Rheumatology
Encyclopedia
Rheumatology 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 tissue
s, autoimmune diseases, vasculitis
, and heritable connective tissue disorders.
The term rheumatology originates from the Greek word rheuma, meaning "that which flows as a river or stream," and the suffix -logy
, meaning "the study of."
Rheumatology is a rapidly evolving medical specialty, with advancements owing largely to new scientific discoveries related to immunology
of these disorders.
Because characteristics of some rheumatological disorders are often best explained by immunology, pathogenesis
of many major rheumatological disorders are now described in terms of the autoimmune system, i.e. as an autoimmune disease
. Correspondingly, most new treatment modalities are also based on clinical research
in immunology and the resulting improved understanding of the genetic
basis of rheumatological disorders. Future treatment may include gene therapy
as well.
At present evidence-based medical treatment of rheumatological disorders has helped patients with rheumatism
lead a near-normal life.
s, connective tissue
s, soft tissue
s around the joints and bones. The term rheumatism is also used to describe rheumatic fever
affecting heart valves. However, the medical profession uses specific terms to describe rheumatological disorders such as rheumatoid arthritis
, ankylosing spondylitis
, gout
and systemic lupus erythematosus
and so on in the medical literature.
Rheumatology is now emerging as an important clinical specialty recognized all over the world. This speciality is rapidly improving and well established along with properly organized post graduate training programs. The term describing clinicians dealing with rheumatism as "rheumatologists" is now a well established term commonly used by the medical community, even though it is not adequately described in dictionaries established for languages. Rheumatologists all over the world are now capable of treating most of the chronic rheumatological disorders with a much better outcome for the patients. This is due to the discovery of new disease modifying agents called biologics which is now a well established form of treatment for the patients suffering with chronic and disabling joint disorders.
Degree (M.D. or D.O.) through fellowship programs in the United States, or specialist registrar positions in the Unitied 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 number of years allocated for specialized training in rheumatology for postgraduate trainees in different countries could vary according to the requirements of different 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. Clinicians who specialize on this specialty are called Rheumatologists.
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.
There are many international organizations representing rheumatologists all over the world. The American College of Rheumatology
( ACR), the Association of Rheumatology Health Professionals
(ARHP), the European League Against Rheumatism
(EULAR), Asia Pacific League of Associations for Rheumatology
(APLAR), International League of Associations for Rheumatology (ILAR) and the British Society of Rheumatology (BSR) are the main international organizations established and organizing many activities related to this specialty, these organizations strive to propagate and consolidate Rheumatology endeavors internationally , furthermore, there are associations and colleges of Rheumatology representing Rheumatologists from each and every nation scattered throughout the world which represent the above mentioned organizations from each nation. Rheumatologists are physicians specialized in rheumatic diseases.
For example, there are approximately 480 consultant rheumatologists in the UK. Rheumatologists are increasing in numbers in all countries, as there is an increasing demand for specialists on this field with an increasing population of aging patients who need specialized treatment.
Fibromyalgia
and, on the other hand, more complicated ones, often requiring a rheumatologist or other specialised physicians.
s, NSAIDs (Non-Steroid Anti-Inflammatory Drugs), steroid
s (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 the individual needs of the individual patient which is also dependent on the response and the tolerability of medications.
, 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.
Internal medicine
Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...
and pediatrics
Pediatrics
Pediatrics or paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician or paediatrician...
, devoted to diagnosis
Medical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...
and therapy
Therapy
This is a list of types of therapy .* Adventure therapy* Animal-assisted therapy* Aquatic therapy* Aromatherapy* Art and dementia* Art therapy* Authentic Movement* Behavioral therapy* Bibliotherapy* Buteyko Method* Chemotherapy...
of rheumatic diseases. Clinicians who specialize in rheumatology are called rheumatologists. Rheumatologists deal mainly with clinical problems involving joints, soft tissue
Soft tissue
In anatomy, the term soft tissue refers to tissues that connect, support, or surround other structures and organs of the body, not being bone. Soft tissue includes tendons, ligaments, fascia, skin, fibrous tissues, fat, and synovial membranes , and muscles, nerves and blood vessels .It is sometimes...
s, autoimmune diseases, vasculitis
Vasculitis
Vasculitis refers to a heterogeneous group of disorders that are characterized by inflammatory destruction of blood vessels. Both arteries and veins are affected. Lymphangitis is sometimes considered a type of vasculitis...
