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Rheumatology and Rheumatic diseases. What does a rheumatologist do?

Rheumatology is the branch of medicine that deals with the diagnosis and treatment of systemic autoimmune diseases and musculoskeletal diseases called rheumatic diseases. A rheumatologist is a doctor specialized in the field of rheumatology. Rheumatology is involved in the treatment of over 200 diseases, including inflammatory and autoimmune diseases such as arthritis, lupus and soft tissue diseases such as back pain and fibromyalgia, and diseases affecting bones such as osteoporosis. Rheumatologists may also examine genetic disorders that affect joints. Most of rheumatic diseases are chronic. They are thought to be caused by a complex combination of genetic predisposition and environmental factors. However, early diagnosis and continuous treatment is vital in preventing serious consequences and complications. 

What is Rheumatology?

Rheumatology is a branch of medicine that deals with the diagnosis and treatment of autoimmune and inflammatory diseases affecting bones, muscles, joints, and blood vessels. It is a sub-specialty of internal medicine and pediatrics.

Rheumatism and Rheumatic Diseases

Rheumatism indicates various painful and inflammatory conditions involving joints, muscles, bones, cartilage and ligaments. Rheumatic diseases are differentiated by pain, swelling and loss of movement and function in one or more areas of the musculoskeletal system. They are common diseases affecting all ages and genders (mostly seen in women). While rheumatic diseases affect the connective or supportive structures of the body, they may also affect the rest of the organs, such as the skin, eyes, internal organs and nervous system. (1)

Inflammation and Rheumatism

Rheumatic diseases are mostly inflammatory and autoimmune. Inflammatory rheumatic diseases develop due to certain bacteria, immune system disorders or damage caused by substances such as uric acid. They cause stiffness and deformation in joints, muscles and bones. There are signs of inflammation such as swelling, redness and burning sensation in the affected areas. In autoimmune diseases, the immune system attacks the healthy tissues of the body. Autoimmune diseases do not only involve joints. They can also affect multiple systems of the body. (2)

What is in the field of Rheumatology?

The study field of rheumatology is joints, soft tissues, genetic connective tissue diseases and autoimmune diseases. In addition to autoimmune and inflammatory diseases affecting joints such as rheumatoid arthritis (RA), gout and lupus, it also treats injured joints such as tennis elbow or Achilles tendonitis and musculoskeletal problems and injuries that limit the movement. You may also visit a rheumatologist for a chronic back or neck pain.

What are Rheumatic Diseases?

  • Diseases commonly treated by rheumatology: Osteoarthritis, gout, rheumatoid arthritis, chronic lower back pain, tendinitis, lupus, dermatomyositis, Lyme disease, mixed connective tissue disease, polychondritis, polymyositis, polymyalgia rheumatica, sarcoidosis, Sjögren syndrome, scleroderma, vasculitis.
  • Soft tissue diseases: Fibromyalgia, lower back pain, tennis elbow, olecranon bursitis
  • Diseases affecting bones: Fluorosis, osteoporosis, osteomalacia, renal osteodystrophy, rickets.
  • Nerve compressions: Sciatic, cervical radiculopathy, carpal tunnel syndrome.
  • Genetic joint disorders: Achondroplasia, Ehlers-Danlos syndrome, generalized joint hypermobility, Marfan syndrome.

Common Rheumatic Disorders

Some of the most common rheumatic diseases include:

  • Osteoarthritis: It is a type of arthritis most commonly involving hands, hips, knees or feet. It wears down cartilage tissue in the joints. It is colloquailly known as calcification.
  • Rheumatoid arthritis: It is one of the most commonly seen types of inflammatory rheumatic diseases in the world which involves the joints facing each other. It is one of the rheumatic diseases that causes the most damage and deformity to joints. It is an autoimmune disease in which the immune system attacks the soft tissue that protects joints.
  • Fibromyalgia: It is the soft tissue rheumatism, which manifest itself with generalized muscle pain and chronic pain in certain parts of the musculoskeletal system.
  • Lupus (Systemic lupus erythematosus – SLE): It is an autoimmune disease causing inflammation in many parts of the body, including the skin, joints, kidneys, blood, lungs, the heart and the brain.
  • Gout: It is a type of arthritis most commonly seen in big toe, which occurs due to the accumulation of uric acid crystals in the joints. The crystals cause feelings of pins and needles.
  • Childhood rheumatism (Juvenile idiopathic arthritis): It is a chronic inflammation of the joints accompanied by fever and rash. It is the most common type of arthritis in children.
  • Bursitis: Inflammation of fluid-filled sacs (bursae) on soft tissue that reduce friction by lining a joint or a bone.
  • Ankylosing spondylitis (AS): Ankylosing spondylitis is a rare type of arthritis that causes pain and stiffness in the spine.
  • Reactive arthritis (Reiter’s syndrome): Arthritis caused by an infection in an unrelated part of the body, such as the intestines, reproductive organs or urinary tract.
  • Systemic sclerosis (Scleroderma): It is an autoimmune rheumatic disease that thickens the skin and causes its compression, inflammation. It causes scarring in other parts of the body, including blood vessels, joints and some organs.
  • Vasculitis: A condition where the blood vessel walls become inflamed. When it involves multiple vascular and organ systems, it is called systemic vasculitis.

