What Is Rheumatology?
Rheumatology is a rapidly evolving medical sub-specialty, devoted to the diagnosis and therapy of rheumatic diseases. These diseases especially affect joints, tendons, ligaments, bones, and muscles. There are more than 200 types of these diseases, including rheumatoid arthritis, osteoarthritis, gout, lupus, back pain, osteoporosis, lupus and tendinitis. Some of these are very serious diseases that can be difficult to diagnose and treat. Rheumatic diseases can also involve internal organs.
The cause of every major rheumatological disorder is now best explained by imbalance in the autoimmune system. Hence, rheumatic diseases are often referred as autoimmune disease. The treatment modalities are also based on clinical research on autoimmune system. Evidence-based medical treatment of rheumatological disorders has helped patients with these disorders lead a near normal life.
There is an increasing demand for specialists in this field with an increasing population of patients who need specialized treatment. Rheumatologists are increasing in numbers in all countries.
Who Is a Rheumatologist?
A consultant rheumatologist is a doctor who specialises in diagnosing and treating arthritis and diseases related to rheumatology. Rheumatologists treat over 200 different health problems that affect the joints, bones, muscles and other internal organs (e.g. kidneys, lungs, blood vessels, brain). They focus on non-surgical treatment of arthritis and related rheumatic diseases. Rheumatologists can also specialize in pediatric rheumatology — treating children with rheumatic diseases. Many rheumatologists also conduct research to determine the cause and better treatments for these disabling and sometimes fatal diseases.
Rheumatologists treat arthritis, certain autoimmune diseases, vasculitis, musculoskeletal pain disorders and osteoporosis. There are more than 200 types of these diseases, including rheumatoid arthritis, osteoarthritis, gout, lupus, back pain, osteoporosis, and tendinitis. Some of these are very serious diseases that can be difficult to diagnose and treat.
Adult rheumatologists are specifically trained to be highly skilled in:
1. Developing a differential diagnosis of rheumatic disorders and autoimmune diseases
2. Efficient use of diagnostic evaluations in rheumatic disorders
3. Selecting appropriate medical therapy for treatment of rheumatic disease given the patient’s lifestyle and co-morbidities
4. Monitoring long term efficacy and side effects of multiple medications including anti-inflamatory and biologic agents used to treat rheumatic disease
5. Improving quality of life and decreasing disability of patients suffering from rheumatic disease
6. Providing longitudinal care for chronic rheumatic disease management such as, rheumatoid arthritis, systemic lupus erythematosus and many more.)(should be mention specific diseases or be more generic?)
7. Aspiration and injection of joints for diagnosis and treatment of rheumatic disease
8. Interpretation of radiographic, imaging, (e.g., ultrasound, MRI, CT, dual energy X-ray absorptiometry) and laboratory studies in context of rheumatic disease evaluation
9. Evaluation and management of osteoporosis
Rheumatologists provide a key role in the non-surgical treatment of osteoarthritis, soft tissue rheumatism, back pain, and other aspects of musculoskeletal health. Particularly, attention is paid to care of the geriatric patient who is maybe unable or does not wish to have extensive surgical procedures for the treatment of osteoarthritis, spinal stenosis as well as other conditions.
What causes rheumatic diseases? ?
Rheumatic diseases are generally believed to be caused by a combination of genetic and environmental factors. In other words, you may be born with a susceptibility to a disease, but it may take something in your environment to get the disease started.
Some of these factors have been identified. For example, in osteoarthritis, inherited cartilage weakness or excessive stress on the joint from repeated injury may play a role. Certain viruses may trigger disease in genetically susceptible people. Gender is another factor in some rheumatic diseases. Lupus, rheumatoid arthritis, scleroderma, and fibromyalgia are more common among women. This indicates that hormones or other male-female differences may play a role in the development of these conditions.
