FAQ's on Rheumatology

Q- Who is a Rheumatologist?

Ans- A Rheumatologist is a specialist who deals with the diagnosis and treatment of patients with joint and musculoskeletal problems. He/she first has to specialise as a physician and then receives additional training and experience in the diagnosis and treatment of arthritis and related musculoskeletal conditions.

Q- What is arthritis?

Ans- Arthritis literally means inflammation of a joint. This is due to inflammation of the joint lining called synovium, which results in joint swelling and causes pain and stiffness as the main symptoms.

Q- How do you know whether you have arthritis?

Ans- Patients with Arthritis may experience the following symptoms: pain and swelling of one or more joints, feel stiffness in the joints - more in the morning, redness and warmth of the affected joints and these symptoms van be recurrent or persistent.

Q- Is it seen only in elderly people?

Ans- No, this is a common misconception. Arthritis can affect any age group- even children. However, osteoarthritis which is a disease of the cartilage of the joint (also referred to as ‘wear and tear’ arthritis), affects older people.

Q- Is arthritis more common in women?

Ans- Yes, arthritis generally is more common in women than men. Rheumatoid arthritis is 3 times more common in women.

Q- What are the risk factors for osteoarthritis?

Ans- A genetic predisposition is the most important risk factor. Other factors that may impact osteoarthritis are: Obesity, Mechanical/surgical trauma to a joint, Excessive use of a joint such as with impact sports or ballet dancers.

Q- Any special diet for arthritis?

Ans- No special diet is required for arthritis patients except Gout where a diet low in animal protein and limiting alcohol intake can be helpful in the overall treatment.

Q- Will exercise help my joints?

Ans- Exercise is important to maintain the flexibility, range of movement at the joint and to strengthen the muscles. However, exercise will not reduce joint inflammation and usually should be started, only after effective control of inflammation with proper therapy.

Q- What is the difference between a Rheumatologist and an Orthopedic Surgeon?

Ans- Rheumatologists are Physicians and Orthopaedic surgeons are surgeons; therefore all medically related joint disorders are dealt by a Rheumatologist. When the joints are badly damaged or when there are fractures, then you need to consult an orthopedic surgeon

Q- What do Rheumatologists treat?

Ans- Rheumatologists are specially trained to deal with different arthritic conditions, autoimmune disorders, metabolic bone diseases and soft tissue rheumatic conditions.

Q- What are the common Rheumatological conditions in general population?

Ans- Rheumatological conditions can be considered under two main headings- inflammatory or non-inflammatory.

The inflammatory conditions include: Rheumatoid Arthritis; SLE (Systemic Lupus Erythematosus); Gout and other crystal deposition diseases; Connective tissue diseases (Scleroderma, Wegener’s, Churg-strauss, Polyarteritis nodosa, MCTD, Polymyositis, Dermatomyositis, Polymyalgia Rheumatica, Giant cell arteritis); Ankylosing Spondylitis; Psoriatic Arthritis; Reactive Arthritis; Juvenile (Paediatric) Idiopathic Arthritis.

The non-inflammatory conditions include: Osteoarthritis; Osteoporosis; Osteomalacia; Rickets; low back pain; Fibromyalgia; Tendonitis and bursitis.

Q- What are the commonly used drugs in the treatment of arthritis?

Ans- The drugs/medicines used for the treatment of arthritis and related disorders can be classified under the following categories:

1.       Non-steroidal anti-inflammatory agents (NSAIDs): These drugs, as the name implies, are anti-inflammatory and are not steroids. They are commonly referred to as ‘pain-killers’. However, they work by reducing inflammation and in addition also have pain relieving (analgesic) properties. They do not have any specific disease modifying or controlling actions, but can be useful for symptomatic benefit. Some NSDAIDs are: Ibuprofen, Diclofenac, Naproxen etc. There is a group of NSAIDs called Cox-II inhibitors that are considered to be easier on the stomach and they include: Etoricoxib and Celecoxib.

2.       Analgesics: These include: Paracetamol and Tramadol and are ‘pure’ pain relievers.

3.       Disease-Modifying Drugs (DMARDs): These are medicines that have a specific disease modifying/controlling effect and are also referred to as immuno-suppressants. These include: Chloroquine, Methotrexate, Sulfasalazine, Azathiaprine, Cyclophosphamide etc.

4.       Miscellaneous: There are a number of other medicines that may be used, such as Colchicine, Allopurinol or Febuxostat, used for Gout.

Q- How can a Rheumatologist help you?

Ans- A Rheumatologist helps by:

1.       Evaluating a patient with joint complaints and making a correct diagnosis;

2.       Planning the correct treatment for the patient;

3.       Monitoring the patient periodically as indicated, to recognise and complications and/or side effects as early as possible;

4.       In preventing joint damage and improving quality of life of the patient.

Q- What Is Arthritis and What Are Rheumatic Diseases?

Ans- Arthritis literally means joint inflammation. Although joint inflammation describes a symptom or sign rather than a specific diagnosis, the term “arthritis” is often used to refer to any disorder that affects the joints. These disorders fall within the broader category of rheumatic diseases. These are diseases characterized by inflammation (signs include redness or heat, swelling, and symptoms such as pain) and loss of function of one or more connecting or supporting structures of the body. These diseases especially affect joints, tendons, ligaments, bones, and muscles. Common signs and symptoms are pain, swelling, and stiffness. Some rheumatic diseases also can involve internal organs.