, and heritable connective tissue disorders.
The term rheumatology originates from the Greek word rheuma, meaning "that which flows as a river or stream," and the suffix -logy
-logy
-logy is a suffix in the English language, used with words originally adapted from Ancient Greek language ending in -λογία...
, meaning "the study of."
Rheumatology is a rapidly evolving medical specialty, with advancements owing largely to new scientific discoveries related to immunology
Immunology
Immunology is a broad branch of biomedical science that covers the study of all aspects of the immune system in all organisms. It deals with the physiological functioning of the immune system in states of both health and diseases; malfunctions of the immune system in immunological disorders ; the...
of these disorders.
Because characteristics of some rheumatological disorders are often best explained by immunology, pathogenesis
Pathogenesis
The pathogenesis of a disease is the mechanism by which the disease is caused. The term can also be used to describe the origin and development of the disease and whether it is acute, chronic or recurrent...
of many major rheumatological disorders are now described in terms of the autoimmune system, i.e. as an autoimmune disease
Autoimmune disease
Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. In other words, the body actually attacks its own cells. The immune system mistakes some part of the body as a pathogen and attacks it. This may be restricted to...
. Correspondingly, most new treatment modalities are also based on clinical research
Clinical research
Clinical research is a branch of medical science that determines the safety and effectiveness of medications, devices, diagnostic products and treatment regimens intended for human use...
in immunology and the resulting improved understanding of the genetic
Genetics
Genetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....
basis of rheumatological disorders. Future treatment may include gene therapy
Gene therapy
Gene therapy is the insertion, alteration, or removal of genes within an individual's cells and biological tissues to treat disease. It is a technique for correcting defective genes that are responsible for disease development...
as well.
At present evidence-based medical treatment of rheumatological disorders has helped patients with rheumatism
Rheumatism
Rheumatism or rheumatic disorder is a non-specific term for medical problems affecting the joints and connective tissue. The study of, and therapeutic interventions in, such disorders is called rheumatology.-Terminology:...
lead a near-normal life.
Rheumatism
Rheumatism is a non-specific term used to describe any painful disorder affecting the loco-motor system including joints, muscleMuscle
Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...
s, connective tissue
Connective tissue
"Connective tissue" is a fibrous tissue. It is one of the four traditional classes of tissues . Connective Tissue is found throughout the body.In fact the whole framework of the skeleton and the different specialized connective tissues from the crown of the head to the toes determine the form of...
s, soft tissue
Soft tissue
In anatomy, the term soft tissue refers to tissues that connect, support, or surround other structures and organs of the body, not being bone. Soft tissue includes tendons, ligaments, fascia, skin, fibrous tissues, fat, and synovial membranes , and muscles, nerves and blood vessels .It is sometimes...
s around the joints and bones. The term rheumatism is also used to describe rheumatic fever
Rheumatic fever
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection, such as strep throat or scarlet fever. Believed to be caused by antibody cross-reactivity that can involve the heart, joints, skin, and brain, the illness typically develops two to three weeks after...
affecting heart valves. However, the medical profession uses specific terms to describe rheumatological disorders such as rheumatoid arthritis
Rheumatoid arthritis
Rheumatoid arthritis is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints. The process produces an inflammatory response of the synovium secondary to hyperplasia of synovial cells, excess synovial fluid, and the development...
