Rheumatology

What Is Rheumatology?

Rheumatology is a specialty that focuses on diagnosing, treating, and managing various medical conditions related to muscles, bones, joints, and connective tissues. These conditions generally involve autoimmune disorders wherein the immune system attacks the body's own tissues. This situation can lead to swelling, extreme discomfort, and pain.

Rheumatologists are physicians who practice rheumatology and treat disorders like osteoarthritis, systemic lupus erythematosus, arthritis, lupus, gout, ankylosing spondylitis, and Sjogren's syndrome among others. They focus on easing symptoms, managing the condition, and enhancing the patient's quality of life.

What Are Some Of The Diseases Commonly Treated Under Rheumatology?

Rheumatic diseases impact the joints, muscles, and connective tissues of the body. All the conditions under rheumatology influence and strike the autoimmune and inflammatory processes. Marengo Asia Hospital's rheumatology team holds extensive experience and works jointly with other healthcare experts such as orthopedic surgeons, physiotherapists, and occupational therapists to provide the best care to patients. Some of the most common conditions treated under rheumatology include:

1. Rheumatoid Arthritis (RA): Rheumatoid Arthritis is a medical disorder where the immune system of the body attacks the synovium. Synovium refers to the lining of the membranes that cover the joints. When the membrane gets attacked, it can lead to severe inflammation in the body which can eventually cause damage to the cartilage and bone within the joint. If a person has RA he/she can experience symptoms like extreme joint pain, stiffness, and swelling in the body.
2. Osteoarthritis (OA): OA is a degenerative joint disease that impacts the joints and can lead to stiffness, swelling, and pain in the joints. It is the most common type of arthritis and can significantly hamper patients' mobility and quality of life. Osteoarthritis is caused by the damage of the joint and cartilage. Cartilage refers to a rubbery substance that is responsible for protecting the bone's ends and helping them move easily against each other. If a person has osteoarthritis, it means their cartilage has been damaged due to which their bones are against each other, causing extreme pain and other osteoarthritis symptoms
3. Systemic Lupus Erythematosus (SLE): SLE is a condition where the immune system attacks its own tissues, causing harm to various processes and organs of the body. Some of the most common symptoms of Systemic Lupus Erythematosus include fever, fatigue, dry eyes, headaches, hair loss, mouth ulcers, and kidney problems. This condition can cause kidney inflammation, and various cardiovascular diseases as well.
4. Ankylosing Spondylitis (AS): AS is a rare medical disorder that leads to arthritis in the spine. It typically starts in the lower back and can extend to the neck or other joints throughout the body. "Ankylosis" means fused bones and "Spondylitis" means swelling in the spinal bones. Severe cases of AS can cause a hunched spine and can also harm the eyes, heart, and lungs.
5. Psoriatic Arthritis (PsA): This condition is associated with psoriasis. Psoriasis is a skin problem that leads to itchiness and discomfort and is depicted by red, scaly patches. PsA can impact any joint and is often asymmetric. It can cause joint damage and deformation if left untreated. It can also affect other organs, such as the eyes and heart.
6. Gout: Gout is caused by the concentration of uric acid crystals in the joints, which leads to terrible pain and inflammation. The areas where uric acid crystals accumulate become red, swollen, and tender. Pain attacks associated with Gout generally occur at night and regular attacks can eventually cause chronic gouty arthritis. Gout can also cause kidney stones and kidney damage.
7. Sjogren's Syndrome: This syndrome targets the glands that are responsible for producing moisture, causing dry eyes and withered mouths. Sjogren's Syndrome can occur solely or can also occur with other autoimmune disorders. Patients suffering from this condition can experience problems with swallowing, pain in the joints, and dryness in areas like the nose and skin. This condition under rheumatology can lead to complications like oral infections, corneal ulcers, dental decay, swelling of salivary glands, and, in severe cases, liver issues, non-Hodgkin's lymphoma, and various gastrointestinal issues.

What Are The Various Tests Performed Under Rheumatology?

Numerous diagnostic tests are performed under rheumatology to diagnose conditions like osteoarthritis and plan the most suitable treatment. Here are some common tests conducted by healthcare experts in rheumatology:

