Rheumatology is a specialty of medicine that involves nonsurgical 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 the 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 an additional two to three years in specialized rheumatology training.

What are these diseases?

Rheumatic diseases can be classified into 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 kidneys, lungs, brain and can be life-threatening. Osteoporosis results in fractures with minimal injury and affects the 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 is unknown, there are specific risk factors.

• Age: Contrary to the popular belief that arthritis affects only the 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.
• A family history of arthritis also increases the chances of developing arthritis.
• Calcium deficient diet, lack of exposure to sunlight, lack of exercise 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 characterized 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 organs 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 a 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 arthritis very well and prevents deformities and damage. Drugs like Steroids, Azathiopurine prevent abnormal attacks on the immune system and can be organ and life-saving.
• Biologics are highly effective drugs that are used in severe arthritis.

DR. SACHIN KATARKAR
RHEUMATOLOGIST
M.D. (Med), PG In Rheumatology

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