, ankylosing spondylitis
Ankylosing spondylitis
Ankylosing spondylitis , previously known as Bekhterev's disease, Bekhterev syndrome, and Marie-Strümpell disease is a chronic inflammatory disease of the axial skeleton with variable involvement of peripheral joints and nonarticular structures...
, gout
Gout
Gout is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis—a red, tender, hot, swollen joint. The metatarsal-phalangeal joint at the base of the big toe is the most commonly affected . However, it may also present as tophi, kidney stones, or urate...
and systemic lupus erythematosus
Systemic lupus erythematosus
Systemic lupus erythematosus , often abbreviated to SLE or lupus, is a systemic autoimmune disease that can affect any part of the body. As occurs in other autoimmune diseases, the immune system attacks the body's cells and tissue, resulting in inflammation and tissue damage...
and so on in the medical literature.
Rheumatology is now emerging as an important clinical specialty recognized all over the world. This speciality is rapidly improving and well established along with properly organized post graduate training programs. The term describing clinicians dealing with rheumatism as "rheumatologists" is now a well established term commonly used by the medical community, even though it is not adequately described in dictionaries established for languages. Rheumatologists all over the world are now capable of treating most of the chronic rheumatological disorders with a much better outcome for the patients. This is due to the discovery of new disease modifying agents called biologics which is now a well established form of treatment for the patients suffering with chronic and disabling joint disorders.
Rheumatologist
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 Doctor of MedicineDoctor of Medicine
Doctor of Medicine is a doctoral degree for physicians. The degree is granted by medical schools...
Degree (M.D. or D.O.) through fellowship programs in the United States, or specialist registrar positions in the Unitied 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 number of years allocated for specialized training in rheumatology for postgraduate trainees in different countries could vary according to the requirements of different 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. Clinicians who specialize on this specialty are called Rheumatologists.
Rheumatologists treat arthritis
Arthritis
Arthritis is a form of joint disorder that involves inflammation of one or more joints....
, autoimmune diseases, pain disorders affecting joints, and osteoporosis
Osteoporosis
Osteoporosis is a disease of bones that leads to an increased risk of fracture. In osteoporosis the bone mineral density is reduced, bone microarchitecture is deteriorating, and the amount and variety of proteins in bone is altered...
. There are more than 200 types of these diseases, including rheumatoid arthritis
Rheumatoid arthritis
Rheumatoid arthritis is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints. The process produces an inflammatory response of the synovium secondary to hyperplasia of synovial cells, excess synovial fluid, and the development...
, osteoarthritis
Osteoarthritis
Osteoarthritis also known as degenerative arthritis or degenerative joint disease, is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion...
, gout
Gout
Gout is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis—a red, tender, hot, swollen joint. The metatarsal-phalangeal joint at the base of the big toe is the most commonly affected . However, it may also present as tophi, kidney stones, or urate...
, lupus
Systemic lupus erythematosus
Systemic lupus erythematosus , often abbreviated to SLE or lupus, is a systemic autoimmune disease that can affect any part of the body. As occurs in other autoimmune diseases, the immune system attacks the body's cells and tissue, resulting in inflammation and tissue damage...
, 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.
There are many international organizations representing rheumatologists all over the world. The American College of Rheumatology
American College of Rheumatology
The American College of Rheumatology is an organization of and for physicians, health professionals, and scientists that advances rheumatology through programs of education, research, advocacy and practice support that foster excellence in the care of people with arthritis and rheumatic and...
( ACR), the Association of Rheumatology Health Professionals
Association of Rheumatology Health Professionals
The Association of Rheumatology Health Professionals, a division of the American College of Rheumatology, is a professional membership society composed of non-physician health care professionals specializing in rheumatology such as: nurses, advanced practice nurses, occupational therapists,...
(ARHP), the European League Against Rheumatism
European League Against Rheumatism
The is an international organisation in the field of rheumatology. The society publishes a medical journal, the Annals of the Rheumatic Diseases, and organises an annual scientific meeting, the Annual European Congress of Rheumatology....