Study fields of Rheumatology

Rheumatologists may focus on treating certain rheumatic conditions or studying on a specific field. Sub-specialties of rheumatology are:

  • Autoimmune and inflammatory diseases
  • Non-inflammatory degenerative joint disorders
  • Soft tissue diseases
  • Chronic pain
  • Metabolic disorders affecting bones
  • Rheumatic conditions affecting children and adolescents

Symptoms of Rheumatic Diseases

  • Chronic joint pain
  • Pain in the various parts of the body
  • Sensitivity
  • Inflammation with swelling, stiffness, redness and/or burning of joints
  • Deformation in joints
  • Restriction of movement or loss of flexibility in joints
  • Morning stiffness
  • Excessive fatigue, low energy, or weakness
  • Weight loss
  • Idıopathic fever
  • Eye infections
  • Difficulty in taking a deep breath
  • Muscle pain
  • Rash and scars
  • Digestive system complications
  • Decreased kidney function
  • Neurological symptoms

Rheumatological Examination

A rheumatologist asks questions about the medical history of a patient and his/her family. If available, the rheumatologist evaluates previously performed tests. The rheumatologist then performs a physical examination to see if there is inflammation in the body. The rheumatologist examines all joints, muscles and bones that are swollen, stiff or painful. They may ask for a blood test, an MRI scan, or radiological examinations to determine the course of the treatment.

Rheumatology tests

Imaging methods such as X-ray, ultrasound, MRI scan and CT (Computed tomography) may be used to determine the degree of joint damage. The amount of inflammation in the body is measured by laboratory tests done on blood, urine, joint fluid or tissue samples. (3)

Some of the important tests performed are:

  • Arthrography: Arthrography is performing a CT scan, MRI or fluoroscopy after the injection of a contrast agent or physiological saline solution into the joint cavity. It is used to evaluate intra-articular structures in detail and to determine the causes of joint pain. It is effective in detecting diseases in ligaments, tendons and cartilage.
  • Antinuclear antibody (ANA) test: This test detects levels of antibodies in the blood frequently found in people with connective tissue diseases or other autoimmune disorders such as lupus.
  • C-Reactive Protein (CRP) Test: It is a simple blood test that helps detect inflammation by measuring the level of CRP in the blood. Protein levels in the blood often increase due to rheumatoid arthritis or any other disease that causes inflammation.

What is a Rheumatologist? What they treat?

A rheumatologist is an internal disease specialist or pediatrician specialized in the diagnosis and treatment of musculoskeletal diseases and systemic autoimmune diseases. The rheumatologist follows-up patients during the course of their disease.

Which methods are commonly used by a Rheumatologist?

A rheumatologist uses interventional methods, drugs and physical therapy for joints and tendons to manage pain, reduce inflammation, and improve the quality of life of a patient.

Treatment of Rheumatic Diseases

There are various options in the treatment of rheumatic diseases. Drug therapy, physical therapy, or joint/tendon injections are some of these options. In chronic cases and severe conditions, new biological agents may be used in a treatment.

A rheumatologist can also work with different specialists. For example, when a surgery is required, he or she may get help from an orthopedic surgeon. He or she may consult a psychologist or social worker to prepare a patient and his/her family for the changes that the disease may bring. The treatment team may also include an exercise physiologist, occupational therapist, pediatrician and nutritionist.

Treatment methods used in rheumatic diseases

A rheumatologist uses interventional methods, drugs and physical therapy for joints and tendons to manage pain, reduce inflammation, and improve the quality of life of a patient.

Which practices does a Rheumatologist use?

  • Joint injections and aspirations: Steroids are injected directly into a joint in a joint injection. In a joint aspiration, fluid is extracted from a joint for diagnostic purposes or to treat inflammation and pain.
  • Drug therapy: Topical analgesics, corticosteroids with anti-inflammatory properties or opioids can be used in the treatment of rheumatic diseases. Additionally, anti-rheumatic drugs that reduce immune system activity or slow the progression of the rheumatic disease can be prescribed. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, meloxicam, and aspirin may relieve joint inflammation and reduce the pain in joints.
  • Physical therapy: A rheumatologist can refer a patient to physical therapy. The physiotherapist applies training, exercise and special treatment techniques for arthritis and musculoskeletal disorders. He or she can utilize acupuncture and chiropractic treatment. He or she can inform the patient about how to manage everyday activities.

Prevention of rheumatic diseases

  • Keep your ideal weight,
  • Do not smoke,
  • Maintain good dental health,
  • Exercise regularly,
  • Have a healthy, balanced and calcium-rich diet,
  • Limit the consumption of alcohol and coffee
  • Manage your stress
  • Take a sunbathe (4)

Suggestions for People with Rheumatic Diseases

  • Rheumatic diseases require continuous and regular treatment. Do not disrupt your treatment or cancel your appointments.
  • Avoid conditions which trigger your disease
  • Be informed of your illness.

When to see a Rheumatologist?

  • If you have joint pain that does not go away or begins spreading to the other joints,
  • If you have close relatives who have lupus, rheumatoid arthritis, psoriasis or a different inflammatory disorder in addition to joint pain,
  • If you have symptoms accompanying the joint pain, such as fever with an unknown cause, excessive fatigue, weight loss, or rash,
  • If there is swelling in your joints (although there is not much aching, pain or stiffness)
  • If some of your symptoms improve when treated but recur after the discontinuation of a drug, you should definitely see a rheumatologist.

Are rheumatic diseases fatal?

Most of rheumatic diseases are chronic. Rheumatic diseases which are not treated properly may cause permanent joint damage and disability. They may affect your everyday activities such as working capacity, walking, climbing stairs, cooking, personal hygiene negatively; however, they are not fatal.

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