Diseases Treated By Rheumatologist / Arthritis
- Rheumatoid arthritis
- Reactive Arthritis
- Psoriatic arthropathy
- Enteropathic spondylitis
- Juvenile idiopathic arthritis(JIA)
- Septic arthritis
- Hypermobolity syndrome
- Seleroderma(systmic selerosis)
- Microscopic polyangiitis
- Wegener’s granulomatosis
- Henoch-Schonlein purpura
- Takayasu’s arthritis
- Kawasaki’s disease
- Sjogren’s syndrome
- Polymyalgia rheumatiea
- Churg-Strauss Syndrome
- Giant cell arteritis, Temporal arteritis
- Beheet’s syndrome
- Churg- strass syndrome
Common Signs and Symptoms of Arthritis
- Swelling in one or more joints
- Stiffness around the joints in the early morning or with inactivity
- Constant or recurring pain or tenderness in a joint
- Difficulty using or moving a joint normally
- Warmth and redness in a joint
Diseases For Patient Education
- Rheumatoid Arthritis
- Systemic Sclerosis
- Psoriatic arthropathy
- Juvenile idiopathic arthritis(JIA)
Do You Know?
- Children do get arthritis too.
- There are new treatments for RA which can stop disease progression.
- Process of permanent joint damage can set in as early as 12 weeks from onset of symptoms in RA. Early treatment prevents joint damage.
- Having RA increases risk of heart attack and stroke.
- Patients do not get any symptoms from osteoporosis until they fracture a bone.
- There are non-surgical treatment options for osteoarthritis.
- In the early stages of arthritis blood tests and joint examination can be normal.
- Rheumatoid Factor and ANA can be seen in normal population.
- Ultrasound scan is 7 times more sensitive than plain X-ray in identifying the arthritis changes.
Methotrexate may cause very serious, life-threatening side effects. You should only take methotrexate to treat cancer or certain other conditions that are very severe and that cannot be treated with other medications. Talk to your doctor about the risks of taking methotrexate for your condition.
Sulfasalazine is used to treat bowel inflammation, diarrhea (stool frequency), rectal bleeding, and abdominal pain in patients with ulcerative colitis, a condition in which the bowel is inflamed. Sulfasalazine delayed-release (Azulfidine EN-tabs) is also used to treat rheumatoid arthritis in adults and children whose disease has not responded well to other medications. Sulfasalazine is in a class of medications called anti-inflammatory drugs. It works by reducing inflammation (swelling) inside the body.
Hydroxychloroquine (HCQ), sold under the brand name Plaquenil among others, is a medication used for the prevention and treatment of certain types of malaria. Specifically it is used for chloroquine-sensitive malaria. Other uses include treatment of rheumatoid arthritis, lupus, and porphyria cutanea tarda. It is taken by mouth.
Leflunomide (Arava) is a drug approved to treat adult moderate to severe rheumatoid arthritis. It belongs to a class of medications called disease-modifying antirheumatic drugs (DMARDs). This class of medicines can decrease joint damage and disability caused by rheumatoid arthritis. Leflunomide is often used to treat rheumatoid arthritis alone or in combination with other DMARDs.
A biologic drug is a product that is produced from living organisms or contain components of living organisms. Biologics include recombinant proteins, tissues, genes, allergens, cells, blood components, blood, and vaccines. Biologics are used to treat numerous disease and conditions
Where Does It Hurt?
- Salivary glands
- Nerve tissue
- Bone marrow
- Blood vessels
Living With arthritis
We know that arthritis can be a painful condition and that symptoms like fatigue can seriously affect what you feel able to do on a daily basis. There is plenty you can do to ease your symptoms, understand your condition and gain a sense of independence, both at home at work.
- Arthritis Medication
- Natural Arthritis Treatments
- Joint Surgery
- Understanding Your Arthritis Treatment Plan
Early arthritis clinic, case Adolescent Rheumatology with a transitional case, combined Rheumatology-pulmonology clinic, Rheumatology-Cardiology clinic, and Joint Rheumatology dermatology clinic, Osteoporosis clinic.
There are facilities available here for preventive health check-up.
Other facilities we provide here are an antenatal, postnatal special counseling session for rheumatology patients, yoga exercise, physiotherapy, and even diet consultation.
