Rheumatology Conditions and Treatment for Inflammatory Disorders

Rheumatology is the sub-speciality of medicine that focuses primarily on joints, soft tissues, connective tissue disorders and autoimmune diseases such as gout, rheumatoid arthritis, lupus erythematosus, ankylosing spondylitis, degenerative joint diseases, and vasculitis.

Rheumatologists are consultants who specialise in rheumatology.

What are the types of rheumatic diseases and their symptoms?

The most common rheumatic diseases include:

1. Rheumatoid arthritis (RA)

RA is a chronic inflammatory and autoimmune disease. Autoimmune is a condition whereby your immune system attacks and destroys healthy cells in your joints by mistake).

Symptoms include:

Typically symmetrical swollen, stiff, and painful small joints (feet, hand, and wrist)
It may involve larger joints
Stiffness worsens in the morning
Fatigue
Poor appetite
Fever

Learn more about common extra articular manifestations of rheumatoid arthritis.

2. Osteoarthritis

Osteoarthritis is called a degenerative joint disease. It is the commonest form of arthritis. Osteoarthritis mainly occurs in the knee, hips, and fingers.

Symptoms include:

Joint pain during movements that worsens at the end of the day
Crepitus
Joint instability
Joint stiffness

3. Psoriatic arthritis (PsA)

PsA is an autoimmune disease associated with psoriasis (a chronic skin disease). It can affect small or large joints.

Symptoms include:

Swollen, painful joints
Joint stiffness
Pain
Rashes
Changes in colour and texture of nails
Fatigue

4. Ankylosing spondylitis

Ankylosing spondylitis is an autoimmune disease that affects the sacroiliac joints and spine.

Symptoms include:

Gradual onset of lower back pain that worsens at night
Morning back stiffness
Pain radiating to the hips and buttocks
Fatigue

5. Gout

Gout develops due to the build-up of uric acid crystals within the joint. Gout usually affects the big toe joint initially.

Symptoms include:

Intense pain in joints like the big toe, knees, ankles, wrists, and fingers
Red and swollen joints
Joint stiffness

6. Systemic Lupus Erythematosus (SLE)

SLE is a chronic autoimmune disease that can affect multiple organs and can be fatal. Medical interventions and lifestyle modifications can help manage the disease.

Symptoms include:

Itchy and painful rashes across cheeks (butterfly rash)
Arthritis
Photosensitivity (sensitivity to light)
Oral ulcers
Seizure
Chest pain
Fatigue
Raynaud’s phenomenon - fingers and toes become white/pale or blue

7. Systemic sclerosis

A connective tissue disorder that may affect your organs, blood circulation, and skin.

Symptoms include:

Oedematous fingers (swelling due to fluid accumulation)
Shiny skin
Thickening of the skin on fingers
Joint pain
Joint stiffness
Raynaud’s phenomenon
Telangiectasia - dilated blood vessels visible on the skin surface
Pain while swallowing (odynophagia)
Difficulty swallowing (dysphagia)

8. Sjogren’s syndrome

Sjogren’s syndrome is an autoimmune disorder that affects moisture-producing glands (salivary and lacrimal glands).

Symptoms include:

Dry eyes
Dry mouth
Dry skin
Vaginal dryness
Fatigue
Polyarthritis
Swelling between ears and jaws (swollen salivary glands)
Joint or muscle pain

9. Vasculitis

Vasculitis is an autoimmune disease that causes inflammation of the blood vessels.

Vasculitis can present as a minor problem to a more severe condition where it affects your entire body. Signs and symptoms of vasculitis depend on the type and severity of the disease.

Symptoms include:

Fever
Weight loss
Loss of appetite
Fatigue
Body aches

What is paediatric rheumatology?

As the name implies, paediatric rheumatologists treat rheumatic diseases in children.

Commonly observed rheumatic diseases in children are:

Juvenile Idiopathic Arthritis (JIA)
Juvenile dermatomyositis or vasculitis
Systemic Lupus Erythematosus

Common symptoms include:

Prolonged fever with unknown cause
Muscle weakness
Deformity
Muscle weakness
Limping

It is crucial to immediately seek medical consultation if your child complains of any of the symptoms above.

How are rheumatic diseases diagnosed?

Diagnosis is made based on various investigations. Your doctor will first evaluate your medical history and symptoms before conducting a physical examination.

Tests that may be requested are:

Imaging modalities: X-rays, computed tomography (CT) scan, magnetic resonance imaging (MRI), ultrasound, and dual-energy x-ray absorptiometry (DEXA) scan
Joint aspiration
Blood tests: Rheumatoid factor (RF), anti-citrullinated peptide antibodies (ACPA), antinuclear antibodies (ANA), antiphospholipid antibodies
Tissue biopsy

What are the treatment options for rheumatic diseases?

The treatment options differ according to the types of rheumatic diseases.

Treatments options include:

Medications
- Analgesics: Paracetamol, Non-steroidal anti-inflammatory drugs (NSAIDs)
- Corticosteroids
Physical and occupational therapy
Surgery

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