A Rheumatologist is a physician who has undergone further specialised training in the management of diseases related to bones, joints, soft tissues and auto-immunity. A rheumatologist differs from orthopedicians in that trauma related cases and surgeries are managed exclusively by orthopedicians. Auto-immune diseases are those where the body's defence mechanism which should normally protect the body from external infections and insults, attacks the body itself. These diseases commonly affect the joints also and hence the umbrella term arthritis may refer to auto-immune diseases.
Rheumatologic diseases commonly affect women more than men. However some diseases may be more common in men. Children may also be affected by these diseases, so no age or gender is immune from these conditions. There may be a genetic component in some diseases so a history of a family member suffering from similar complaints is an important clue to the diagnosis. In general, a rheumatologist should be consulted when there is joint pain, swelling or deformity, without preceding trauma history. As any organ can be affected by these diseases, other common symptoms include skin rashes, hair loss, fever, weight loss, decreased blood cell counts or in more severe cases, eye involvement, breathlessness, chest pain, numbness or weakness, seizures, loss of consciousness.
As females are prone to these diseases, pregnancy and rheumatologic diseases require special care and management by a rheumatologist and obstetrician. Common diseases which are managed by a rheumatologist include rheumatoid arthritis, lupus or SLE (Systemic Lupus Erythematosus), Systemic Sclerosis, Sjogren's Syndrome, Dermatomyositis, Vasculitis, Spondyloarthritis including Ankylosing Spondylitis, Psoriatic Arthritis, Reactive Arthritis, Gout, Crystal Deposit Diseases, Juvenile Idiopathic Arthritis, Sarcoidosis, Osteoporosis and other Metabolic Bone Diseases. On the first meeting with a rheumatologist, a detailed history and physical examination will be done to look at all possible symptoms and organs involved. Based on these and any available previous reports, a clinical diagnosis will be reached.
To confirm the disease, the rheumatologist may ask for specialised tests like rheumatoid factor, ANA, HLA B27, apart from other blood tests like blood counts, urine examination, liver and kidney tests. Required radiographs or other imaging may be done to confirm the disease and assess the extent of joint damage. The rheumatologist will then give a clear picture of the disease, the organs involved, the complications, plan of management and prognosis of the disease. Regular review is important for proper management and for early detection of complications of the disease or drugs and prevention.
Drugs used in the management of rheumatologic diseases are commonly pain killers (NSAIDs), steroids (like prednisolone), and immuno-suppressive drugs like methotrexate, cyclophosphamide, azathioprine, etc. These drugs should be used under medical supervision only and require regular clinical review and regular clinical review and regular blood tests to assess the efficacy and possible adverse effects. A new class of drugs called biologicals are now available which have improved the treatment and prognosis of those diseases which have not responded to the initial medication. A healthy diet, regular exercise and stress management all help in improving disease control and quality of life.
As the cause of these diseases is not completely known, rheumatologic diseases do not have a definite cure. However with early diagnosis and appropriate management, they can be well controlled and people suffering with these diseases will be able to have no or minimal impact on their activities. Untreated, these diseases vary in their severity and the damage may be restricted to joints, leading to difficulties in daily life activities or may be organ threatening leading to permanent compromise in function or in more severe cases, may be life threatening.
Contact a rheumatologist early if you have any of the above mentioned symptoms. The earlier the disease is identified and treatment begun, the better the prognosis.
-Challapalli Srinivas Chakravarthy-
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