Apart from all these unique of Rheumatology Arthritis and Rheumatology center is the only center in North Maharashtra where guidance and surgical treatment for Rheumatology deformity correction given. Her aim is to provide awareness regarding Rheumatological condition in our population and make modern treatments available to the patient to improve quality of life.
Frequently Asked Questions (FAQ's)
A Rheumatologist is a specialist who is an expert in diagnosis and treatment of diseases affecting the joints, bones, muscles, ligaments, soft tissue and autoimmune diseases.
Joint diseases which can be treated with medicines, are treated by a Rheumatologist. Orthopedic surgeons specialize in surgical treatment of joints and management of fractures.
There are more than 100 different Rheumatological diseases, some of the common ones include – Rheumatoid arthritis, psoriatic arthritis, Osteoarthritis, Ankylosing spondylitis, gout, osteoporosis, fibromyalgia, lupus, vasculitis and other autoimmune diseases.
Most Rheumatic diseases are autoimmune in nature. An autoimmune disease develops when your immune system, which normally defends your body against diseases by mistake attacks the healthy tissues and organs of your body resulting in various symptoms and diseases.
Rheumatoid arthritis is a common inflammatory disease that affects the joints. Rheumatoid arthritis causes severe pain and swelling in your joints, as a result, it becomes difficult to bend and use them.
Rheumatoid arthritis can affect all age groups including children. It affects people in 30’s 40’s with higher frequency over 50 years of age. The disease is 3 times more common n females than males.
- Swelling, redness, warmth in joints
- Stiffness in the joints worse in morning getting better with movement
- Some people can experience tiredness, weight loss, fever.
Yes, there are certain conditions like fibromyalgia which cause generalized pain in muscles and soft tissue.
Patients use phrases like “I hurt all over” or “I have head to toe pain”. They also describe poor sleep and feeling tired all the time. Patients may also have difficulties with headaches, irritable bowel syndrome, or mood.
Rheumatoid arthritis affects all joints but particularly tends to affect small joints first of hands and feet. As the disease progresses it involves the wrists, knees, ankles, elbows, hips and shoulders.
If the disease is left untreated it causes significant pain and disability in the person limiting day to day activities. Also, in the future, the disease can cause significant irreversible damage to the underlying joints resulting in deformities.
With early diagnosis, treatment can be initiated with medicines which reduces pain and prevents damage in joints.
Rheumatoid arthritis is a clinical diagnosis made by your Rheumatologist based on medical history and findings on physical examination. Blood tests can be ordered to look for inflammation and antibodies associated with Rheumatoid arthritis.
Rheumatoid arthritis is an autoimmune disease which causes inflammation in the joints whereas Osteoarthritis is the disease of “wear and tear”.
In most people with osteoarthritis cartilage in the joints can wear out because of mechanical damage from years of use.
Osteoporosis is a “silent disease”. It is very common in women over the age of 55 years. Most people who have osteoporosis do not know it
Until they develop a fracture. It is very important to get a bone density scan done in women to detect and treat osteoporosis effectively.
Anybody can get arthritis, although it is more common in females
Not exactly, depends on the genes passed on to your children, if both parents have it then children have it.
Arthritis has types, viral arthritis is self limiting, Rheumatoid arthritis is highly treatable and we can achieve remission free periods.
Low purine diet for gout patients, otherwise eat healthy, drink healthy and maintain optimal body weight and BMI.
Rheumatism is a term used to describe inflammation of joints, ligaments, fascia covering ligaments, tendons, where as arthritis indicates only joint inflammation. But these two terms are often interchangeable.
Other than viral arthritis, and few other soft tissue conditions the treatment is lifelong.
Overuse of any drug is harmful, Steroids are wonderful if used judiciously, Use it according to your rheumatolgist advice.
Biologics are the newer drugs for treatment of rheumatic diseases. They are very effective and give great results in shorter duration. Must be taken under the guidance of your Rheumatologist.
What is gout?
It is a condition in which uric acid, a by-product of normal metabolism rises above the normal levels, and gets accumulated as crystals in joints causing pain, swelling, and redness.
Whom does it affect?
It mainly affects older males, the ratio of male: female is 4:1.