There are more than 100 rheumatic diseases. Some are described as connective tissue diseases because they affect the supporting framework of the body and its internal organs. Others are known as autoimmune diseases because they occur when the immune system, which normally protects the body from infection and disease, harms the body’s own healthy tissues.

Q- What are some examples of rheumatic diseases?

Ans- Osteoarthritis – This is the most common type of arthritis, affecting an estimated 27 million adults in the United States. Osteoarthritis primarily the cartilage, which is the tissue that cushions the ends of bones within the joint, as well as the underlying bone. In osteo¬arthritis, there is damage to the cartilage, which begins to fray and may wear away entirely. There is also damage to the bone stock of the joint. Osteoarthritis can cause joint pain and stiffness. Disability results most often when the disease affects the spine and the weight-bearing joints (the knees and hips).

Rheumatoid arthritis – This inflammatory disease of the immune system targets first the synovium, or lining of the joint, resulting in pain, stiffness and swelling of the affected joints initially and then if persistent, joint damage and loss of function of the joints. Inflammation most often affects joints of the hands and feet and tends to be symmetrical (occurring equally on both sides of the body). This symmetry helps distinguish rheumatoid arthritis from other forms of the disease. The world wide prevalence of rheumatoid arthritis is about 1%.

Juvenile idiopathic arthritis – This disease is the most common form of inflammatory arthritis in childhood, causing pain, stiffness, swelling, and loss of function of the joints. This condition may be associated with rashes or fevers and may affect ¬various parts of the body.

Fibromyalgia – Fibromyalgia is a chronic disorder that ¬causes pain throughout the tissues that support and move the bones and joints. Pain, stiffness, and localized tender points occur in the muscles and tendons, particularly those of the neck, spine, shoulders, and hips. Patients also may experience fatigue and sleep disturbances. Fibromyalgia affects millions of adults in the United States.

Systemic lupus erythematosus – Systemic lupus erythematosus (also known as lupus or SLE) is an autoimmune disease in which the immune system harms the body’s own healthy cells and tissues. This can result in inflammation of and damage to the joints, skin, kidneys, heart, lungs, blood vessels, and brain. By conservative estimates, lupus affects about 150,000 people.

Scleroderma – Also known as systemic sclerosis, scleroderma means literally “hard skin.” The disease affects the skin, blood vessels, and joints. It may also affect internal organs, such as the lungs and kidneys. In scleroderma, there is an abnormal and excessive production of collagen (a fiber-like protein) in the skin and internal organs.

Spondyloarthropathies – This group of rheumatic diseases principally affects the spine. One common form – ankylosing spondylitis – also may affect the hips, shoulders, and knees. The tendons and ¬ligaments around the bones and joints become inflamed, resulting in pain and stiffness. Ankylosing spondylitis tends to affect people in late adolescence or early adulthood. Reactive arthritis is another spondyloarthropathy. It develops after an infection involving the lower urinary tract, bowel, or other organ. It is commonly associated with eye problems, skin rashes, and mouth sores.

Infectious arthritis – This is a general term used to describe forms of arthritis that are caused by infectious agents, such as bacteria or viruses. Parvovirus arthritis and gonococcal arthritis are examples of infectious arthritis. Arthritis symptoms also may occur in Lyme disease, which is caused by a bacterial infection following the bite of certain ticks. In those cases of arthritis caused by bacteria, early diagnosis and treatment with antibiotics are crucial to removing the infection and minimizing damage to the joints.

Gout – This type of arthritis results from deposits of needle-like crystals of uric acid in the joints. The crystals cause episodic inflammation, swelling, and pain in the affected joint, which is often the big toe. An estimated 2.1 million Americans have gout.

Polymyalgia rheumatica – Because this disease involves tendons, muscles, ligaments, and tissues around the joint, symptoms often include pain, aching, and morning stiffness in the shoulders, hips, neck, and lower back. It is sometimes the first sign of giant cell arteritis, a disease of the arteries characterized by headaches, inflammation, weakness, weight loss, and fever.

Polymyositis – This rheumatic disease causes inflammation and weakness in the muscles. The disease may affect the whole body and cause disability.

Psoriatic arthritis – This form of arthritis occurs in some patients with psoriasis, a scaling skin disorder. Psoriatic arthritis often affects the joints at the ends of the fingers and toes and is accompanied by changes in the fingernails and toenails. Back pain may occur if the spine is involved.

Bursitis – This condition involves inflammation of the bursae, small, fluid-filled sacs that help reduce friction between bones and other moving structures in the joints. The inflammation may result from arthritis in the joint or injury or infection of the bursae. Bursitis produces pain and tenderness and may limit the movement of nearby joints.

Tendonitis (tendonitis) – This condition refers to inflammation of tendons (tough cords of tissue that connect muscle to bone) caused by overuse, injury, or a rheumatic condition. Tendonitis produces pain and tenderness and may restrict movement of nearby joints.