Rheumatology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Rheumatology, a subspecialty of internal medicine and pediatrics is devoted to the diagnosis and therapy of rheumatic diseases. The term originates from the Greek rheuma, meaning "that which flows as a river or stream" and the suffix -ology, meaning "the study of". Rheumatologists mainly deal with problems involving the joints and the allied conditions of connective tissue.
Rheumatology is a rapidly evolving specialty; new scientific discoveries related to this specialty are largely related to better understanding of immunology of these disorders. Pathogenesis of major rheumatological disorders is now described as auto immune disorders. Immunology explains pathogenesis and the characteristics of rheumatological disorders, and the new treatment modalities are also based on immunology, better understanding of genetic basis of rheumatological disorders makes rheumatology a specialty rapidly developing as a specialty based on new scientific discoveries. New treatment modalities are based on scientific research on immunology, cytokines, T lymphocytes, B lymphocytes and the future therapies may be directed more towards gene therapy as well. Currently, practice of rheumatology is largely based on clinical research, evidence based medical treatment of rheumatological disorders has helped patients with rheumatism lead a near normal life without any disabilities. Those clinicians specialized on this specialty are called rheumatologists.
Rheumatism
Rheumatism is a non-specific term used to describe any painful disorder affecting the loco-motor system including joints, muscles, connective tissues, soft tissues around the joints and bones. The term rheumatism is also used to describe rheumatic fever affecting heart valves. However, the medical profession use 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 all over the world, along with well organized post graduate training programs organized for the postgraduate trainees in this field. The term describing clinicians as "rheumatologists" is now a well established term in the medical community, even though it is not well described in language dictionaries. Rheumatologists all over the world are now capable of treating most of the chronic rheumatological disorders with a much better outcome for the patients that is with 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. Large proportion of patients with rheumatoid arthritis, up to seventy percent according to some studies can now be cured with the introduction and wide spread use of biologic treatment for the treatment of arthritic disorders since the beginning of twenty first century.
Rheumatologist
Rheumatologist. (Consultant Rheumatologist.)
Rheumatologist is a clinician specialized in the field of medical subspecialty called rheumatology and hold either a Doctor of Osteopathy degree (D.O.) or Doctor of Medicine Degree (M.D.). Training in this field requires four years undergraduate school, 4 years of medical school, and then postgraduate training. Rheumatologists are internists, physicians 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 also based on scientific research, currently, practice of rheumatology is largely evidence based. Those clinicians specialized on this specialty are called rheumatologists.
Rheumatologists treat arthritis, certain autoimmune diseases, musculoskeletal pain disorders and osteoporosis. There are more than 200 types of these diseases, including rheumatoid arthritis, osteoarthritis, gout, lupus, back pain, osteoporosis, fibromyalgia 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 programmes and occupational therapy is also goes hand in hand with this specialty.
There are many international organizations representing Rheumatologists all over the world. American College of Rheumatology( ACR), the European League Against Rheumatism (EULAR), Asia Pacific League of Associations for Rheumatology(APLAR), International League of Associations for Rheumatology (ILAR) 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 ageing patients who need specialized treatment.
Diseases
Diseases diagnosed or managed by the rheumatologist include:
- Rheumatoid arthritis
- lupus erythematosus
- Sjögren's syndrome
- scleroderma (systemic sclerosis)
- dermatomyositis
- polychondritis
- polymyositis
- polymyalgia rheumatica
- osteoarthritis
- septic arthritis
- fibromyalgia
- sarcoidosis
- gout, pseudogout
- spondyloarthropathies
- vasculitis
- Juvenile Idiopathic Arthritis (JIA)
Diagnosis
Apart from an extensive medical history, there are useful methods of diagnosis both performed easy enough in a physical examination 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 test tests the flexion of the lower back.
Specialised
- Laboratory tests (e.g. erythrocyte sedimentation rate, rheumatoid factor)
- X-rays of affected joints and other imaging methods
- Cytology and chemical pathology of fluid aspirated from affected joints (e.g. to differentiate between septic arthritis and gout)
Treatment
Most rheumatic diseases are treated with analgesics, NSAIDs (Non-Steroid Anti-Inflammatory Drugs), steroids (in serious cases), DMARDs (Disease-Modifying Anti-Rheumatic Drugs), monoclonal antibodies, such as infliximab and adalimumab, and the soluble TNF receptor etanercept.
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.
Scientific research
Recently, a large body of scientific research deals with the background of autoimmune disease, 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.
External links
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