What is Rheumatology?
For those who are not familiar with my specialty, a rheumatologist is a board certified internist, who is experienced in the diagnosis and treatment of diseases of joints, muscles, and bone. Arthritis is a chronic disease that is characterized by acute and chronic inflammation and can result in joint destruction, impaired mobility, and sometimes permanent disability. Autoimmune diseases, such as systemic lupus erythematosus, are illnesses that occur when the body’s tissues are attacked by its own immune system. Patients with autoimmune diseases produce special proteins or antibodies in their blood that target tissues within their own body rather than foreign infectious agents like viruses and bacteria, resulting in inflammation. Many of you don’t know that there are over 100 types of arthritis. Arthritis is the major cause of disability and chronic pain in American women.
Who should see a rheumatologist?
Anyone who has moderate to severe pain in the joints, muscles, and bones for more than a few weeks or prolonged history of musculoskeletal complaints with constitutional symptoms should obtain a consult. An internist may rule out other common diseases, such as thyroid disease, liver disease, depression, malignancy, infection and Diabetes.
Rheumatologists are specially trained to do the necessary detective work to discover the cause of the swelling and pain. Once the diagnosis is made, the rheumatologist then consults with nurses, physical and occupational therapists, psychologists, social workers to implement a treatment plan and to help the patient and his or her family to cope with the life changes. Some treatment options include analgesics, anti-inflammatory agents (Advil, Naproxen), steroids, immunosuppressive therapies (disease modifying agents, biologic injections), injections of steroids or hylauronic acid, in addition to alternative therapies, like chondroitin and glucosamine supplements and acupuncture.
What diseases do rheumatologists treat?
Some of the disorders that are treated by a rheumatologist may include:
• vitamin D deficiency
• rheumatoid arthritis
• gout and psuedogout
• systemic lupus erythematosus (lupus)
• sjorgren’s syndrome
• undifferentiated connective tissue disease (UCTD) or mixed connective tissue disease (MCTD)
• Lyme disease
• psoriatic arthritis
• ankylosing spondyltis and other spondyloarthropathies
• arthritis associated with inflammatory bowel disease
• carpal tunnel syndrome
• tendonitis and bursitis
• Paget’s Disease
What happens after a diagnosis of arthritis or autoimmune condition?
Once you are diagnosed with arthritis, an autoimmune disease, or musculoskeletal disorder, you may ask yourself or the physician if all arthritic conditions are similar. There are many types of arthritis…..some which are associated with more systemic inflammation than others. Rheumatoid arthritis, lupus, psoriatic arthritis, and even gout are types of rheumatic diseases that are highly associated with early and accelerated heart disease and high cholesterol resulting in cardiac complications. The physician should do a cardiac risk assessment involving family and social history, smoking history, cholesterol, blood pressure (BP) and weight measurements, in addition to providing the patient with nutritional and exercise counseling to reduce risk. Patients who have moderate to high cardiac risk most likely will need medication to reduce disease activity and improve cholesterol, BP to avoid systemic complications. Don’t forget to engage in aerobic and weight bearing exercises at least three times a week. Also taking steps such as limiting daily alcohol intake and eating a well balanced diet are important to lower disease activity in arthritis.
Remember that you have control over modifiable cardiac risk factors such as weight, smoking, blood pressure, and cholesterol.
What have I learned?
There are a few major points that I would like to emphasize:
1) As females, it has been shown that we experience symptoms differently from our male counterparts. If you are experiencing extreme fatigue, constitutional symptoms, prolonged joint pain or swelling, muscle weakness, loss of height or any other prolonged musculoskeletal complaints, ask your primary care physician to refer you to a rheumatologist for an extensive workup.
2) “Not every patient is created equal and not every arthritis is created equal."
Depending on risk factors for a musculoskeletal condition and the degree of disease activity, the patient and physician will need to tailor the regimen according to the patient's disease profile. Depending on the type of arthritis the patient has, more preventative care may be needed for one type over the other.
3) Arthritis is a chronic condition like Diabetes and Hypertension (high blood pressure) which will require long-term management and needs to be taken seriously like these other conditions.
The onset of arthritis can’t be completely prevented. Physicians can hypothesize that environmental, hormonal and genetic influences do play a role in the development. We can prevent progression of joint, cartilage, tendon and muscle destruction by treating arthritis early after early diagnosis.
4) Lastly, arthritis is not a condition that is solely localized to the joint. It can be a systemic disease which involves other organs.
It was too late for my friend to learn this very important fact. We as women play many roles in our lives including being a mother, daughter/sister, wife, caretaker, employers and employees, professionals....we need to be empowered to care for ourselves and take the necessary measures to ensure that our musculoskeletal disorder or autoimmune disease does not progress into permanent disability, therefore not allowing us to fulfill our roles in society. This same sentiment refers to the male patients living with arthritis or autoimmune diseases.
I know that with the help from national organizations, federal funded research programs, and academic institutions, rheumatologists will eventually find a cure for arthritis so that patients may lead a life without major disability or morbidity.