Rheumatology

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Rheumatology
System Musculoskeletal
Significant diseases Systemic lupus erythematosus, Rheumatoid arthritis, Psoriatic arthritis, Ankylosing spondylitis
Significant tests Joint aspirate, Rheumatological exam, X-ray
Specialist Rheumatologist

Rheumatology (Greek ρεύμα, rheuma, river) is a sub-specialty in internal medicine and pediatrics, devoted to diagnosis and therapy of rheumatic diseases. Clinicians who specialize in rheumatology are called rheumatologists. Rheumatologists deal mainly with clinical problems involving joints, soft tissues, autoimmune diseases, vasculitis, and heritable connective tissue disorders.

Many of these diseases are now known to be disorders of the immune system, and rheumatology is increasingly the study of immunology.

Rheumatism[edit]

Rheumatism is a colloquial term referring to any painful disorder affecting the loco-motor system including joints, muscles, connective tissues, soft tissues around the joints, and bones. This also includes rheumatic heart disease, which is specific to heart valves but has symptoms similar to rheumatic fever, which typically develops after a streptococcal infection. Rheumatologists are clinicians dealing with arthritis and other rheumatological disorders such as rheumatoid arthritis, ankylosing spondylitis, gout, systemic lupus erythematosus.

One of the major changes in modern rheumatology is the development of new drugs called biologics, or disease modifying agents, which can control severe disease more effectively.[1]

Rheumatologist[edit]

Rheumatologist
Occupation
Names Doctor, Medical Specialist
Occupation type
Specialty
Activity sectors
Medicine
Description
Education required
Doctor of Medicine (M.D.) or
Doctor of Osteopathic Medicine (D.O.)

A rheumatologist is a physician specialized in the field of medical sub-specialty called rheumatology, and holds either a board certification after specialized training after attaining a medical degree (M.D. or D.O.) through fellowship programs in the United States, or specialist registrar positions in the United Kingdom, or DM in India or equivalent programs elsewhere in the world. In the United States, training in this field requires four years undergraduate school, four years of medical school, and then three years of residency, followed by two or three years additional Fellowship training. The requirements may vary in other countries. Rheumatologists are internists or pediatricians who are qualified by additional postgraduate training and experience in the diagnosis and treatment of arthritis and other diseases of the joints, muscles and bones. Many rheumatologists also conduct research to determine the cause and better treatments for these disabling and sometimes fatal diseases. Treatment modalities are based on scientific research, currently, practice of rheumatology is largely evidence based.[2]

Rheumatologists treat arthritis, autoimmune diseases, pain disorders affecting joints, and osteoporosis. There are more than 200 types of these diseases, including rheumatoid arthritis, osteoarthritis, gout, lupus, back pain, osteoporosis, and tendinitis. Some of these are very serious diseases that can be difficult to diagnose and treat. They treat soft tissue problems related to musculoskeletal system sports related soft tissue disorders and the specialty is also interrelated with physiotherapy, physical medicine and rehabilitation of disabled patients. Patient education programs and occupational therapy also go hand in hand with this specialty.

Diseases[edit]

Main article: Rheumatism

Diseases diagnosed or managed by the rheumatologist include:

Degenerative arthropathies[edit]

Inflammatory arthropathies[edit]

Systemic conditions and connective tissue diseases[edit]

Soft Tissue Rheumatism[edit]

Local diseases and lesions affecting the joints and structures around the joints including tendons, ligaments capsules, bursae, stress fractures, muscles, nerve entrapment, vascular lesions, and ganglia. For example:

Diagnosis[edit]

Apart from an extensive medical history, there are useful methods of diagnosis both performed easy enough in a physical examination and, on the other hand, more complicated ones, often requiring a rheumatologist or other specialized physicians.

Physical examination[edit]

Following are examples of methods of diagnosis able to be performed in a normal physical examination.

  • Schober's test tests the flexion of the lower back.
  • Multiple joint inspection
  • Musculoskeletal Examination
    • Screening Musculoskeletal Exam (SMSE) - a rapid assessment of structure and function
    • General Musculoskeletal Exam (GMSE) - a comprehensive assessment of joint inflammation
    • Regional Musculoskeletal Exam (RMSE) - focused assessments of structure, function and inflammation combined with special testing

Specialized[edit]

Treatment[edit]

Most rheumatic diseases are treated with analgesics, NSAIDs (Non-Steroid Anti-Inflammatory Drugs), steroids (in serious cases), DMARDs (Disease-Modifying Anti-Rheumatic Drugs), monoclonal antibodies, such as infliximab and adalimumab, and the soluble TNF receptor etanercept and Methotrexate for moderate to severe Rheumatoid arthritis.[3] Biologic agent Rituximab (Anti-B-Cell Therapy) is now licensed for use in refractory Rheumatoid Arthritis.[4] Physiotherapy is vital in the treatment of many rheumatological disorders. Occupational therapy can help patients finding alternative ways for common movements which would otherwise be restricted by their disease. Patients with rheumatoid arthritis often need a long term, coordinated and a multidisciplinary team approach towards management of individual patients, treatment is often tailored according the individual needs of the individual patient which is also dependent on the response and the tolerability of medications.

Scientific research[edit]

Recently, a large body of scientific research deals with the background of autoimmune disease, the cause of many rheumatic disorders. Also, the field of osteoimmunology has emerged to further examine the interactions between the immune system, joints and bones. Epidemiological studies and medication trials are also being conducted. Scientific research on biologics and clinical trials on monoclonal antibody therapies have added a new dimension to the medical treatment of arthritic disorders.

References[edit]

  1. ^ Rheumatology (Oxford). 2012 Dec;51 Suppl 6:vi28-36. doi: 10.1093/rheumatology/kes278.
  2. ^ http://www.rheumatology.org/Practice/Clinical/Patients/What_is_a_Rheumatologist_/
  3. ^ "Methotrexate for Rheumatoid Arthritis". Arthritis.about.com. Retrieved 2013-06-24. 
  4. ^ Edwards J, Szczepanski L, Szechinski J, Filipowicz-Sosnowska A, Emery P, Close D, Stevens R, Shaw T (2004). "Efficacy of B-cell-targeted therapy with rituximab in patients with Rheumatoid arthritis". N Engl J Med 350 (25): 2572–2581. doi:10.1056/NEJMoa032534. PMID 15201414. 

External links[edit]