(EULAR), Asia Pacific League of Associations for Rheumatology
Asia Pacific League of Associations for Rheumatology
Asia Pacific League of Associations for Rheumatology is an organization of Rheumatologists, Physicians, Allied Health Professionals, and Scientists that advances rheumatology through programs of education, research, advocacy and practice support that foster excellence in the care of people with...
(APLAR), International League of Associations for Rheumatology (ILAR) and the British Society of Rheumatology (BSR) are the main international organizations established and organizing many activities related to this specialty, these organizations strive to propagate and consolidate Rheumatology endeavors internationally , furthermore, there are associations and colleges of Rheumatology representing Rheumatologists from each and every nation scattered throughout the world which represent the above mentioned organizations from each nation. Rheumatologists are physicians specialized in rheumatic diseases.
For example, there are approximately 480 consultant rheumatologists in the UK. Rheumatologists are increasing in numbers in all countries, as there is an increasing demand for specialists on this field with an increasing population of aging patients who need specialized treatment.
Inflammatory arthropathies
- Rheumatoid arthritisRheumatoid arthritisRheumatoid arthritis is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints. The process produces an inflammatory response of the synovium secondary to hyperplasia of synovial cells, excess synovial fluid, and the development...
- spondyloarthropathiesSpondyloarthropathySpondyloarthropathy is any joint disease of the vertebral column. Spondyloarthropathy with inflammation is called spondylarthritis. In contrast, spondylopathy is a disease of the vertebra itself, but many conditions involve both spondylopathy and spondyloarthropathy...
- Ankylosing spondylitisAnkylosing spondylitisAnkylosing spondylitis , previously known as Bekhterev's disease, Bekhterev syndrome, and Marie-Strümpell disease is a chronic inflammatory disease of the axial skeleton with variable involvement of peripheral joints and nonarticular structures...
- Reactive arthritisReactive arthritisReactive arthritis , is classified as an autoimmune condition that develops in response to an infection in another part of the body. Coming into contact with bacteria and developing an infection can trigger the disease. Reiter's syndrome has symptoms similar to various other conditions collectively...
(reactive arthropathy) - Psoriatic arthropathy
- Enteropathic spondylitis
- Ankylosing spondylitis
- Juvenile Idiopathic ArthritisJuvenile idiopathic arthritisJuvenile idiopathic arthritis is the most common form of persistent arthritis in children. JIA is a subset of arthritis seen in childhood, which may be transient and...
(JIA) - Crystal arthropathies: goutGoutGout is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis—a red, tender, hot, swollen joint. The metatarsal-phalangeal joint at the base of the big toe is the most commonly affected . However, it may also present as tophi, kidney stones, or urate...
, pseudogout - Septic arthritisSeptic arthritisSeptic arthritis is the purulent invasion of a joint by an infectious agent which produces arthritis. People with artificial joints are more at risk than the general population but have slightly different symptoms, are infected with different organisms and require different treatment. Septic...
- Ross River VirusRoss River virusRoss River virus is a small encapsulated single-strand RNA alphavirus endemic to Australia, Papua New Guinea and other islands in the South Pacific. It is responsible for a type of mosquito-borne non-lethal but debilitating tropical disease known as Ross River fever, previously termed "epidemic...
- Barmah Forest VirusBarmah Forest virusBarmah Forest virus is a virus currently found only in Australia. According to a Queensland Public Health Services fact sheet, "there is no specific drug treatment" for the virus, but the disease is non-fatal and relatively mild. The virus is transmitted to humans by bites from infected...
Systemic conditions and connective tissue diseases
- LupusSystemic lupus erythematosusSystemic lupus erythematosus , often abbreviated to SLE or lupus, is a systemic autoimmune disease that can affect any part of the body. As occurs in other autoimmune diseases, the immune system attacks the body's cells and tissue, resulting in inflammation and tissue damage...