Which is the most common site for gouty arthritis?
The base of the big toe is the most common site for gout in the beginning.
What are the signs and symptoms of gout?
- Intense continuous pain in joints especially the big toe.
- Hot red swollen skin and feeling of pressure around the affected area and accompanied by stretching/tearing pain in the skin
What are the causes/risk factors of gout?
Genetic factors: one out of 4 people have a family history of gout.
Consuming purine-rich food such as organ meats (liver, heart, kidney) beans, peas, etc. excessive eating, drinking alcohol, a medication that decreases body’s ability to remove uric acid like diuretics (water tablets), Vitamin D3, cyclosporine, etc. also can precipitate gout. People with diabetes, high cholesterol, obesity are also in the risk group.
What can cause a flare-up in gout?
- Having an infection
- Sustained joint injury
- Surgery or being hospitalized
- Increased alcohol intake
What are the medications for gout?
- NSAIDs (Non steroidalanti inflammatory drugs) like ibubrufen
- Cox 2 inhibitors (to be used with caution, due to cardio vascular complication)
- Uric acid synthesis inhibitors like allopurinol for life long to keep uric acid level below 6.
- Colchicine and low dose steroid for acute gout.
What is osteoarthritis?
This is the most common form of arthritis mostly called as the ‘wear and tear’ disease. It is believed to be a degenerative disease and is caused by dysregulation of normal degeneration and repair process of articular cartilages. Current view include a genetic and low-grade inflammatory process as causes for OA.
How does osteoarthritis affect joints?
In a normal joint, a firm rubbery material called the cartilage covers the ends of each bone. This acts as a cushion, or a shock absorber, providing a smooth surface between the bones.
In osteoarthritis, the smooth cartilage softens and becomes pitted, and with time sections of cartilages may be worn away completely, leaving the ends of the bones unprotected. Without their normal gliding surface, the joints become painful and difficult to move. As the cartilage breaks down further, the joint loses its shape, the bone underneath thickens and grow out of the sides (hooklike spurs) further reducing movement.
What are the causes of osteoarthritis?
It was considered to be caused due to normal wear and tear of joints for a long time, but now several other factors are identified rather than one single cause.
- Joint damage by injury
- Joint damage by chronic obesity
- Heredity/genetic factors
- Low-grade inflammation
Osteoarthritis is not caused by bacteria or poisons in the blood, acids in the body, diet deficiencies or excess, gland abnormalities, or weather, exercise or sudden shock, although these may influence pain due to arthritis
What are the symptoms of osteoarthritis?
- Pain/swelling of joints
- Stiffness of joints lasting for a few minutes
- Pain that worsens with weight-bearing and improves with rest.
- Morning stiffness for a few minutes
How is Osteoarthritis diagnosed?
A thorough history of your joint pain will be collected by your doctor. Several blood tests may be necessary to rule out other forms of arthritis. X-ray of the affected joints may also be necessary. Usually, the base of thumbs, knees, spine & other weight-bearing joints is most affected.
What is the treatment for osteoarthritis?
Since the cause of osteoarthritis is unknown, treatment will not reverse the changes to the joint, but much can be done to help. The disease process can be achieved. If the disabling effects of the disease are to be avoided, proper medical attention is essential. Neglect and delay are the worst enemies in overcoming osteoarthritis.
The treatment include
- Rest and guided exercise
- Weight loss
- Surgery of badly affected joints
- Other forms of physical therapy
What are the medications used in osteoarthritis?
Generally, simple analgesics like paracetamol is all that is required for pain control.
Sometimes, non steroidal anti-inflammatory drugs (NSAIDs) may be useful for pain relief, if needed. Intraarticular Steroid/hyaluronan is also used at times to decrease symptoms of active disease. Glucosamine is a shark cartilage product that is found to be beneficial in osteoarthritis. Calcium supplements are also necessary. Treating co-existing morbidities like diabetes, hypertension, low vitamin D state, chronic pain (fibromyalgia) also helps in improving the overall outcome.
How long is the treatment necessary?
