Rheumatology

Rheumatology is the sub-specialty of medicine that focuses primarily on joints, soft tissues, connective tissue disorders and systemic autoimmune diseases such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, gout, degenerative joint disease, systemic lupus erythematosus, systemic sclerosis and vasculitis.

Rheumatologists are consultants who specialize in the management of rheumatic diseases.

Types of rheumatic diseases

1. Rheumatoid arthritis (RA)

   Rheumatoid arthritis (RA) is a chronic inflammatory and autoimmune disease (your immune system attacks healthy cells in your joints by mistake).

   Symptoms include:

   • Typically symmetrical swollen, stiff, and painful small joints (feet, hand, and wrist)
   • It may involve larger joints
   • Stiffness worsens in the morning and after periods of inactivity
   • Fatigue
   • Poor appetite
   • Fever

2. Psoriatic arthritis (PsA)

   PsA is a type of chronic inflammatory arthritis associated with psoriasis (a chronic skin disease characterized by red, scaly patches on the skin). It can affect small or large joints.

   Symptoms include:

   • Swollen and painful joints
   • Joint stiffness 
   • Back pain
   • Skin rashes
   • Changes in colour and texture of nails
   • Fatigue

3. Ankylosing spondylitis (AS)

   This autoimmune disease affects primarily the sacroiliac joints and spine.

   Symptoms include:

   • Gradual onset of lower back pain that worsens at night
   • Morning back stiffness
   • Pain radiating to the hips and buttocks 
   • Pain and swelling in the hips, shoulders and other joints
   • Fatigue

4. Gout

   Gout develops due to a build-up of uric acid crystals within the joint. It usually affects the big toe joint initially.

   Symptoms include:

   • Sudden and intense pain in joints like the big toe, knees, ankles, wrists, and fingers
   • Red and swollen joints
   • Joint stiffness

5. Osteoarthritis

   Osteoarthritis, a degenerative joint disease is the commonest form of arthritis. It is characterized by the breakdown of cartilage, the protective tissue that cushions the ends of bones in the joints. It mainly occurs in the knee, hips, and fingers.

   Symptoms include:

   • Joint pain during movements that worsens at the end of the day
   • Grinding or popping sensation in the joints
   • Joint instability
   • Joint stiffness
   • Reduced range of motion of the joints

6. Systemic lupus erythemathosus (SLE)

   SLE is a chronic autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs.

   Symptoms include:

   • Skin rashes, especially a butterfly-shaped rash across the face
   • Joint pain
   • Photosensitivity (sensitivity to light)
   • Oral ulcers
   • Fever
   • Fatigue
   • Loss of appetite/weight
   • Raynaud’s phenomenon - fingers and toes become white/pale or blue on exposure to cold
   • Chest pain
   • Shortness of breath
   • Abdominal pain
   • Headaches
   • Confusion
   • Seizures
   • Issues with kidneys (excess protein in urine)
   • Blood clots in the legs, lungs or brain
   • Abnormalities in blood cell counts such as anemia, low white cell or platelet count

7. Systemic sclerosis

   Systemic sclerosis is a rare connective tissue disorder that may affect your organs, blood vessels and skin.

   Symptoms include:

   • Swollen fingers
   • Shiny skin
   • Thickening of the skin
   • Joint pain
   • Joint stiffness
   • Raynaud’s phenomenon - fingers and toes become white/pale or blue on exposure to cold
   • Telangiectasia - dilated blood vessels visible on the skin surface
   • Pain while swallowing (odynophagia)
   • Difficulty with swallowing (dysphagia)
   • Shortness of breath
   • Diarrhea
   • Issues with kidneys (excess protein in urine)

8. Idiopathic inflammatory myopathies (IIM)

   Idiopathic inflammatory myopathies (IIM) are a group of rare autoimmune diseases that cause inflammation and weakness in the muscles of the body.

   Symptoms include:

   • Muscle weakness and pain
   • Fatigue
   • Difficulty with movement
   • Difficulty with swallowing
   • Shortness of breath
   • Skin rashes

9. Sjogren’s syndrome

   Sjogren’s syndrome is an autoimmune disorder that affects the moisture-producing glands (salivary and lacrimal glands).

   Symptoms include:

   • Dry eyes
   • Dry mouth
   • Dry skin
   • Vaginal dryness
   • Fatigue
   • Difficulty with swallowing
   • Joint pain
   • Swelling between ears and jaw (swollen salivary glands)

10. Vasculitis

    Vasculitis is a group of rare autoimmune disorders that causes inflammation of the blood vessels. It can affect any part of the body, including the skin, kidneys, lungs and nervous system.

    Signs and symptoms of vasculitis depend on the type and severity of the disease.

    Common symptoms include:

    • Fever
    • Weight loss
    • Loss of appetite
    • Fatigue
    • Body aches
    • Skin rashes
    • Joint pain
    • Organ damage

Rheumatic diseases diagnosis

Diagnosis is made based on history taking, symptoms review, thorough physical examination and various investigations.

Tests that may be requested:

• Imaging modalities: X-rays, computed tomography (CT) scan, magnetic resonance imaging (MRI), musculoskeletal ultrasound and dual-energy x-ray absorptiometry (DEXA) scan
• Joint aspiration
• Blood tests: Rheumatoid factor (RF), anti-citrullinated peptide antibodies (ACPA), antinuclear antibodies (ANA), antiphospholipid antibodies, HLA B27
• Tissue biopsy

Rheumatic diseases treatment options

The treatment options differ according to the types of rheumatic diseases. Treatments options include:

• Disease-modifying antirheumatic drugs
• Biologic response agents
• Immunosuppressive drugs
• Analgesics: Paracetamol, Non-steroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroids
• Physical and occupational therapy
• Surgery
• Lifestyle modifications

Rheumatologists at Gleneagles Hospitals

Speak to your doctor to learn more about rheumatic diseases. The caring and multidisciplinary team of healthcare professionals are available for consultation and to provide the best care. Make a move towards improving your health and quality of life.

Get in touch with us to book an appointment today. We assure you the best possible care tailored to your specific needs.