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Rheumatology

Rheumatology is a specialty that deals with the inflammation in the internal organs, soft tissue, and the musculoskeletal system, namely the joints, muscles, and bones. Part of internal medicine, a rheumatologist looks at complex multi-system illnesses, specifically those of inflammatory and autoimmune origin. While there may some overlapping of the conditions treated by a rheumatologist and an orthopaedic surgeon, a mark difference is that a rheumatologist uses non-surgical methods while an orthopaedic surgeon treats injuries, congenital diseases, and degenerative conditions using surgical methods.

It is unclear what really causes your immune system to attack your own cells and tissues. Nevertheless, researchers have seen correlation between rheumatic diseases with family history, overweight, trauma, infection, nervous system problems, metabolic issues, stress on joints, environmental triggers, and gender. Many rheumatic diseases are complex and chronic, and often difficult to diagnose especially in the early stages because their symptoms may appear like other health conditions. Delayed treatment may lead to permanent joint damage. Hence, it’s important to be able to recognise symptoms and consult your doctor promptly. Symptoms for rheumatic diseases often manifest itself in the joints so if you have a family history of rheumatic or autoimmune diseases, make sure to be on the lookout for abnormalities such as muscle weakness, pain, swelling, prolonged (>1 hour) stiffness, chronic pain or tenderness, warmth and redness, and limited movement. Since rheumatic disease isn’t limited to just the musculoskeletal system, the symptoms of the disease in the soft tissue and other internal organs may be seen as dermatitis, dryness in the eyes and/or mouth, fatigue, hair loss, itching, and inflammation in the lining of the lungs.

During your initial consultations with a rheumatologist, it is common for your doctor to ask about your medical, family history and lifestyle habits and perform a physical exam. You should also bring along any prior medical test results and scans, a detailed and recent list of medication and supplements you are taking, and a list of any allergies or intolerances to medication you may have. As mentioned earlier, a lot of rheumatic symptoms can be seen in other conditions and with how complex rheumatic diseases can be, it is often difficult or even impossible to screen for it. Instead, a rheumatologist would perform one or more diagnostic procedures based on your symptoms:

Biopsy, to determine if an autoimmune disease is affecting the tissue
Blood tests, e.g., creatinine, ALT/AST, RF, to check kidney or liver function
Bone density test (DEXA scan)
Imaging scan, e.g., CT, MRI, ultrasound, to view organs and structures
Chest x-ray, to assess the lungs
to evaluate the heart
Electromyogram, to evaluate the nerve and muscle function
Endoscopy, to evaluate gastrointestinal symptoms
Nailfold videocapillaroscopy, to assess microcirculation problems
Analysis for fluid in the joints
Urine test, to detect protein and blood in the urine
Tuberculosis test, to detect and treat latent TB infection which may be activated from immunosuppressant drugs used in the treatment of rheumatism (6)

List of conditions:

Diffuse connective tissue diseases, e.g., rheumatoid arthritis, juvenile arthritis, lupus erythematosus, scleroderma, diffuse fasciitis, polymyositis, necrotizing vasculitis, Sjögren’s syndrome
Arthritis associate with spondylitis, e.g., ankylosing spondylitis, Reiter’s syndrome, psoriatic arthritis, arthritis associated with inflammatory bowel disease
Osteoarthritis, e.g., osteoarthrosis
Rheumatic syndromes associated with infections agents, e.g., bacterial, viral, fungal, parasitic, Whipple’s disease
Metabolic and endocrine diseases associated with rheumatic states, e.g.:

Crystal-associated conditions, e.g., gout, pseudogout

Biochemical abnormalities, e.g., haemophilia, Marfan syndrome, Ehlers-Danlos syndrome, diabetes, hyperthyroidism, hypothyroidism, immunodeficiency disease

Hereditary disorders, e.g., familiar Mediterranean fever, hypermobility syndromes

Neoplasms (abnormal tumour or mass), e.g.: ganglion, osteochondromatosis, synovial sarcoma, haemangiosarcoma, leukemia, multiple myeloma, metastatic malignant tumours
Neurovascular disorders, e.g., Charcot joint, compression syndrome, Raynaud’s disease
Bone and cartilage disorders, e.g., osteoporosis, osteomalacia, Paget’s disease of bone, congenital hip dysplasia, scoliosis
Extraarticular disorders, e.g., bursitis, tendon lesions, cysts, intervertebral disc disorder, fibromyalgia, psychogenic rheumatism
Miscellaneous disorders associated with articular manifestations, e.g., palindromic rheumatism, sarcoidosis

With the exception of septic arthritis, there is no cure for rheumatic diseases and treatment serves only to alleviate pain and inflammation. Depending on the type and severity of the disease, our specialists here at PHKL will treat rheumatism with one or more of the following procedures.

List of procedures:

Medication
1. Nonsteroidal anti-inflammatory drugs (NSAIDS) to reduce pain and inflammation
2. Corticosteroids to reduce inflammation, pain, and slow joint damage
3. Disease-modifying antirheumatic medications (DMARDs) to slow disease progression and/or correct immune system abnormalities
4. Biologic agents to decrease and interrupt the inflammation process
Physical therapy, e.g., using hot/cold pack, splinting, using assistive devices to avoid stressing painful joints, massage, exercising
Surgery, to repair or replace damaged joints. E.g., synovectomy, tendon repair, joint fusion, total joint replacement
Joint aspiration & injection
Ultrasound assessment of joints

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