Rheumatology deals with over 100 disease conditions wherein joint pain is a common feature. Those conditions lead to pain in a ‘joint area’ and can be from within the joint or from nearby structures such as muscles, ligaments, and bones. There are multiple symptoms that would lead to patient being diagnosed with Rheumatic Disease. Those conditions could be related to pain in single joint or multiple joints along with swelling in some cases. The underlying condition can be osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, gout, septic arthritis, systemic lupus, vasculitis, or just soft tissue rheumatism. All these are some of the conditions that come under the scope of Rheumatology as a super specialty of Medicine.
Causes for most of the rheumatic conditions are not well understood. ‘Wear and tear’ of joints due to old age, trauma, previous surgery, occupational strain, and other causes is a feature of degenerative diseases such as osteoarthritis (knees, spine, hands). Inflammatory diseases are due to autoimmunity or immune dysfunction wherein the white cells do not recognize other cells of the body and attack them leading to inflammation. This then leads to arthritis, vasculitis, nephritis, and so on according to the disease pathology. Most rheumatic conditions, except a few like gout and spondarthritis, are more common in females. This is indicative of hormonal factors. There are genetic and environmental factors too that are responsible for some of these diseases.
Most of the rheumatic conditions can be diagnosed by a good clinical history and clinical examination by a well-trained rheumatologist. Laboratory tests are needed just to confirm the diagnosis. It is always better to ask for limited number of specific tests rather than obtaining a ‘panel’ of so called ‘arthritis tests’. Rheumatoid factor is needed in cases of inflammatory polyarthritis just to confirm the diagnosis. ANA test should never be advised unless a systemic autoimmune disease such as systemic lupus is suspected.
Many rheumatic conditions are a lifelong problem for the patient. They cannot be cured completely but can be very well controlled with modern drug-management. Early diagnosis is the key deciding factor in most cases. This allows aggressive treatment and a strict disease control which prevents development of deformities and damage at a later stage. Number of drugs and their doses can be reduced at a later stage when the disease is under control. Life-style modifications and psychological equilibrium also form a part of management.
Around 15% of population is estimated to be suffering from musculoskeletal pain at any given point in time. There is extreme shortage of trained rheumatologist all over the world. The subject is usually neglected during graduate studies. Most patients seek advice from orthopedic surgeons who are trained in surgery and are unable to deal with medical conditions which need close monitoring and use of medications that are potentially toxic. It is, therefore, better for primary care physicians to learn more about this emerging super specialty and use the knowledge for better patient-care.
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