Rheumatology

Overview

Rheumatic diseases affect your joints tendons, ligaments, bones, and muscles. Among them are many types of arthritis, a term used for conditions that affect your joints.

Sometimes they’re called musculoskeletal diseases. Common symptoms include:

• Joint pain
• Loss of motion in a joint or joints
• Inflammation -- swelling, redness, and warmth in a joint or affected area

The medical field that studies these types of conditions is called rheumatology. If your regular doctor thinks you have a rheumatic disease, they’ll probably send you to a rheumatologist -- a doctor who’s specially trained to treat them.

Your rheumatologist will examine you to diagnose your condition, then oversee a treatment plan for you that will likely include medications, regular exercise, a healthy diet, stress management, and rest.

Common Rheumatic Disorders

Years ago, conditions like this fell under the broad heading of rheumatism. Now there are more than 200 distinct rheumatic diseases. Among the most common ones are:

• Osteoarthritis
• Rheumatoid arthritis (RA)
• Lupus
• Spondyloarthropathies -- ankylosing spondylitis (AS) and psoriatic arthritis (PsA)
• Sjogren’s syndrome
• Gout
• Scleroderma
• Infectious arthritis
• Juvenile idiopathic arthritis
• Polymyalgia rheumatica

What Causes Rheumatic Disease?

Most of these conditions happen when your immune system goes awry and attacks your own tissues. Doctors aren’t sure what causes this. Sometimes it’s in your genes. Other times it’s a result of something in the world around you, like cigarette smoke, pollution, or something that causes an infection. Gender also plays a role -- rheumatic diseases seem to affect women more than men.

Ankylosing Spondylitis

Ankylosing spondylitis usually starts gradually as lower back pain. It usually involves the joints where the spine attaches to the pelvis, known as the sacroiliac joints.

Ankylosing spondylitis is more common in young men, especially from the teenage years to age 30.

Symptoms:

• Gradual pain in the lower back and buttocks
• Lower back pain that worsens and works its way up the spine
• Pain felt between the shoulder blades and in the neck
• Pain and stiffness in the back, especially at rest and when getting up
• Pain and stiffness that get better after activity
• Pain in the middle back and then upper back and neck (after 5-10 years)

If the condition worsens, your spine may become stiffer. It may become hard to bend for everyday activities.

Diagnosis: Your doctor will give you a physical exam and ask you about your medical history. You may get X-rays of your back, looking at the sacroiliac joints. A blood test for a protein called HLA-B27 may help confirm a diagnosis.

Lupus

Lupus (also called SLE or systemic lupus erythematosus) is an autoimmune disease. It can affect many organs in your body.

Symptoms:

• Joint pain
• Fatigue
• Joint stiffness
• Rashes, including a "butterfly" rash across the cheeks
• Sun sensitivity
• Hair loss
• Blue or white fingers or toes when exposed to cold (called Raynauds phenomenon)
• Problems in other organs such as the kidneys
• Blood disorders, such as anemia and low levels of white blood cells or platelets
• Chest pain from inflammation of the lining of the heart or lungs
• Seizures or strokes

Diagnosis: Your doctor will ask about your medical history, do a physical exam, and order lab tests of blood and urine samples. Blood tests for lupus include:

•     Antinuclear antibody test (ANA). Most people with lupus have a positive ANA blood test.
•     Anti-double stranded DNA antibody (Anti-dsDNA)
•     Anti-Smith antibody (Anti-Sm)

Osteoarthritis (OA)

Unlike most rheumatic diseases, osteoarthritis isn’t linked to problems with your immune system. It results from damage to cartilage, the cushiony material on the end of your bones. As it wears down, your joints hurt and become harder to move. It usually affects the knees, hips, lower back, neck, fingers, and feet.

Symptoms:

• Pain
• Swelling
• Warmth
• Stiffness

Muscle weakness can make joints unstable. Depending on what parts of the body it affects, OA can make it hard to walk, grip objects, dress, comb your hair, or sit.

Diagnosis: Your doctor will ask about your medical history and symptoms. You’ll also get a physical exam. You may also need to get blood tests or let your doctor take a sample of fluid from an affected joint.

Usually by the time someone with OA seeks treatment, there are changes visible on an X-ray of the joint. The X-ray may show narrowing of the joint space or the presence of bone spurs. In some cases, your doctor might request an MRI (magnetic resonance imaging) to provide a picture of the inside of your joint.

Psoriatic Arthritis

A form of autoimmune arthritis sometimes linked with skin symptoms of psoriasis. There are 5 types:

• Symmetric affects joints on both sides of your body. It’s the most common, and it’s similar to RA.
• Asymmetric doesn’t affect the same joints on either side. It may be milder than other forms.
• Distal affects the ends of your fingers and toes, along with your nails.
• Spondylitis affects your spine and neck.
• Arthritis mutilans attacks the small joints at the ends of your fingers and toes. It may be the most severe kind.

Symptoms: They mimic other forms or arthritis:

• Painful swollen joints
• Stiffness -- loss or range of motion
• Swollen fingers and toes -- they’re often called sausage fingers or toes
• Tendon or ligament pain
• Rash
• Changes to fingernails and toenails
• Fatigue
• Inflamed eyes
• Flares -- periods of high disease activity and symptoms

Most people may have skin symptoms before they get joint symptoms. Sometimes it affects the joints first. Some people never have skin symptoms.

Diagnosis: It’s a hard disease to pin down. It can resemble RA, gout, and even osteoarthritis.

Genes play a role in this disease, so your doctor will ask about your medical history and that of your relatives. They’ll look at your joints to see if they’re swollen and inflamed, and might draw fluid from one to make sure gout or infectious arthritis isn’t the cause of your problems. They’ll also check your skin for signs of psoriasis. Imaging tests can show if you have joint damage. Blood tests for psoriatic arthritis that look for signs of inflammation include:

• C-reactive protein
• Erythrocyte sedimentation rate
• Rheumatoid factor -- people with psoriatic arthritis almost always test negative

Rheumatoid Arthritis (RA)

RA happens when the immune system attacks your own tissues and causes joint pain, swelling, and stiffness. It’s not part of normal aging.

Symptoms:

• Pain and swelling in multiple joints (usually the same joints on both sides of your body, like both wrists or both ankles)
• Problems in other organs such as the eyes and lungs
• Joint stiffness, especially in the morning
• Fatigue
• Lumps called rheumatoid nodules

Diagnosis: You’ll get a checkup and tell your doctor about your health history. The doctor may take X-rays and samples of your joint fluid. They’ll do blood tests that look for different signs of inflammation. These include:

• Antinuclear antibody (ANA)
• Anti-cyclic citrullinated peptides (anti-CCP)
• Complete blood count
• C-reactive protein (CRP)
• Erythrocyte sedimentation rate (ESR)
• Rheumatoid factor (RF)

Sjogrens Syndrome

Sjogrens syndrome causes parts of your body to dry out, like the eyes or mouth. Some people also have RA and lupus. Others just have Sjogren’s. The cause is unknown, but it happens when your immune system attacks those body parts. Its more common in women than men.

Symptoms:

• Dry eyes (the glands in your eyes don’t make enough tears)
• Eye irritation and burning
• Dry mouth (the glands in your mouth don’t make enough saliva)
• Tooth decay, gum disease, or thrush
• Swollen glands on the sides of your face
• Joint pain and stiffness (rarely)
•  Internal organ diseases (rarely)

Diagnosis: Your doctor will do a physical exam and ask about your medical history. You may also get other tests. To confirm the diagnosis, the doctor may do a biopsy, taking tissue from your inner lip to check in a lab.