Rheumatology

Various Rheumatic Conditions

Here are some conditions to be aware of:

• Bone, muscle and joint pain: Also known as musculoskeletal pain, this condition can cause bones to ache, joints to become stiff and inflamed, and muscles to experience spasms and cramps. Increased physical activity often makes musculoskeletal pain worse.
• Fatigue and lethargy: Many people with rheumatic conditions can have permanently inflamed joints. This can lead to general weakness, drowsiness and exhaustion that is fatigue.
• Arthritis:

1. Osteoarthritis: This is the most common type of arthritis, worsening with age and severity of physical activity. It involves wear-and-tear damage to a joint’s cartilage, which is the hard coating on the ends of bones where they form a joint. Cartilage damage can result in bone grinding directly on bone, which causes pain and restricted movement.
2. Rheumatoid arthritis: An autoimmune disorder not caused by wear or tear, rheumatoid arthritis occurs when the immune system mistakenly attacks its own body’s tissues. Rheumatoid arthritis affects the lining of joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.
3. Psoriatic arthritis: Psoriatic arthritis is a form of arthritis that affects people who have psoriasis, a condition that causes red patches of skin topped with silvery scales. This condition can affect any part of the body, including fingertips and spine, and can range from relatively mild to severe.

• Neck and back pain: Also known as Spondylitis involves inflammation in spinal bones, or vertebrae, often leading to acute neck and back pain.

1. Spondyloarthritis: Spondyloarthritis is a type of arthritis that attacks the spine and, in some people, the joints of the arms and legs. The main symptom in most patients is low back pain.
2. Ankylosing spondylitis: Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the bones in the spine (vertebrae) to fuse together making movement tougher and lowers flexibility. Ankylosing spondylitis is mostly hereditary. It tends to start in the teens and in 20s and affects males 2-3 times more often than females.

• Autoimmune conditions: Autoimmune conditions with rheumatic components include lupus, Sjögren’s syndrome, antiphospholipid antibody syndrome. Sjögren’s syndrome often occurs in combination with other such disorders, such as rheumatoid arthritis and lupus.
• Osteoporosis and vitamin D deficiency: Osteoporosis causes bones to become weak and brittle, such that even a minor fall or push can cause fractures. Older women who are past menopause are at highest risk. Low vitamin D intake can cause bone loss, leading to osteoporosis and fractures.
• Inflammatory myopathies and vasculitis: Inflammatory myopathies are a group of diseases that involve chronic muscle inflammation and muscle weakness. Vasculitis involves an inflammation of the blood vessels as vessel walls become thick and narrow, affecting blood supply to tissues and organs. Muscle and joint pain, fatigue and fever are common symptoms.
• Gout: Gout is a common form of arthritis that affects men more than women. It involves sudden, severe attacks of pain, swelling, redness and tenderness in one or more joints, most often in the big toe. Uric acid crystals, which form when there is too much uric acid in the blood, can cause gout.
• Pseudogout: Pseudogout is one form of arthritis that involves sudden and painful swelling in one or more joints. It mostly targets the knee joints and sometimes the wrists and ankles. This condition is linked to the presence of calcium pyrophosphate dihydrate crystal deposits that affect the joints especially with aging.
• Fibromyalgia and soft tissue rheumatism: Soft-tissue rheumatism comprises a category of disorders that produce pain, swelling, or inflammation not caused by arthritis in the tissues. The disorders include tendinitis and fibromyalgia among others. Acute muscle pain along with fatigue, poor sleep and memory are common indicators of fibromyalgia.

When to seek doctor’s advice?

Everyone experiences muscle and joint pain from time to time, but if it takes more time than expected to heal or causes intense pain, you may be advised to go for a rheumatology evaluation. Rheumatologists are specialists in diagnosing, managing and treating arthritis and rheumatic diseases in both children and adults. Rheumatic conditions tend to run in the family, so it is important to be aware of your family’s medical history.

An early check-up is suggested if you have:

• Relatives with autoimmune diseases like Lupus
• Relatives with rheumatic conditions
• Joint pain that worsens rapidly
• A history of bone or joint related injury

Treatments

• Infusion therapy: Infusion medications are used for moderate to severe cases of conditions like rheumatoid arthritis. Infusion treatments are administered directly into the bloodstream with the ability to target inflammation at the source. This process results in better absorption of the treatment. Joint and soft tissue injections are administered in a relaxing setting.
• Biologic injections: They are used to target specific molecules, which generally cause inflammation in a rheumatoid arthritis condition. Biologic agents are known to cut down the inflammatory process, which results in joint damage in rheumatoid arthritis. These injections are known to be more effective as they are specifically targeted. Your doctor will be the right person to guide you on which biologic can suit your condition.
• Musculoskeletal ultrasounds: High quality ultrasounds are able to detect signs of inflammation and damage like loss of cartilage or bone erosions. Ultrasound can also help reduce inflammation of the sheaths surrounding tendons.
• Non-surgical treatments: Certain conditions can be treated through the skin rather than invasive surgery. Physical and occupational therapy can relieve pain, reduce inflammation, and help preserve joint structure and function for patients with disc diseases, neck, shoulder, back, elbow, knee and ankle pain.
• Soft tissue and Intra-articular injections: can be used in conditions like tendinitis, bursitis and osteoarthritis
• Medication: There are many medications to decrease joint pain, swelling, and inflammation, and prevent or slow down the disease. The type of drugs that a doctor recommends will depend on the severity of the rheumatic condition and how well you respond to the medications.
• Specialty care: This is offered for patients with chronic rheumatic diseases like psoriatic arthritis, where cure is not possible. Treatment is aimed at controlling symptoms and preventing joint damage. Without proper care and treatment, these conditions can be disabling.
• Surgery: These are the multiple treatment options, which allow for proper management of many rheumatic conditions. It is when bone damage from conditions like arthritis has become severe or pain is not controlled with medications, that surgery becomes the tool to restore function to a damaged joint.

Preventive Measures

Following are a few steps that you can take as a prevention to preserve your bone, joint and muscle health:

• Make sure that your diet is calcium and vitamin D rich.
• Consume fish and fish oil, which are rich in a number of nutrients, particularly omega-3 fatty acids and vitamins A and D.
• Legumes, low fat dairy and daily fruit and vegetable intake are recommended, while processed meats and fried food should be avoided.
• Quitting smoking is ideal. Smoking and exposure to cigarette smoke can affect the immune system by increasing stress on the body and triggering inflammation.
• Regular exercise, even low-impact exercise, can help with chronic disease prevention.

Maintaining proper bone and health care can keep many severe rheumatic conditions at bay, which is especially important with aging. However, prevention may not always be possible, especially when the condition is of genetic origin or an autoimmune disease like ankylosing spondylitis, fibromyalgia, lupus and so on. You should consult a doctor without delay to avoid worsening of your condition/s.