A pediatrician, who received further training in the diagnosis (detection), and treatment of diseases that affect the muscles, bones, joints, ligaments, and tendons is called a rheumatologist. These diseases can cause painful days, swelling in the body, stiffness in the body, and potentially cause joint deformities. A very old-fashioned word for these problems is “rheumatism.” Therefore, a “rheumatologist” is a doctor that treats rheumatism.
A rheumatologist is a board-certified internist or pediatrician, who is highly qualified by additional training and experience in the diagnosis and treatment of arthritis and other diseases of the joints, muscles, and bones.
Overview
Rheumatologists give treatment for a number of diseases called “systemic autoimmune diseases.” Other terms are “collagen vascular diseases,” and “connective tissue diseases.” This is a group of diseases in which a person’s bad immune system attacks the person’s own body. This causes inflammation in areas of the body where it is not needed causing problems such as pain, swelling, and organ damage. These can affect any part of the body including the eyes, skin, nerves, kidneys, lungs, heart, and other internal organs. All the diseases can cause inflammation of the joints or arthritis.
Hence, rheumatologists are considered the experts in treating this group of disorders. Some examples of systemic autoimmune diseases are as-
There are more than appx 100 different types of arthritis and musculoskeletal conditions. The role of an orthopedic surgeon is to perform surgery on bones and joints (which is also called the musculoskeletal system), and the purpose of the rheumatologist is to diagnose which type of musculoskeletal disease a person has and to treat it using nonsurgical methods
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Prasidh hospital is dealing with more than appx 100 types of rheumatic diseases, which include:
• osteoarthritis
• rheumatoid arthritis
• musculoskeletal pain disorders
• osteoporosis
• gout
• back pain
• myositis
• fibromyalgia
• tendonitis
• vasculitis
• certain autoimmune diseases, such as lupus, antiphospholipid syndrome, and scleroderma
Diagnosis
Rheumatoid arthritis could be difficult to diagnose in the early stages because the early signs and symptoms mimic those of many other diseases. There will be no one blood test or physical finding to confirm the diagnosis.
During the physical exam, our doctor will check your joints for swelling, redness, and warmth. Our doctor may also check your reflexes and muscle strength.
Blood tests
People with rheumatoid arthritis usually have an elevated erythrocyte sedimentation rate (which is called the ESR, also known as sed rate) or C-reactive protein (CRP) level, which may indicate the presence of an inflammatory process in the body. We may suggest other common blood tests to look for rheumatoid factor and anti-cyclic citrullinated peptide (or anti-CCP) antibodies.
Imaging tests
Our doctor may recommend X-rays to help track the progression of rheumatoid arthritis in your joints over time. MRI and ultrasound tests could help your doctor judge the severity of the disease in your body.
There is no cure for rheumatoid arthritis. But clinical studies indicate that remission of symptoms is more likely when treatment begins early with medications, usually known as disease-modifying antirheumatic drugs (DMARDs).
Medications
The types of medications recommended by our doctor would depend on the severity of your symptoms and how long you've had rheumatoid arthritis.
NSAIDs. Nonsteroidal anti-inflammatory drugs or NSAIDs could relieve pain and reduce inflammation. NSAIDs include ibuprofen (such as Advil, Motrin IB, others) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. Its side effects may include stomach irritation, heart problems, and kidney damage.
Steroids. Corticosteroid medications, like prednisone, reduce inflammation and pain and slow joint damage. Its side effects might include thinning of bones, weight gain, and diabetes. Doctors usually prescribe a corticosteroid to relieve symptoms quickly, with the goal of gradually tapering off the medication.
Conventional DMARDs. These drugs may slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs is including methotrexate (Trexall, Otrexup, others), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine). Its side effects vary but may include liver damage and severe lung infections.
Biologic agents. This is also known as biologic response modifiers, this newer class of DMARDs includes abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), sarilumab (Kevzara) and tocilizumab (Actemra).
Biologic DMARDs are generally most effective when paired with a conventional DMARD, such as methotrexate. This type of drug also may increase the risk of infections.
Targeted synthetic DMARDs. Baricitinib (or Olumiant), tofacitinib (or Xeljanz) and upadacitinib (Rinvoq) might be used if conventional DMARDs and biologics haven't been effective. Higher doses of tofacitinib may increase the risk of blood clots in the lungs, serious heart-related events, and cancer.
Therapy
Therapy is the next step to give along with or after the medication. Maybe your doctor may refer you to a physical or occupational therapist who can teach you exercises to help keep your joints flexible. The therapist might also suggest new ways to do daily tasks that will be easier on your joints. For example, you might want to pick up an object using your forearms.
Assistive devices could make it easier to avoid stressing your painful joints. For example, a kitchen knife equipped with a hand grip helps protect your finger and wrist joints. Certain tools, like buttonhooks, could make it easier to get dressed. Catalogs and medical supply stores are good places to search for ideas.
Surgery
The first step we want to take is medication but there are some stubborn things that sometimes do not go with only medicines so the last step we follow is surgery.
Rheumatoid arthritis surgery might involve one or more of the following procedures:
• Synovectomy. It’s a surgery to remove the inflamed lining of the joint
• Tendon repair. This is done to repair the tendons around your joint.
• Joint fusion. This is used for pain relief when a joint replacement isn't an option.
• Total joint replacement. During joint replacement surgery, our surgeon removes the damaged parts of your joint and then inserts a prosthesis made of metal and plastic. Surgery may carry a risk of bleeding, infection and pain.