- Sjögren's syndromeSjögren's syndromeSjögren's syndrome , also known as "Mikulicz disease" and "Sicca syndrome", is a systemic autoimmune disease in which immune cells attack and destroy the exocrine glands that produce tears and saliva....
- SclerodermaSclerodermaSystemic sclerosis or systemic scleroderma is a systemic autoimmune disease or systemic connective tissue disease that is a subtype of scleroderma.-Skin symptoms:...
(systemic sclerosis) - PolymyositisPolymyositisPolymyositis is a type of chronic inflammation of the muscles related to dermatomyositis and inclusion body myositis.-Signs and symptoms:...
- DermatomyositisDermatomyositisDermatomyositis is a connective-tissue disease related to polymyositis and Bramaticosis that is characterized by inflammation of the muscles and the skin.- Causes :...
- Polymyalgia rheumaticaPolymyalgia rheumaticaPolymyalgia rheumatica , abbreviated as PMR, is a syndrome with pain or stiffness, usually in the neck, shoulders, and hips. The pain can be very sudden, or can occur gradually over a period of time...
- Mixed connective tissue diseaseMixed connective tissue diseaseIn medicine, mixed connective tissue disease , commonly abbreviated as MCTD, is an autoimmune disease, in which the body's defense system attacks itself. It was characterized in 1972....
- PolychondritisPolychondritisRelapsing polychondritis is a condition characterized by deterioration of cartilage....
- SarcoidosisSarcoidosisSarcoidosis , also called sarcoid, Besnier-Boeck disease or Besnier-Boeck-Schaumann disease, is a disease in which abnormal collections of chronic inflammatory cells form as nodules in multiple organs. The cause of sarcoidosis is unknown...
- VasculitisVasculitisVasculitis refers to a heterogeneous group of disorders that are characterized by inflammatory destruction of blood vessels. Both arteries and veins are affected. Lymphangitis is sometimes considered a type of vasculitis...
- Polyarteritis nodosaPolyarteritis nodosaPolyarteritis nodosa is a vasculitis of medium & small-sized arteries, which become swollen and damaged from attack by rogue immune cells. Polyarteritis nodosa is also called Kussmaul disease or Kussmaul-Maier disease...
- Henoch-Schönlein purpuraHenoch-Schönlein purpuraHenoch–Schönlein purpura is a disease of the skin and other organs that most commonly affects children. In the skin, the disease causes palpable purpura ; often with joint and abdominal pain...
- Serum sicknessSerum sicknessSerum sickness in humans is a reaction to proteins in antiserum derived from an non-human animal source. It is a type of hypersensitivity, specifically immune complex hypersensitivity . The term serum sickness–like reaction is occasionally used to refer to similar illnesses that arise from the...
- Wegener's granulomatosisWegener's granulomatosisWegener's granulomatosis , more recently granulomatosis with polyangiitis , is an incurable form of vasculitis that affects the nose, lungs, kidneys and other organs. Due to its end-organ damage, it is life-threatening and requires long-term immunosuppression...
- Giant cell arteritis, Temporal arteritisTemporal arteritisGiant-cell arteritis or Horton disease is an inflammatory disease of blood vessels most commonly involving large and medium arteries of the head...
- Takayasu's arteritisTakayasu's arteritisTakayasu's arteritis is a form of large vessel granulomatous vasculitis with massive intimal fibrosis and vascular narrowing affecting often young or middle-aged women of Asian descent...
- Behçet's syndrome
- Kawasaki's disease (mucocutaneous lymph node syndrome)
- Buerger's diseaseBuerger's diseaseThromboangiitis obliterans is a recurring progressive inflammation and thrombosis of small and medium arteries and veins of the hands and feet...
(thromboangiitis obliterans)
- Polyarteritis nodosa
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, ganglions, localised Soft tissues disorders. For example:- Low back painLow back painLow back pain or lumbago is a common musculoskeletal disorder affecting 80% of people at some point in their lives. In the United States it is the most common cause of job-related disability, a leading contributor to missed work, and the second most common neurological ailment — only headache is...
