Rheumatology

Rheumatology

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

Rheumatology (Greek ρεύμα, rheuma, flowing current) 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. Rheumatology is increasingly the study of immunology.

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.

Rheumatologist

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.

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 and physical medicine and rehabilitation. Patient education programs and occupational therapy also go hand in hand with this specialty.

Diseases

Main article: Rheumatism

Diseases diagnosed or managed by the rheumatologist include:

Degenerative arthropathies

• Osteoarthritis

Inflammatory arthropathies

• Rheumatoid arthritis
• Spondyloarthropathies
  • Ankylosing spondylitis
  • Reactive arthritis (reactive arthropathy)
  • Psoriatic arthropathy
  • Enteropathic arthropathy
• Juvenile Idiopathic Arthritis (JIA)
• Crystal arthropathies: gout, pseudogout
• Septic arthritis

Systemic conditions and connective tissue diseases

• Lupus
• Sjögren's syndrome
• Scleroderma (systemic sclerosis)
• Polymyositis
• Dermatomyositis
• Polymyalgia rheumatica
• Mixed connective tissue disease
• Relapsing polychondritis
• Adult-onset Still's disease
• Sarcoidosis
• Fibromyalgia
• Vasculitis
  • Microscopic polyangiitis
  • Eosinophilic granulomatosis with polyangiitis (formerly known as Churg–Strauss Syndrome)
  • Granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis)
  • Polyarteritis nodosa
  • Henoch-Schönlein purpura
  • Serum sickness
  • Giant cell arteritis, Temporal arteritis
  • Takayasu's arteritis
  • Behçet's syndrome
  • Kawasaki's disease (mucocutaneous lymph node syndrome)
  • Buerger's disease (thromboangiitis obliterans)

Soft Tissue Rheumatism

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:

• Low back pain
• Tennis elbow
• Golfer's elbow
• Olecranon bursitis

Diagnosis

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

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

• Laboratory tests (e.g. Erythrocyte Sedimentation Rate, Rheumatoid Factor, Anti-CCP (Anti-citrullinated protein antibody), ANA (Anti-Nuclear Antibody) )
• X-rays, Ultrasounds, and other imaging methods of affected joints
• Cytopathology and chemical pathology of fluid aspirated from affected joints (e.g. to differentiate between septic arthritis and gout)

Treatment

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. Biologic agent Rituximab (Anti-B-Cell Therapy) is now licensed for use in refractory Rheumatoid Arthritis. 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 to the individual needs of the individual patient which is also dependent on the response and the tolerability of medications. Rheumasurgery has also played an integral part in the treatment of rheumatic disorders.

Scientific research

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.

External links

• Association des medecins rhumatologues du Quebec
• American College of Rheumatology
• European League Against Rheumatism
• Consortium of Rheumatology Researchers of North America, Inc.
• British Society for Rheumatology
• Canadian Rheumatology Association
• Association of Rheumatology Health Professionals
• Future Rheumatology journal-Cutting edge commentary and analysis in the field of Rheumatology
• Indian Journal of Rheumatology
• What the heck is Rheumatology?