Rheumatology

Rheumatology (Greek ῥεῦμα, rheûma, flowing current) is a branch of medicine devoted to the diagnosis and management of disorders whose common feature is inflammation in the bones, muscles, joints, and internal organs. Rheumatology covers more than 100 different complex diseases, collectively known as rheumatic diseases, which includes many forms of arthritis as well as lupus and Sjögren's syndrome. Doctors who have undergone formal training in rheumatology are called rheumatologists.
Many of these diseases are now known to be disorders of the immune system, and rheumatology has significant overlap with immunology, the branch of medicine that studies the immune system.
Rheumatologist
A rheumatologist is a physician who specializes in the field of medical sub-specialty called rheumatology. A rheumatologist holds a board certification after specialized training. In the United States, training in this field requires four years undergraduate school, four years of medical school, and then three years of residency, followed by two or three years additional Fellowship training. The requirements may vary in other countries. Rheumatologists are internists 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 based on scientific research, currently, practice of rheumatology is largely evidence based.
Rheumatologists treat arthritis, autoimmune diseases, pain disorders affecting joints, and osteoporosis. There are more than 200 types of these diseases, including rheumatoid arthritis, osteoarthritis, gout, lupus, back pain, osteoporosis, and tendinitis. Some of these are very serious diseases that can be difficult to diagnose and treat. They treat soft tissue problems related to the musculoskeletal system, and sports related soft tissue disorders.
Diseases
Diseases diagnosed or managed by rheumatologists include:
Degenerative arthropathies
Osteoarthritis
Inflammatory arthropathies
Rheumatoid arthritis
Spondyloarthropathies
Ankylosing spondylitis
Reactive arthritis (reactive arthropathy)
Psoriatic arthropathy
Enteropathic arthropathy
Juvenile Idiopathic Arthritis (JIA)
Crystal arthropathies: gout, pseudogout
Septic arthritis
Systemic conditions and connective tissue diseases
Lupus
Ehlers-Danlos syndrome
Sjögren's syndrome
Scleroderma (systemic sclerosis)
Polymyositis
Dermatomyositis
Polymyalgia rheumatica
Mixed connective tissue disease
Relapsing polychondritis
Adult-onset Still's disease
Sarcoidosis
Fibromyalgia
Myofascial pain syndrome
Vasculitis
Microscopic polyangiitis
Eosinophilic granulomatosis with polyangiitis
Granulomatosis with polyangiitis
Polyarteritis nodosa
Henoch–Schönlein purpura
Serum sickness
Giant cell arteritis, Temporal arteritis
Takayasu's arteritis
Behçet's disease
Kawasaki disease (mucocutaneous lymph node syndrome)
Thromboangiitis obliterans
Hereditary periodic fever syndromes
Soft tissue rheumatism
Local diseases and lesions affecting the joints and structures around the joints including tendons, ligaments capsules, bursae, stress fractures, muscles, nerve entrapment, vascular lesions, and ganglia. For example:
Low back pain
Tennis elbow
Golfer's elbow
Olecranon bursitis
Diagnosis
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.
Multiple joint inspection
Musculoskeletal Examination
Screening Musculoskeletal Exam (SMSE) - a rapid assessment of structure and function
General Musculoskeletal Exam (GMSE) - a comprehensive assessment of joint inflammation
Regional Musculoskeletal Exam (RMSE) - focused assessments of structure, function and inflammation combined with special testing
Specialized
Laboratory tests (e.g. Erythrocyte Sedimentation Rate, Rheumatoid Factor, Anti-CCP (Anti-citrullinated protein antibody), ANA (Anti-Nuclear Antibody) )
X-rays, Ultrasounds, and other imaging methods of affected joints
Cytopathology 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 (nonsteroidal anti-inflammatory drug), steroids (in serious cases), DMARDs (disease-modifying antirheumatic drugs), monoclonal antibodies, such as infliximab and adalimumab, the TNF inhibitor etanercept, and methotrexate for moderate to severe rheumatoid arthritis. The biologic agent rituximab (anti-B cell therapy) is now licensed for use in refractory rheumatoid arthritis.
Physiotherapy is vital in the treatment of many rheumatological disorders. Occupational therapy can help patients find alternative ways for common movements that would otherwise be restricted by their disease. Patients with rheumatoid arthritis often need a long term, coordinated and a multidisciplinary team approach towards management of individual patients. Treatment is often tailored according to the individual needs of each patient which is also dependent on the response and the tolerability of medications.
Beginning in the 2000s, the incorporation of biopharmaceuticals (which include inhibitors of TNF-alpha, certain interleukins, and the JAK-STAT signaling pathway) into standards of care is one of the paramount developments in modern rheumatology.
Rheumasurgery
Rheumasurgery (or rheumatoid surgery) is a subfield of orthopedics occupied with the surgical treatment of patients with rheumatic diseases. The purpose of the interventions is to limit disease activity, soothe pain and improve function.
Rheumasurgical interventions can be divided in two groups. The one is early synovectomies, that is the removal of the inflamed synovia in order to prevent spreading and stop destruction. The other group is the so-called corrective intervention, i.e. an intervention done after destruction has taken place. Among the corrective interventions are joint replacements, removal of loose bone or cartilage fragments, and a variety of interventions aimed at repositioning and/or stabilizing joints, such as arthrodesis.
Research directions
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. The Rheumatology Research Foundation is the largest private funding source of rheumatology research and training in the United States.
History
Rheumasurgery emerged in the cooperation of rheumatologists and orthopedic surgeons in Heinola, Finland, during the 1950s.
In 1970 a Norwegian investigation estimated that at least 50% of patients with rheumatic symptoms needed rheumasurgery as an integrated part of their treatment.
The European Rheumatoid Arthritis Surgical Society (ERASS) was founded in 1979.
Around the turn of the 21st century, focus for treatment of patients with rheumatic disease shifted, and pharmacological treatment became dominant, while surgical interventions became rarer.
References
External links
Association des medecins rhumatologues du Quebec
American College of Rheumatology
European League Against Rheumatism
Consortium of Rheumatology Researchers of North America, Inc.
British Society for Rheumatology
Canadian Rheumatology Association
Association of Rheumatology Health Professionals
German Society for Rheumatology