Patient Education

Rheumatology is a rapidly evolving medical sub-specialty, devoted to the diagnosis and therapy of rheumatic diseases. These diseases especially affect joints, tendons, ligaments, bones, and muscles. There are more than 200 types of these diseases, including rheumatoid arthritis, osteoarthritis, gout, lupus, back pain, osteoporosis, lupus and tendinitis. Some of these are very serious diseases that can be difficult to diagnose and treat. Rheumatic diseases can also involve internal organs.

The cause of every major rheumatological disorder is now best explained by imbalance in the autoimmune system. Hence, rheumatic diseases are often referred as autoimmune disease. The treatment modalities are also based on clinical research on autoimmune system. Evidence-based medical treatment of rheumatological disorders has helped patients with these disorders lead a near normal life.

There is an increasing demand for specialists in this field with an increasing population of patients who need specialized treatment. Rheumatologists are increasing in numbers in all countries.

A consultant rheumatologist is a doctor who specialises in diagnosing and treating arthritis and diseases related to rheumatology. Rheumatologists treat over 200 different health problems that affect the joints, bones, muscles and other internal organs (e.g. kidneys, lungs, blood vessels, brain). They focus on non-surgical treatment of arthritis and related rheumatic diseases. Rheumatologists can also specialize in pediatric rheumatology — treating children with rheumatic diseases. Many rheumatologists also conduct research to determine the cause and better treatments for these disabling and sometimes fatal diseases.

Rheumatologists treat arthritis, certain autoimmune diseases, vasculitis, musculoskeletal pain disorders 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.

Rheumatologists receive years of education and training. After they earn a medical degree (five years of medical school), they complete a residency program (3-4 years) in internal medicine. They have another three to five years in specialized rheumatology training. After completing their rheumatology training, they must pass a rigorous national exam.

Arthritis literally means joint inflammation (redness, increased warmth, swelling and pain). Joint inflammation describes a symptom or sign rather than a specific diagnosis. These disorders fall within the broader category of rheumatic diseases. These diseases especially affect joints, tendons, ligaments, bones, and muscles. Common signs and symptoms are pain, swelling and stiffness. Rheumatic diseases also can involve internal organs.

There are more than 200 rheumatic diseases. Rheumatic diseases are often referred as connective tissue diseases because they affect the supporting framework of the body and its internal organs. They are also known as auto-immune diseases because they occur when the immune system, which normally protects the body from infection and disease, harms the body’s own healthy tissues.

Rheumatic diseases are generally believed to be caused by a combination of genetic and environmental factors. In other words, you may be born with a susceptibility to a disease, but it may take something in your environment to get the disease started.

Some of these factors have been identified. For example, in osteoarthritis, inherited cartilage weakness or excessive stress on the joint from repeated injury may play a role. Certain viruses may trigger disease in genetically susceptible people. Gender is another factor in some rheumatic diseases. Lupus, rheumatoid arthritis, scleroderma, and fibromyalgia are more common among women. This indicates that hormones or other male-female differences may play a role in the development of these conditions.

• Swelling in one or more joints
• Stiffness around the joints in the early morning or with inactivity
• Constant or recurring pain or tenderness in a joint
• Difficulty using or moving a joint normally
• Warmth and redness in a joint

• Children do get arthritis too.
• There are new treatments for RA which can stop disease progression.
• Process of permanent joint damage can set in as early as 12 weeks from onset of symptoms in RA. Early treatment prevents joint damage.
• Having RA increases risk of heart attack and stroke.
• Patients do not get any symptoms from osteoporosis until they fracture a bone.
• There are non-surgical treatment options for osteoarthritis.
• In the early stages of arthritis blood tests and joint examination can be normal.
• Rheumatoid Factor and ANA can be seen in normal population.
• Ultrasound scan is 7 times more sensitive than plain X-ray in identifying the arthritis changes.

• Methotrexate is a disease-modifying drug. It helps to prevent joint damage, rather than simply treating symptoms.
• It is not a pain killer or steroid.
• Improvement from methotrexate may be seen at 6 weeks but it may take 12 weeks for full benefit to be realized.
• Methotrexate should be taken ONCE A WEEK. It is dangerous if taken daily.
• It’s important to have blood tests regularly to look for any liver/blood cell related side effects.
• You should take Folic acid tablets 5 days a week to avoid side effects of methotrexate. Do not take Folic acid on the day you take methotrexate and following day (see example below).
• If you catch an infection which requires you to take antibiotics it is advised to withhold methotrexate for 2 weeks and inform your rheumatologist.
• Alcohol increases the risk of liver damage for people taking methotrexate.
• Methotrexate should NOT be taken if you are pregnant or plan to become pregnant.
• It is unsafe to continue methotrexate without timely follow up and supervision of your rheumatologist.

• Chest X-ray
• Blood tests – complete blood count, liver and renal profile.
• Exclude active infection

• • Sulphasalazine is a disease-modifying drug. It helps to prevent joint damage, rather than simply treating symptoms.
  • It is not a pain killer or steroid.
  • Improvement from Sulphasalazine may be seen at 6 weeks but it may take 12 weeks for full benefit to be realized.
  • Sulphasalazine should be taken daily.
  • It’s important to have blood tests regularly to look for any liver/blood cell related side effects.
  • If you catch an infection which requires you to take antibiotics it is advised to withhold Sulphasalazine for 2 weeks and inform your rheumatologist.
  • Sulphasalazine is generally considered safe during pregnancy. However, you should always discuss with your rheumatologist.
  • AIt is unsafe to continue Sulphasalazine without timely follow up and supervision of your rheumatologist.

• Blood tests – complete blood count, liver and renal profile.
• Exclude active infection.
• Check for allergy to sulpha drugs.

• Fever/infection
• Rash
• Planning to conceive