoriatic arthritis
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Connective
tissue diseasesD I S O R D E R S
Systemic Lupus Erythematosus (SLE or Lupus) is a potentially severe autoimmune disease in which the immune system produces antibodies that attack the body's tissues, causing inflammation and damage. Lupus normally develops in women and can affect virtually any part of the body but more frequently the skin (rashes after sun exposure), the joints (pain and swelling) and several internal organs including the kidneys, the heart and the lungs. Other common symptoms include extreme tiredness (fatigue), fever, and weight loss, swelling of the lymph glands, hair loss and mouth ulcers. Effective treatments are available for lupus; these depend on the involved organs and the severity of the disease.Systemic Lupus Erythematosus
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Connective
tissue diseasesD I S O R D E R S
Sjogren’s syndrome (SS) is the second most common rheumatic autoimmune disease and mainly affects women (9:1 female to male ratio). It is often underdiagnosed or diagnosed with long delays. SS causes inflammation of several glands in the body resulting in dry mouth, dry eyes, dry throat, dry skin and vaginal dryness. Other symptoms typically include severe fatigue, multiple joint and muscle pain and peripheral neuropathy (i.e. pins & needles with burning pain in arms and legs). In some patients, other complications can occur including involvement of kidneys, lungs and lymphoma.Sjogren’s syndrome
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Connective
tissue diseasesD I S O R D E R S
Raynaud’s phenomenon causes the blood supply to fingers or toes to be reduced in cold or emotionally stressful conditions, which results in discomfort and the affected areas changing colour. These colour changes are often accompanied by pain or a tingling feeling. It is important that patients with Raynaud’s are assessed by a Rheumatologist in order to exclude the presence of an underlying connective tissue disease such as lupus, scleroderma or Sjogren’s syndrome.Raynaud’s phenomenon
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Connective
tissue diseasesD I S O R D E R S
Vasculitis means inflammation of the blood vessels due to activation of the immune system. It can cause a variety of different problems and severe complications starting with general feeling unwell, fever, sweats, fatigue and weight loss. Other symptoms vary according to which part of the body is affected, for example: skin ulcers, nosebleeds, red or painful eyes, pins and needles or weakness in the arms and legs, joint pain or swelling, muscle aches, coughing and shortness of breath, strokes, problems passing urine or blood in the urine. Headaches, pain in the jaw and problems with the eyes can also be serious symptoms.Vasculitis
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Connective
tissue diseasesD I S O R D E R S
Polymyositis and dermatomyositis are rare but potentially severe autoimmune conditions in which the immune system attacks the body's muscles (myositis meaning muscle inflammation). Typical symptoms include muscle weakness in arms and legs and generally feeling unwell. In dermatomyositis also the skin is affected causing a rash (often on the chest and hands) and swelling around the eyes. The diagnosis is made using a combination of blood tests, imaging (i.e. muscle MRI) and electromyography followed by a muscle biopsy of the affected area. The disease requires immediate treatment with appropriate drugs.Polymyositis/Dermatomyositis
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Pain
syndromesD I S O R D E R S
Fibromyalgia is a common condition, causing widespread muscle pain, non-resting sleep, headaches, forgetfulness and difficulty in concentrating. The exact causes of fibromyalgia are not known, but anxiety, physical and/or mental trauma, and sleep disturbance are thought to play a part. Fibromyalgia is frequently associated with chronic fatigue syndrome that causes persistent fatigue (exhaustion) that affects everyday life and does not improve after sleep or rest. Biological, genetic, infectious, and psychological mechanisms have been proposed, but the cause is not understood. Diagnosis is based on a careful assessment of signs and symptoms, clinical examination and exclusion of underlying autoimmune diseases.Fibromyalgia and Chronic fatigue syndrome
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Degenerative
joint disordersD I S O R D E R S
Osteoarthritis is a condition that affects the surfaces of the joints and is also known as “wear and tear”. In osteoarthritis, the cartilage which forms a cushion between bone ends in the joints gradually thins, and the bone underneath thickens. In severe osteoarthritis, the bones rub against each other causing pain (i.e. knee pain when climbing up and down stairs). Progressively, this process can severely damage the joint, causing disability.Osteoarthritis
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Degenerative
joint disordersD I S O R D E R S
Back pain is a common problem which affects up to 80% of the general population. It can be caused by a simple muscle, tendon or ligament strain or by a more serious problem. Often back pain is due to a range of factors, including: poor posture, lack of exercise resulting in stiffening of the spine, muscle strains or sprains. There are also specific conditions which are associated with pain felt in the back like spondylosis, sciatica or spinal stenosis. A specialist Rheumatology consultation can help in distinguishing the underlying cause and guide appropriate treatment.Back pain
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Degenerative
joint disordersD I S O R D E R S
Carpal tunnel syndrome is a condition in which the median nerve is compressed inside the wrist tissues and this can cause pain or aching, tingling or numbness in the affected hand. Women are more affected than men and hormonal changes can play a significant role.Carpal tunnel syndrome
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Bone
disordersD I S O R D E R S
Osteoporosis is a disease of the bones which more frequently affects post-menopausal women. It is caused by reduced calcium content in the bones which become weak. It is associated with aging and it is accelerated by several factors (smoking, excessive alcohol, lack of physical exercise, long-term use of steroid treatment, thyroid problems etc). The disease normally remains silent for many years until a weakened bone fractures following a minor trauma. Thus, an early diagnosis in high risk individuals through a DEXA (dual energy x-ray absorptiometry) scan is essential in order to prevent future fractures. Treatment includes calcium/Vitamin D supplements and bisphosphonates which need to be monitored by a Rheumatologist.Osteoporosis
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Bone
disordersD I S O R D E R S
Paget’s disease is a rare condition which affects the way bones renew and repair. In this condition, bone is reabsorbed more rapidly than new bone is made, causing it to become weaker than normal, until it bends or breaks. Bone pain is also typical of the disease. If untreated it causes irreversible bone damage and severe fractures.Paget’s disease
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