Care for people with rheumatic and musculoskeletal diseases has improved in the developed world, but in many low-income countries, these diseases are underdiagnosed, undertreated and continue to cause disability, morbidity and mortality - a global health inequality. We discuss the challenges of diagnosing and treating RMDs in low-resource settings, with Tanzania as an example. https://doi.org/10.1093/rap/rkad079