- Tennis elbowTennis elbowLateral epicondylitis or lateral epicondylalgia, also known as tennis elbow, shooter's elbow and archer's elbow, is a condition where the outer part of the elbow becomes sore and tender...
- Golfer's elbowGolfer's elbowGolfer's elbow, or medial epicondylitis, is an inflammatory condition of the medial epicondyle of the elbow. It is in some ways similar to tennis elbow....
- Olecranon bursitisOlecranon bursitisOlecranon bursitis is a condition characterised by pain, swelling and inflammation of the olecranon bursa located in the elbow....
Fibromyalgia
Fibromyalgia
Fibromyalgia is a medical disorder characterized by chronic widespread pain and allodynia, a heightened and painful response to pressure. It is an example of a diagnosis of exclusion...
Diseases affecting bones
- OsteoporosisOsteoporosisOsteoporosis is a disease of bones that leads to an increased risk of fracture. In osteoporosis the bone mineral density is reduced, bone microarchitecture is deteriorating, and the amount and variety of proteins in bone is altered...
- OsteomalaciaOsteomalaciaOsteomalacia is the softening of the bones caused by defective bone mineralization secondary to inadequate amounts of available phosphorus and calcium, or because of overactive resorption of calcium from the bone as a result of hyperparathyroidism...
- Renal osteodystrophy
- Fluorosis
- RicketsRicketsRickets is a softening of bones in children due to deficiency or impaired metabolism of vitamin D, magnesium , phosphorus or calcium, potentially leading to fractures and deformity. Rickets is among the most frequent childhood diseases in many developing countries...
Congenital and familial Disorders affecting Joints
- Hyperextensible joints
- Ehlers-Danlos SyndromeEhlers-Danlos syndromeEhlers–Danlos syndrome is a group of inherited connective tissue disorders, caused by a defect in the synthesis of collagen . The collagen in connective tissue helps tissues to resist deformation...
- AchondroplasiaAchondroplasiaAchondroplasia dwarfism occurs as a sporadic mutation in approximately 85% of cases or may be inherited in an autosomal dominant genetic disorder that is a common cause of dwarfism...
- Marfan's Syndrome
Diagnosis
Apart from an extensive medical history, there are useful methods of diagnosis both performed easy enough in a physical examinationPhysical examination
Physical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...
and, on the other hand, more complicated ones, often requiring a rheumatologist or other specialised physicians.
Physical examination
Following are examples of methods of diagnosis able to be performed in a normal physical examination.- Schober's testSchober's testSchober's test is a test used in rheumatology to measure the ability of a patient to flex his/her lower back.-Procedure:The examiner makes a mark approximately at the level of L5 . The examiner then places one finger ~5 cm below this mark, and another, second, finger, ~10 cm above this mark. The...
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
Specialised
- LaboratoryMedical laboratoryA medical laboratory or clinical laboratory is a laboratory where tests are done on clinical specimens in order to get information about the health of a patient as pertaining to the diagnosis, treatment, and prevention of disease.-Departments:...
testsBlood testA blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via fingerprick....
(e.g. Erythrocyte Sedimentation RateErythrocyte sedimentation rateThe erythrocyte sedimentation rate , also called a sedimentation rate or Biernacki Reaction, is the rate at which red blood cells sediment in a period of 1 hour...
, Rheumatoid FactorRheumatoid factorRheumatoid factor is an autoantibody most relevant in rheumatoid arthritis. It is defined as an antibody against the Fc portion of IgG. RF and IgG join to form immune complexes that contribute to the disease process...
, Anti-CCP (Anti-Cyclic Citrullinated Peptide antibody), ANA (Anti-Nuclear Antibody)Anti-nuclear antibodyAnti-nuclear antibodies are autoantibodies directed against contents of the cell nucleus....