Blood Tests

1. Erythrocyte Sedimentation Rate (ESR): This test is one of the most common tests performed for several rheumatic diseases. In this test, the healthcare specialist computes the rate at which the red blood cells ( RBCs) settle at the bottom of a tube. A high ESR means excessive inflammation in the body, which is a symptom of rheumatoid arthritis, Sjogren's syndrome, juvenile idiopathic arthritis (JIA), and lupus. The ESR test does not convey the accurate cause of inflammation in the body, however it helps in diagnosing disease activity.
2. C-Reactive Protein (CRP): This test measures the amount of CRP ( a protein developed by the liver) in response to inflammation. High CRP levels mean inflammation in the body and are a symptom of rheumatoid arthritis, and other inflammatory diseases. CRP test is more accurate compared to ESR and can detect changes in inflammation more rapidly.
3. Rheumatoid Factor (RF): This test finds the amount of rheumatoid factor antibodies in the blood. A positive RF indicates the person has rheumatoid arthritis and other autoimmune conditions. However, the high rheumatoid factor can also indicate other conditions and be present in healthy individuals. This test is typically used alongside other tests to diagnose various rheumatic diseases.
4. Anti-Cyclic Citrullinated Peptide (Anti-CCP): Anti-CCP is an auto-antibody. Antibodies in the body are proteins that assist in battling infections. However, auto-antibodies are proteins due to which the immune system attacks the healthy tissues of the body. Auto-antibodies overrun peptides that are present in the lining of the joints, causing inflammation in that area. This can lead to extreme pain, inflammation, and joint damage. A positive anti-CCP indicates a person has RA, however, it can also mean the patient has other conditions like tuberculosis, autoimmune hepatitis, and systemic lupus.
5. Antinuclear Antibody (ANA): This test ascertains antibodies that attack the nucleus of the cells. Antinuclear antibodies are generally present in patients when they are suffering from conditions like rheumatoid arthritis (RA), Sjögren’s syndrome, scleroderma (systemic sclerosis), mixed connective tissue disease (MCTD), and drug-induced lupus. A positive antinuclear antibody test must be understood in the context of clinical symptoms. It is because this test can be positive in some healthy individuals as well.

Imaging Tests

1. X-rays: X-rays are used to see bone and joint structures. It helps catch changes like bone spurs which indicate conditions like osteoarthritis and rheumatoid arthritis.
2. Magnetic Resonance Imaging (MRI): This test is used in the production of detailed images of cartilage, tendons, and ligaments together with bones. It is of paramount importance in the detection of early damage to joints and inflammation or anomaly of the soft tissue in conditions such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.
3. Ultrasound: It uses high-frequency sound waves to create images of soft tissues and joints. It allows the detection of inflammation, fluid accumulation, or other very early changes within the joints. Ultrasound also helps doctors in guiding joint injections and aspirations.
4. Dual-Energy X-ray Absorptiometry (DEXA): Dual-Energy X-ray Absorptiometry is a means of measuring the density of bone minerals for osteoporosis, a condition characterized by weak bones common among individuals with chronic inflammatory diseases or those who have been on corticosteroids for a long period. The test is done for diagnosing osteoporosis and estimating the risk of fractures.

What Are The Various Surgeries Performed At Marengo Asia Hospitals To Treat Rheumatic Diseases?

Rheumatologists don't perform surgeries on their own, they collaborate with orthopedic surgeons to do that. Some of the common surgeries performed by healthcare specialists to treat various rheumatic conditions include the following:

• Arthroscopy: Arthroscopy is a minimally invasive surgical procedure in which a thin and flexible tube is inserted in the body through tiny incisions. This thin tube has a camera attached to it that helps in visualizing and treating the joint problems. This procedure assists in diagnosing and treating medical conditions like torn meniscus, ligament injuries, Synovitis, and damaged cartilage. Since arthroscopy is a minimally invasive procedure, it helps with minimal disruption of the tissue, quick recovery, less complications and pain.
• Joint Replacement Surgery (Arthroplasty): Joint replacement surgery is a procedure to remove or replace some or all of the joint. In this procedure, the healthcare specialist removes the damaged parts of the joints and replaces it with a prosthesis (artificial joint). This artificial joint is built from plastic, ceramic, or metal. Joints like Hips, Ankles, Knees, Shoulders, Elbows, Wrists, Fingers, and Toes can be treated with an arthroplasty.
• Synovectomy: Synovectomy is the surgical procedure to remove synovial membrane. Synovial membrane is a connective tissue that borders the cavities of joints, tendon sheaths, and bursae (fluid-filled sacs between tendons and bones). This membrane gets inflamed in conditions like rheumatoid arthritis, psoriatic arthritis, osteoarthritis, and lupus (systemic lupus erythematosus). Synovectomy aims to excise this inflamed membrane to reduce pain, swelling, and stiffness.
• Tenosynovectomy: A tenosynovectomy is performed to treat either inflammation or thickening of the tissue surrounding the tendon. This kind of surgery is done arthroscopically. It relieves pain and restores motion to the affected area by detachment of the inflamed or degenerated tendon sheath and can treat conditions such as tenosynovitis, De Quervain's Tenosynovitis, trigger finger, rheumatoid arthritis.
• Tendon Repair or Reconstruction: Tendon Repair or Reconstruction is a procedure that involves the suturing or grafting of damaged tendons to reestablish strength and function. This procedure can be accomplished using both open surgery or arthroscopy and is applied to treat tendon injuries or degeneration, like rotator cuff tears or ruptures of the Achilles tendon. Tendon Repair is very effective in reducing pain and increasing mobility.