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Rheumatology is a sub-specialty in internal medicine and pediatrics, devoted to diagnosis and therapy of rheumatic diseases. Clinicians who specialize in rheumatology are called rheumatologists. Rheumatologists deal mainly with clinical problems involving joints, soft tissues, autoimmune diseases, vasculitis, and heritable connective tissue disorders.

The term rheumatology originates from the Greek word rheuma, meaning "that which flows as a river or stream," and the suffix -logy, meaning "the study of."

Rheumatology is a rapidly evolving medical specialty, with advancements owing largely to new scientific discoveries related to immunology of these disorders. Because characteristics of some rheumatological disorders are often best explained by immunology, pathogenesis of many major rheumatological disorders are now described in terms of the autoimmune system, i.e. as an autoimmune disease. Correspondingly, most new treatment modalities are also based on clinical research in immunology and the resulting improved understanding of the genetic basis of rheumatological disorders. Future treatment may include gene therapy as well. At present evidence-based medical treatment of rheumatological disorders has helped patients with rheumatism lead a near-normal life.

Rheumatism[link]

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 uses 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.^{[citation needed]}

Rheumatologist[link]

A rheumatologist is a physician specialized in the field of medical sub-specialty called rheumatology, and holds either a board certification after specialized training after attaining a medical degree (M.D. or D.O.) through fellowship programs in the United States, or specialist registrar positions in the United Kingdom, or DM in India or equivalent programs elsewhere in the world. In the United States, training in this field requires four years undergraduate school, four years of medical school, and then 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 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, autoimmune diseases, pain disorders affecting joints, 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. 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 programs and occupational therapy also go hand in hand with this specialty.

There are many international organizations representing rheumatologists all over the world. The American College of Rheumatology ( ACR), the Association of Rheumatology Health Professionals (ARHP), the European League Against Rheumatism (EULAR), Asia Pacific League of Associations for Rheumatology (APLAR), International League of Associations for Rheumatology (ILAR) and the British Society of Rheumatology (BSR) 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[link]

Dise

Systemic conditions and connective tissue diseases[link]

• Lupus
• Sjögren's syndrome
• Scleroderma (systemic sclerosis)
• Polymyositis
• Dermatomyositis
• Polymyalgia rheumatica
• Mixed connective tissue disease
• Polychondritis
• Sarcoidosis
• 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)

Soft Tissue Rheumatism[link]

Local diseases and lesions affecting the joints and structures around the joints including tendons, ligaments capsules, bursae, Stress Fractures, muscles, nerve entrapment, vascular lesions, ganglions, localised Soft tissues disorders. For example:

• Low back pain
• Tennis elbow
• Golfer's elbow
• Olecranon bursitis
• Fibromyalgia

Diseases affecting bones[link]

• Osteoporosis
• Osteomalacia
• Renal osteodystrophy
• Fluorosis
• Rickets

Congenital and familial Disorders affecting Joints[link]

• Hyperextensible joints
• Ehlers-Danlos Syndrome
• Achondroplasia
• Marfan's Syndrome

Diagnosis[link]

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[link]

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.
• Multiple joint inspection
• Musculoskeletal Examination
  • Screening Musculoskeletal Exam (SMSE) - a rapid assessment of structure and function
  • General Musculoskeletal Exam (GMSE) - a comprehensive assessment of joint inflammation
  • Regional Musculoskeletal Exam (RMSE)- focused assessments of structure, function and inflammation combined with special testing

Specialised[link]

• Laboratory tests (e.g. Erythrocyte Sedimentation Rate, Rheumatoid Factor, Anti-CCP (Anti-Cyclic Citrullinated Peptide antibody), ANA (Anti-Nuclear Antibody) )
• X-rays, Ultrasounds, and other imaging methods of affected joints
• Cytopathology and chemical pathology of fluid aspirated from affected joints (e.g. to differentiate between septic arthritis and gout)

Treatment[link]

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 and Methotrexate for moderate to severe Rheumatoid arthritis.^[1] Biologic agent Rituximab (Anti-B-Cell Therapy) is now licensed for use in refractory Rheumatoid Arthritis. .^[2] 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[link]

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[link]

1. ^ http://arthritis.about.com/cs/mtx/a/mtx.htm
2. ^ Edwards J, Szczepanski L, Szechinski J, Filipowicz-Sosnowska A, Emery P, Close D, Stevens R, Shaw T (2004). "Efficacy of B-cell-targeted therapy with rituximab in patients with Rheumatoid arthritis". N Engl J Med 350 (25): 2572–2581. DOI:10.1056/NEJMoa032534. PMID 15201414. 

External links[link]

• American College of Rheumatology
• British Society for Rheumatology
• Canadian Rheumatology Association
• Association of Rheumatology Health Professionals
• Future Rheumatology journal-Cutting edge commentary and analysis in the field of Rheumatology