) - X-rayX-rayX-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
s, UltrasoundUltrasoundUltrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...
s, and other imaging methods of affected joints - CytopathologyCytopathologyCytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by Rudolf Virchow in 1858. A common application of cytopathology is the Pap smear, used as a screening tool, to detect precancerous cervical lesions and prevent cervical...
and chemical pathology of fluid aspirated from affected joints (e.g. to differentiate between septic arthritisSeptic arthritisSeptic arthritis is the purulent invasion of a joint by an infectious agent which produces arthritis. People with artificial joints are more at risk than the general population but have slightly different symptoms, are infected with different organisms and require different treatment. Septic...
and goutGoutGout is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis—a red, tender, hot, swollen joint. The metatarsal-phalangeal joint at the base of the big toe is the most commonly affected . However, it may also present as tophi, kidney stones, or urate...
)
Treatment
Most rheumatic diseases are treated with analgesicAnalgesic
An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....
s, NSAIDs (Non-Steroid Anti-Inflammatory Drugs), steroid
Steroid
A steroid is a type of organic compound that contains a characteristic arrangement of four cycloalkane rings that are joined to each other. Examples of steroids include the dietary fat cholesterol, the sex hormones estradiol and testosterone, and the anti-inflammatory drug dexamethasone.The core...
s (in serious cases), DMARDs (Disease-Modifying Anti-Rheumatic Drugs), monoclonal antibodies, such as infliximab
Infliximab
Infliximab is a monoclonal antibody against tumour necrosis factor alpha . It is used to treat autoimmune diseases. Remicade is marketed by Janssen Biotech, Inc...
and adalimumab
Adalimumab
Adalimumab is the third TNF inhibitor, after infliximab and etanercept, to be approved in the United States. Like infliximab and etanercept, adalimumab binds to TNFα, preventing it from activating TNF receptors; adalimumab was constructed from a fully human monoclonal antibody, while infliximab...
, and the soluble TNF receptor etanercept
Etanercept
Etanercept is a drug that treats autoimmune diseases by interfering with the tumor necrosis factor by acting as a TNF inhibitor. Pfizer describes in a SEC filing that the drug is used to treat rheumatoid, juvenile rheumatoid and psoriatic arthritis, plaque psoriasis and ankylosing spondylitis...
and Methotrexate
Methotrexate
Methotrexate , abbreviated MTX and formerly known as amethopterin, is an antimetabolite and antifolate drug. It is used in treatment of cancer, autoimmune diseases, ectopic pregnancy, and for the induction of medical abortions. It acts by inhibiting the metabolism of folic acid. Methotrexate...
for moderate to severe Rheumatoid arthritis
Rheumatoid arthritis
Rheumatoid arthritis is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints. The process produces an inflammatory response of the synovium secondary to hyperplasia of synovial cells, excess synovial fluid, and the development...
. 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
Occupational therapy
Occupational therapy is a discipline that aims to promote health by enabling people to perform meaningful and purposeful activities. Occupational therapists work with individuals who suffer from a mentally, physically, developmentally, and/or emotionally disabling condition by utilizing treatments...
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
Recently, a large body of scientific research deals with the background of autoimmune diseaseAutoimmune disease
Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. In other words, the body actually attacks its own cells. The immune system mistakes some part of the body as a pathogen and attacks it. This may be restricted to...
, the cause of many rheumatic disorders. Also, the field of osteoimmunology
Osteoimmunology
Osteoimmunology is the study of the interface between the skeletal system and the immune system, comprising the “osteo-immune system”...
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 médecins rhumatologues du Québec
- American College of Rheumatology
- British Society for Rheumatology
- Canadian Rheumatology Association
- Association of Rheumatology Health Professionals
- IFR: Institut Ferran de Reumatologia.
- APLAR
- Future Rheumatology journal-Cutting edge commentary and analysis in the field of Rheumatology
- Academic League of Rheumatology from Porto Alegre, Brazil