Since the disease is the abnormality in the degenerative process occurring in joints that is a day to day process, treatment should be continued lifelong. It is similar to taking lifelong medicines for diabetes/high blood pressure.
Some tips to protect joints
Doctors and physiotherapists will sometimes advise you to use such devices as canes, crutches, and walkers. By using these aids you can take off the weight from your joints and help protect them from further damage. Protecting your joints also includes using correct posture as often as possible and there are a few basic rules to keep in mind.
1. A firm mattress or bed board to keep your posture correct at night.
2. Don’t slump: use a straight-backed chair when possible.
3. When walking or standing, pull your stomach in and keep your back as straight as you comfortably can.
4. If you have osteoarthritis in your back or knees, limit lifting weights as much as possible.
5. Avoid bending knees, squatting on the floor, climbing up and down for OA knees.
6. Knee cap/brace, infrared lamp for heating &quadriceps exercise for knee OA are a must.
Life style changes like reducing weight goes a long way.
What is Scleroderma?
Scleroderma literally means “hard skin”. In some forms of Scleroderma only hard/tight skin is the symptom. In other forms the problem goes much deeper, affecting blood vessels and internal organs, such as the heart, lungs and the kidneys.
What are the different types of Scleroderma?
There are two main classes of Scleroderma.
1. Localized Scleroderma affects only certain parts of the body [ skin& related structures].
2. Systemic Scleroderma affects the whole body [affects the tissues beneath the skin such as the blood vessels & major organs].
What are the signs and symptoms of Scleroderma?
Main symptoms of localized scleroderma is thickening of the skin which may occur as a patch [morphea], linear Scleroderma [ A single line or band of thickened & or abnormally colored skin]. These occur mostly in children.
People with a limited form of systemic Scleroderma may present with what is commonly called as the ‘CREST’.
C– Calcinosis formation of calcium deposits in the connective tissues.
R– Raynaud’s phenomenon a condition where hands or feet turn white & cold, then blue in colour. As blood flow returns they become red.
E– Esophageal dysmotility-impaired function of the tube connecting the throat & the stomach that occurs when smooth muscles in the esophagus lose normal movement.
S– Scerodactyly-thick, tight skin on fingers, resulting from deposits of excess of collagen in the skin. Skin appears shiny, tight, darkened & makes it hard to bend/straighten fingers.
T-Telangiectasias-small red spots on the hands & face that are caused by swelling of tiny blood vessels. Other symptoms include tiredness, loss of hunger, weight loss, joint swelling & pain. Generalised or diffuse scleroderma and sine scleroderma are other forms of scleroderma.
What are the causes of Scleroderma?
The exact cause for Scleroderma is not known. Scientists have proved that it is not infectious/transmittable. Studies also show that it is not an inherited disorder though genetic factors play an important role.
Scleroderma can arise from various causes such as
1. Abnormal immune/inflammatory activity
A condition in which the immune system for unknown reasons, turn against ones own body.
2. Genetic make-up – sometimes genes put certain people at risk for Scleroderma, but it is not passed from parent to child like some genetic disorders.
3. Environmental triggers -some viral infections, certain adhesive & coating materials &organic solvents like vinyl chloride or tricholoroethylene and even blood transfusion may trigger the disease in some people, though the evidence is not full proof.
Can a woman with Scleroderma become pregnant?
With regular follow-ups under a physician, women with Scleroderma can have safe pregnancies & healthy babies. If not supervised by an expert, pregnancy & childbirth-related complication do happen.
How is Scleroderma diagnosed?
Diagnosis is largely based on medical history and findings from physical examination. A skin biopsy is rarely needed, but blood tests may be necessary.
How is Scleroderma treated?
Ususally a rheumatologist [a specialist who treats people with diseases of joints, bones, muscles and Immune system] treats the case. Other specialists are also involved such as a dermatologist, nephrologists, cardiologist, gastroenterologist and pulmonary specialist depending on presentation.
Current treatment is mainly focusing on symptom control and management of organ damage. Thus treatment and management focus on relieving symptoms and limiting damage. Mycophenolate is a good drug for overall disease control including lung disease in Scleroderma.