Rheumatology Treatments

Arthritis is a very non-specific term but commonly points towards joint pains. There are, in fact, various types of arthritis and related conditions which can result in joint pains. In medical terms any inflammation of the joint is referred to as arthritis. It can affect any joint and may or may not be related to any other medical condition. In some cases arthritis can affect other systems of the body so a careful look at your medical history is required.

There are certain types of arthritis which runs in the family and are present in our genes like rheumatoid arthritis. Some arthritis are related to increased body weight (obesity) e.g. osteoarthritis. Some have connection with diet, like gout (high purine diet, alcohol).

Some professions which require repetitive bending and manual lifting predispose to joint injury and ultimately joints develop damage leading to arthritis. Sports injuries predispose to arthritis.
Vitamin D deficiency has also been linked to joint pains and muscle pains, however, in some types we still cannot find any risk factor or cause.

As mentioned above weight, diet, alcohol, low vitamin D, family history and psoriasis.

Medical conditions like inflammatory bowel disease, psoriasis, underlying infection. Sports injuries or other injuries to joints and spine.

Sometimes vitamin D deficiency can cause joint pains.

What are the most common types of arthritis?

Broadly speaking we divide it into two main types

1. Mechanical type: osteoarthritis. chronic back pain, postural related pains in neck, back and shoulders.
2. Inflammatory arthritis or auto immune arthritis associated with joint inflammation and early morning stiffness.
3. Crystal arthritis like gout (presence of uric acid crystals in joints) or pseudogout (presence of calcium pyrophosphate crystals in the joints)

Joint pain, joint stiffness, swelling of the joints, back pain, back stiffness, any change in the shape of the joint. Night time pain in any joint or back.

Address the risk factors like weight, choosing healthy life style, drinking alcohol within recommended limits. Consume a diet rich in Vitamin D, and, very importantly, seek rheumatology advice as soon as symptoms appear.

It requires consultation with rheumatologist who can take a careful medical history, perform joint and systemic examination. They will request necessary blood tests, x-rays of joints and antibody tests. In some borderline cases an ultrasound scan of joints can be performed as well as MRI scan to diagnose arthritis at a very early stage.

This largely depends on diagnosis:

Mechanical Arthritis: pain killers, physiotherapy and healthy lifestyle, dietary advice

Inflammatory arthritis: pain killers and disease modifying anti rheumatic drugs .

Crystal: avoiding uric acid rich diet (red meat, alcohol)

Pain killers, physiotherapy, keeping healthy life style, and using specific medications for arthritis like DMARDs (disease modifying anti-rheumatic drugs) which suppress inflammation and help with pain.

Yes it helps in maintaining the function of joints as well as muscle strength. The patients may feel more pain in the beginning but should continue exercises as per their doctor or physiotherapist advice. This pain usually settles when muscles accustom to this new routine of physical exertion.

Arthritis patient are usually at relatively increased risk of infection specifically those who take immunosuppressant drugs and those who require joint injections. Any damage in the joints as a result of chronic inflammation can predispose the joint to infection so early diagnosis and optimum treatment is very important to prevent infections in the joints.

Rheumatology deals with

1. Various types of arthritis of joints and spine:
Rheumatoid arthritis, osteoarthritis, gout, pseudogout, chronic back pain, ankylosing spondylitis, arthritis due to inflammatory bowel disease, and patients suffering from skin psoriasis.

2. Brittle bone disease i.e. Osteoporosis (which results in fractures of bones and spine with trivial injury) so if you experience a fracture at young or old age by minor injury, you should be seen by a rheumatologist to perform further tests and bone density scan to find out if your bones are brittle. If treatment is started in time, it can save you from any future fractures of large joints like hips and vertebral fractures which can cause significant disability in your daily life.

3. Connective tissue diseases like SLE (Lupus), Scleroderma, systemic sclerosis, vasculitis, myositis,

4. All types of vasculitis like Wegener’s granulomatosis, Henoch-Schönlein purpura, giant cell arteritis and polyarteritis nodosa.

5. Vitamin D deficiency.

Rheumatologists are physicians whereas orthopaedics are a surgical team. Joint disorders like arthritis, bone disorders, and muscular problems are assessed, diagnosed and treated medically hence these patients need to be seen and well managed by rheumatologist. An orthopaedic surgeon offers surgical treatment e.g. they deal with management of fractures and surgery of any joint which is at a stage where medical treatment cannot be offered or no longer going to be effective. Usually joint pains associated with injury are seen by orthopaedic team first.