Rheumatology is a specialty of medicine which involves non surgical care of musculoskeletal and autoimmune diseases. Musculoskeletal diseases involve the joints, muscles, bone and tendons. They are a major cause of disability and one of the most common ailments for which a person consults a doctor. Autoimmune diseases are conditions in which the immune system of the body treats its own tissues as foreign and tries to destroy them. Rheumatic diseases consist of more than 100 conditions that can have a profound effect on the ability to perform daily activities and damage internal organs. In the past, treatment of rheumatic diseases included just pain relieving medications and exercises, but in the last two decades, scientific knowledge has revolutionized the entire approach to management of these conditions.
Who is a Rheumatologist?
A rheumatologist is a physician who is qualified, by additional training and experience in the diagnosis and treatment of arthritis and other diseases of the joints, muscles and bones. After four years of medical school and three years of training in internal medicine, rheumatologists devote additional two to three years in specialised rheumatology training.
What are these diseases?
Rheumatic diseases can be classified in to the following groups:
- Arthritis which affects the joints and spine: Rheumatoid Arthritis, Ankylosing Spondylitis, Psoriatic arthritis, Osteoarthritis and Gout
- Autoimmune Multisystem Diseases which affect the joints, skin, various internal organs of the body: SLE, Vasculitis, Myositis and Sarcoidosis
- Metabolic Bone Diseases: Osteoporosis, Osteomalacia and Vitamin D deficiency
- Soft Tissue Rheumatism: Myofascial Pain, Fibromyalgia, Tendinitis and Bursitis
Why one needs to be aware?
Arthritis, if untreated, damages the joints leading to deformities and disability thereby restricting movements and functionality. Autoimmune diseases can irreversibly damage internal organs like kidney, lungs, brain and can be life threatening. Osteoporosis results in fractures with minimal injury and affects quality of life. The good part is that if treated timely, these diseases can be controlled effectively and damage can be prevented.
Are you in the high risk group?
Though the exact cause of many arthritis and autoimmune diseases are unknown, there are specific risk factors.
- Age: Contrary to the popular belief that arthritis affects only elderly, it can affect any age group, including children. Young females in particular are at high risk for arthritis and autoimmune diseases. Post menopausal women are at increased risk of osteoporosis. Osteoarthritis is age related (> 50 yrs) degeneration of joints. Some arthritis affecting the spine is more common in young males.
- Family history of arthritis also increases the chances of developing arthritis.
- Calcium deficient diet, lack of exposure to sunlight, lack of exercises leads to Metabolic Bone Diseases.
- Certain infections, smoking, stress contribute to the risk of arthritis.
What are the common signs and symptoms?
Arthritis (which literally means inflammation of the joints) is characterised by pain swelling and limited movement of the joints along with stiffness which is worst in the morning for at least 30-60 minutes.
Autoimmune diseases lead to fever, rashes, oral ulcers and muscle weakness. Various internal organ involved can cause breathlessness, decreased urine output and convulsions.
Osteoporosis results in fractures at the spine, wrist and hip with minimal trauma.
What is the importance of screening?
- It is a well established fact that treatment for arthritis is most effective when started early. It is therefore, essential to diagnose it in its initial stages. Consulting a rheumatologist at the earliest signs and symptoms helps in early diagnosis. Careful clinical examination, certain blood tests and x-rays are used to confirm the disease.
- Osteoporosis is a silent disease and needs evaluation of bone health with DEXA scan in the high risk group to prevent fractures.
What are the various methods of management?
- Modern science has effective treatment for arthritis and related conditions.
- Disease modifying drugs like Methotrexate controls the arthritis very well and prevents deformities and damage. Drugs like Steroids, Azathiopurine prevent abnormal attack of immune system and can be organ and life saving.
- Biologics are highly effective drugs which are used in severe arthritis.
- Osteoporosis is best treated with Calcium, Vitamin D supplement and bone preserving and bone forming medications.
- Joint injections given in certain cases are effective in controlling arthritis
- Apart from medications, physiotherapy plays important role in maintaining joint mobility and strengthening the muscles. Lifestyle modification, weight loss and activity modification are useful in degenerative joint diseases.
What is the possible prognosis?
In the past, rheumatological diseases were ignored and patients suffered from deformities and disability with many of them being wheel chair bound or bed-ridden. Also, the autoimmune diseases were often not diagnosed correctly with resultant damage to internal organs and also mortality. However, with appropriate expertise and care while utilising the best of currently available treatment modalities, we can effectively prevent the damage and improve patient’s quality of life and also prevent mortality.