Rheumatology

Rheumatology in modern terms is called Clinical Immunology. It is now acknowledged that the under lying cause for a disease like rheumatism is a dysregulation of the normal functioning of the immune system. However for the sake of continuity and ease of identification among patients the term rheumatology is still retained and this branch is often referred to as Clinical Immunology and Rheumatology.

Therefore diseases resulting from the dysregulation (meaning altered regulation) of the normal functioning of the immune system, ( which often results in the immune system - which is meant to protect the body - turning on its own body and hence causing disease of the immune system ) can affect virtually any organ of the body, however the systems most commonly involved are

JointsDisease of joints is called ARTHRITIS (which in turn are of many varieties)
Blood VesselsDiseases of blood vessels are called VASCULITIS (and since blood vessels are ubiquitous in the body, any organ like the brain, heart, lungs, kidneys, gut, skin joint, muscle, etc can be affected)
MusclesDisease affecting muscles is called MYOSITIS
SkinDisease affecting the skin is called Systemic SCLEROSIS
EyesDisease affecting part of the eyes is called UVEITIS
KidneyDisease of the kidney is collectively called NEPHRITIS
Soft Tissue RheumatismA group of conditions which are not included in the above but which can cause tremendous pain over the entire body called FIBROMYALGIA which is fairly commonly.
Chronic Fatigue SyndromeA rarer condition in our country, the disorder causes pain at the insertion of muscles, tendons called ENTHESOPATHY or TENDINITIS respectively
TenosynovitisInflammation around tendons and ligaments called TENOSYNOVITIS which can manifest as CARPAL TUNNEL SYNDROME or TRIGGER FINGERS
SLE (Systemic Lupus Erythematosus)A chronic generalized inflammatory condition which is characterized by fever and affecting all or any combination of organs mentioned above. This condition is diagnosed by the presence of typical antibodies in the blood called ANA antibodies.
Know more about Rheumatology

Rheumatology from the Greek word "rheuma" - meaning that which flows as a river or stream and "ology" meaning study of, is an ancient branch of the practice of medicine which dealt with the diseases of the joints. Physicians who specialize in this branch of medicine are called Rheumatologists or Clinical Immunologists. They do a post doctoral course after an MD in General Medicine to qualify as a Rheumatologist or Clinical Immunologist.

The unifying theme of all these conditions is involvement of the joint at some time and in varying degrees. Therefore arthritis (any word ending with -"itis" means inflammation of the preceding half of the word which will refer to a particular organ) which means inflammation of the joint (which in turn implies a constellation of pain, redness, local warmth, swelling and a loss of function of that part) has many causes and is often a starting point for evaluation for a number of diseases which are covered by the branch of Clinical Immunology and Rheumatology.

Thus inflammation of the joint or arthritis may have as innocuous a cause as a viral fever, which will usually subside by itself even without any treatment to a vasculitis which can be life threatening; therefore arthritis is a symptom which should not be ignored particularly if it persists for more than 4 - 6 weeks.

Having said this, the most common disease of immune dysregulation which causes persistent arthritis is Rheumatoid Arthritis, a disease well known to the lay public and much feared because of the unsightly and crippling deformities of the joints it can cause. This disease is not uncommon and estimated to affect about 1% of the population in India.

Prior to the availability of effective medicines this condition used to be treated only with drugs for the pain and patients told that they had to live with it - a sense of despondency often descended on these patients as they resigned their selves to a life of pain, loss of function and job, disfigurement and misery. Much advancement has taken place in the treatment of this disease and the nihilistic attitude and helplessness of the yesteryears has given way to a new era of hope and optimism wherein with the latest modalities of treatment, virtually a new lease of life can be given to the patients.

Rheumatoid arthritis as mentioned is predominantly a disease of joints but one must remember that it can affect any organ of the body and hence is classified as a systemic inflammatory disease of immune dysregulation much like SLE.

This disease strikes people in the prime of their youth, in the 20's to 40's, affects mostly females and affects the small joints of the hands and feet as well as the larger joint. This disease usually does not affect the spine except in a few cases where the spine in the neck may be involved.

This is in contradiction to another group of diseases called the SPONDYLOARTHROPATHIES which affect the peripheral joints as well as the spine, presenting as low backache and neck pain particularly in females; this disease affects both sexes equally and also presents in the young age group. In young females who may present with neck pain it is often passed off as cervical spondylosis, which is unusual in this age group.

The diagnosis of Rheumatoid Arthritis (RA) is a clinical one aided by blood tests and X-ray, if required. The blood test most commonly used to help in the diagnosis is RF or Rheumatoid Factor, sometimes written as RA (Rheumatoid Arthritis) Factor - this nomenclature is misleading because it implies that it is associated only with RA whereas it can be found in a number of diseases. Another misconception prevailing with the lay public and even with some health care professionals is that if the RF is negative then the arthritis is not RA, it is emphasized that the presence of RF is NOT required to make a diagnosis of RA. RA can be present even if RF is negative. Many of such cases will have another antibody called anti-CCP present. However RA may be present even with anti-CCP being negative.

It is interesting to know that children as young as 2 years can suffer from arthritis described by a group of diseases called JIA or Juvenile Idiopathic Arthritis. The Rheumatology Service of NH has atleast 10 children in the 2 - 4 age group who are doing very well on treatment.