No, it is not only arthritis…
There are more than 100 rheumatic diseases, some being more common than others. Some rheumatic diseases may not always be obvious at the onset and may require some time to make an accurate diagnosis. Let’s explore what rheumatology entails.
Rheumatologists see common conditions like gout where an accumulative of uric acid results in deposition of uric acid crystals in the joints. Gout usually affects men more than women. Post-menopausal women are more at risk of developing gout than pre-menopausal women. Gout usually presents with an acute, painful, swollen joint. Gout can affect any joint in the body, but most people will have an attack of the big toe at some point.
If uric acid levels remain high for years, crystals deposit into the tissue and results in tophi. Tophi are unsightly lumps on the skin that can occur in hands, tendons and even ear cartilage.
Gout is usually easily treated provided a patient is compliant as per treatment.
The hallmark of rheumatic diseases is inflammatory arthritis. Features of inflammatory arthritis include:
- Pain that is worse in the morning and improves with activity
- Morning stiffness lasting for more than an hour
- Usually insidious onset of pain
Rheumatoid arthritis, psoriatic arthritis and systemic lupus erythematosis (SLE) are some examples of conditions that can cause inflammatory arthritis.
A great deal of research has gone into the immunological understanding of these diseases. Targeted therapies are available and have been proven effective in patients who are not controlled by conventional treatment. These newer agents are called “biologics”.
Included in the spectrum of rheumatology are rare autoimmune diseases, which affect the connective tissue, bone, muscle, joint and skin as well as vasculitis (inflammation of the blood vessels).
These diseases usually require immune-suppressive agents to control diseases.
Systemic lupus erythematosis (SLE) is a multisystem autoimmune disease. The manifestations are variable and can affect each person differently. Skin and joint disease are common features whilst other patients can have severe organ dysfunction.
Kidney disease in SLE is the main cause of mortality along with infections in patients that are immunocompromised from the treatment used in SLE.
All patients with lupus should be on chloroquine as this has been shown to prevent flares of the disease.
Fibromyalgia (FM) or fibromyalgia syndrome (FMS) is chronic pain syndrome where people have widespread pain. It is associated with poor sleep and sedentary patients.
FMS is a diagnosis of exclusion. Other causes of pain need to be excluded:
- Thyroid disease
- Rheumatoid arthritis
- SLE
- Psoriatic arthritis
- Drugs-statins
- Myositis
The clinical examination in FMS is usually normal. The range of movements in joints is normal despite having pain. A tender point examination is usually painful confirming the diagnosis. Other symptoms related to FMS include persistent fatigue, waking up unrefreshed and a feeling of mental slowness. A host of somatic symptoms may also accompany patients with FMS. Symptoms like tingling of fingers, dizziness, headaches, abdominal pain, numbness and nausea.
Fibromyalgia is part of the spectrum of diseases where pain amplification is central to the pathogenesis. Patients may have increased pain sensitivity. Alodynia is the painful feeling that patients may get from own pain stimuli, example, shaking hands, hugging. Hyperalgesia is an exaggerated pain response out of keeping with the stimulus.
Treatment of FMS involves simple analgesia management and improving the quality of sleep. A graded exercise program is also vitally important to outcome of FMS.
So what should one expect when visiting a rheumatologist expect?
- Accurate assessment and diagnosis of painful syndromes
- Management of soft tissue rheumatism often with local steroid injections
- Control inflammatory arthritis and to monitor for the potential side effects from these treatments
- Investigate and manage connective tissue diseases and vasculitis
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