Rheumatology

Rheumatology is a sub-specialty in internal medicine and pediatrics, devoted to the diagnosis and therapy of rheumatic diseases. Rheumatologists mainly deal with clinical problems involving joints, soft tissues and allied conditions of connective tissues. The term "rheumatology" originates from the Greek word "rheuma", meaning "that which flows as a river or stream" and the suffix "-ology", meaning "the study of."

Rheumatology is a rapidly evolving medical 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 autoimmune disorders. Immunology explains pathogenesis and the characteristics of rheumatological disorders, and most of the new treatment modalities are based on immunology, better understanding of genetic basis of rheumatological disorders makes rheumatology a specialty rapidly developing as a medical specialty based on new scientific discoveries. New treatment modalities are based on scientific research on immunology, cytokines, T lymphocytes, B lymphocytes and 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. Clinicians who specialize in rheumatology 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 recognized all over the world. This speciality is rapidly improving and well established along with properly organized post graduate training programs. The term describing clinicians dealing with rheumatism as "Rheumatologists" is now a well established term commonly used by the medical community, even though it is not adequately described in dictionaries established for languages. Rheumatologists all over the world are now capable of treating most of the chronic rheumatological disorders with a much better outcome for the patients. This is due to 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. A 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 arthritic disorders since the beginning of twenty first century (citation needed).

Rheumatologist

Rheumatologist. (Consultant Rheumatologist.)

A rheumatologist is a clinician specialized in the field of medical sub-specialty called rheumatology, and holds either a Doctor of Medicine Degree (M.D.) or a Doctor of Osteopathy degree (D.O.). Training in this field requires four years undergraduate school, four years of medical school, and then, in the United States, three years of residency, followed by two or three years additional Fellowship training. The number of years allocated for specialized training in rheumatology for postgraduate trainees in different countries could vary according to the requirements of different countries. 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 based on scientific research, currently, practice of rheumatology is largely evidence based. Clinicians who specialize 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. The 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 aging patients who need specialized treatment.

Diseases

Diseases diagnosed or managed by the rheumatologist include:

*Rheumatoid arthritis
*Lupus
*Sjögren's syndrome
*scleroderma (systemic sclerosis)
*dermatomyositis
*polychondritis
*polymyositis
*polymyalgia rheumatica
*osteoarthritis
*septic arthritis
*fibromyalgia
*sarcoidosis
*gout, pseudogout
*spondyloarthropathies
**ankylosing spondylitis
**reactive arthritis
**psoriatic arthropathy
**enteropathic spondylitis
**reactive arthropathy
*vasculitis
**polyarteritis nodosa
**Henoch-Schönlein purpura
**serum sickness
**Wegener's granulomatosis
**giant cell arteritis
**temporal arteritis
**Takayasu's arteritis
**Behçet's syndrome
**Kawasaki's disease (mucocutaneous lymph node syndrome)
**Buerger's disease (thromboangiitis obliterans)

Juvenile Idiopathic Arthritis(JIA) ;

( JIA inccudes a wide range Joint Disoders affecting Children)

Rheumatic arthritis;

Soft Tissue Rheumatism; ( Localizes diseases and lesions affecting the joints and structures around the joints including tendons ,ligaments capsules, bursae, Stress Fractures, muscles , nerve entrapment, vascular lesions , ganglion, connective tissue abnormalities and localised Soft tissues disorders etc.)

Diseases affecting bones;

Osteoporosis, osteomalasia, renal osteodystrophy, Fluorosis, Rickets Etc.

Congenital and familial Disorders affecting Joints;

Hyperextensible joints;

Ehlers-Danlos Syndrome,Achondroplasisa, Marfan's Syndrome etc.

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.

pecialised

* Laboratory tests (e.g. Erythrocyte Sedimentation Rate, Rheumatoid Factor, Anti-CCP( Anti-Cyclic Citrullinated Peptide antibody), ANA (Anti-Nuclear Antibody) )
* 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. Biologic agent Rituximab (Anti-B-Cell Therapy) is now licensed for use in refractory Rheumatoid Arthritis. . [cite journal | author = Edwards J, Szczepanski L, Szechinski J, Filipowicz-Sosnowska A, Emery P, Close D, Stevens R, Shaw T | title = Efficacy of B-cell-targeted therapy with rituximab in patients with Rheumatoid arthritis. | journal = N Engl J Med | volume = 350 | issue = 25 | pages = 2572-81 | year = 2004 | pmid = 15201414 | doi = 10.1056/NEJMoa032534]

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. 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 the individual needs of the individual patient which is also dependent on the response and the tolerability of medications.

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. Scientific research on biologics and clinical trials on monoclonal antibody therapies have added a new dimension to the medical treatment of arthritic disorders.

References

External links

* [http://www.rheumatology.org American College of Rheumatology]
* [http://www.institutferran.org IFR: Institut Ferran de Reumatologia] .
* [http://www.aplar.org/index.html APLAR]