– Rheumatology –
The work of a rheumatologist is focused on the diagnosis, treatment and medical management of patients with arthritis and other rheumatic diseases – that is disorders that affect the bones, joints, tendons, muscles and ligaments.
In my private office I see patients with a variety of conditions, most of which long-term, chronic and related to arthritis or autoimmune disorders – spinal problems, joint pains, soft tissue disorders. Most of the rheumatic conditions are chronic, they have only a few treatment options that may be expensive and this is one of the challenging aspects of my work.
I would start a diagnosis with some questions to the patient about symptoms, how severe they are and for how long they have been present: swollen areas in the wrists or around the joints, morning stiffness in the joints. This procedure is followed by a physical examination – checking for signs of inflammation in the joints. I would also do a check on the medical history of the patient and his relatives, since a large part of the rheumatic diseases are inheritable.
In addition to this, radiological imaging can be used – either x-ray or musculoskeletal ultrasound – to show changes and degeneration in the bones and joints and confirm initial diagnosis and the severity of the degeneration. If I suspect that a patient has arthritis, I would suggest blood tests or a chemical pathology analysis of tissue from the affected joints to determine the type and confirm the diagnosis.
Rheumatic diseases and Treatment:
All rheumatic diseases are related to the joints and muscles but are caused by different factors from joint wear an tear to autoimmune disorders in which the immune system instead of protecting the body, does damage to it.
There are over 100 rheumatic diseases which a rheumatologist is trained to diagnose and treat. Although they have little in common when it comes to origin, they all cause chronic pain and are hard to treat. The treatment plan, depending on the condition, may include medication, advises for exercise and a healthy diet, but in some severe cases surgery could be required.
We have a lot of patients with Osteoarthritis in the clinic – it is related to wearing out of the joints and affects mostly the elderly – about 70% of the elderly have some developed some form osteoarthritis. This wear out is caused in most cases by overuse of the joints, repetitive movements, thus it is most common in the knees, hips, lower back and neck.
Athletes are affected by this at a younger age, due to the larger load on their joints, while injuries are a significant contributing factor. Obesity is another risk factor by putting additional pressure on the hips and knees. While genetic predisposition can cause osteoarthritis as early as the age of 20, it is quite rare.
When I diagnose a patient I would first ask about the symptoms and do a physical examination. The most common complaints are of pain, swelling and stiffness in the joints. Osteoarthritis can affect the overall mobility of the patient and make everyday tasks difficult. While there is no treatment that can reverse the damage on the joints, regular exercise and weight loss can protect them. Exercise, for example swimming or a physical therapy are one of the first choices for treating OA.
The medication that would be prescribed with the treatment are usually NSAIDs (non-steroidal anti-inflammatory drugs) like aspirin and ibuprofen that relieve the pain and calm inflammations or creams and gels which are applied locally on the affected joints.
The cases of Rheumatoid arthritis also are quite common. This condition may occur at any age since it is not caused by wear like Osteoarthritis, but still usually after the age of 40. The reason for this is a disorder of the immune system in which it attacks the body, instead of protecting it and the synovial membranes (the soft tissue in the joints) suffer the most damage.
Why this happens is still not known with certainty, but it likely to be genetic with environmental factors having a contribution. The symptoms that I will look for when diagnosing a patient will include symmetry in the joint pains and pains in the smaller joints in the hands, limited and painful movement, the presence of rheumatoid nodules in the fingers, fatigue and inflammation which can be measured with blood tests.
Since this condition is chronic, the goal of the treatment is to first calm down the inflammation, stop the progression of the disease and preserve the joints.
Unfortunately, the antirheumatic drugs are not selective and weaken the immune system, which can lead to infections and numerous side effects while saving the joints. Besides the medication, I would recommend physical activity, exercises and therapeutical massages to most patients. Surgical intervention may be required if the pains become unbearable, artificial replacement joints can be implanted – this gives the patient greater freedom of movement and allows returning to daily activities.
The typical cases of arthritis are in adults and the elderly, but every year there are thousands of kids (under the age of 16) are diagnosed with what is called Juvenile arthritis – the symptoms are similar to other types arthritis, but vary depending on the type of the disorder. This is caused by a genetic predisposition and there is no cure, so treatment is focused on relieving the pain and inflammation and providing a normal life to the children.