The Department of Rheumatology, Arthritis & Autoimmunity specialises in diagnosing and treating immune system disorders and rheumatic diseases. These disorders can range from common conditions such as rheumatoid arthritis to rarer diseases such as vasculitis and autoinflammatory diseases. The doctors who treat these diseases are called rheumatologists. Some of the diseases treated by the department include:

Diseases Treated By Rheumatologists

Arthritis - Arthritis can be of different types, such as:

Rheumatoid arthritis
Psoriatic arthritis
Spondyloarthritis (ankylosing spondylitis)
Gout
Osteoarthritis, etc.

Connective Tissue Diseases - Connective tissue diseases such as:

Systemic lupus erythematosus (SLE)
Scleroderma
Sjogren’s Syndrome
Myositis / Dermatomyositis
Mixed and other overlap and undifferentiated connective tissue diseases

Vasculitis - Vasculitis, which includes diseases affecting blood vessels such as

Takayasu’s arteritis
Giant cell arteritis
Polyarteritis nodosa
ANCA-associated vasculitis
Behcet’s disease
Relapsing polychondritis
Cryoglobulinemic vasculitis
DADA-2

Soft Tissue Rheumatism - Fibromyalgia and soft tissue rheumatism affect tendons, ligaments, bursa, and fascia.

Other Conditions - Other conditions like antiphospholipid antibody syndromes, sarcoidosis, IGG4-related disorders, immunodeficiency disorders, and autoinflammatory diseases

Rheumatology Disorders Affect Musculoskeletal System

Generally, most of these disorders affect the musculoskeletal system and present with swelling and inflammation that primarily affect the 'connectors' of the body, including joints, ligaments, tendons, and muscles. Patients present with pain, swelling, deformity of the joints and the spine, and morning stiffness. Patients experience stiffness of the joints/spine that typically lasts for more than 30 minutes in the morning.

However, these diseases can also affect other body parts such as the skin, lungs, kidneys, heart, blood vessels, brain, and nerves, and various combinations of these involvements can be observed.

Lupus - Patients with lupus can have skin and kidney involvement, while patients with scleroderma can have skin, lung, and heart disease.

Sjogren’s Disease - Patients with Sjogren’s syndrome can experience widespread pain and fatigue (extreme tiredness), involvement of the brain and nerves, and dryness of the mouth and eyes, leading to premature loss of teeth and eye irritation/allergies, respectively.

Vasculitis - ANCA-associated vasculitis can involve the eyes, ears, nose, throat, lungs, and kidneys. Patients may sometimes present with systemic features such as unexplained fever and weight loss.

Antiphospholipid Antibody Syndrome - Some patients with antiphospholipid antibody syndrome may have multiple pregnancy losses and abnormal blood clotting.

Almost all of these disorders are characterised by abnormal immune system functioning. The immune system's normal function is to protect the body from infections. In autoimmune and autoinflammatory diseases, the immune system is abnormal and erroneously attacks the body. Hence, these diseases can affect virtually any organ of the body.

Narayana Health provides world-class, compassionate care and service to all patients seeking treatment for autoimmune and rheumatic diseases. As mentioned above, some of these diseases can affect other organ systems. Therefore, our rheumatologists collaborate with other specialists as necessary to create personalised treatment care plans.

Diagnosis of Autoimmune & Rheumatic Diseases

Diagnosing these diseases can be complex, as they can present with varied features, and no single test can diagnose each of these diseases. Hence, the rheumatologist will need to know your detailed medical history (current and past health, family's medical history related to rheumatic diseases and autoimmune disorders) and then proceed to conduct a comprehensive examination of your joints and organ systems.

If they suspect any symptoms of a rheumatic disease, they will order tests. These tests may include

Blood tests
Imaging investigations such as X-rays, ultrasound scans, CT scans, MRI scans
Biopsies include skin, minor salivary gland, kidney, or nerve biopsies.

These tests are ordered to eliminate other potential causes and arrive at a reliable diagnosis. The blood tests aim to identify signs of inflammation, the presence of antibodies related to certain diseases, abnormal blood counts, abnormal organ function, or adverse drug effects, among other factors. Some tests may include rheumatoid factor, anti-CCP antibody, HLA B27, ANA profile, ANCA, and Myositis profile.

Treatment of Autoimmune & Rheumatoid Diseases

Comprehensive care for patients includes patient education and medications, as well as physical and occupational therapy, and rarely surgery. Medications may include NSAIDs, glucocorticoids, DMARDs (disease-modifying anti-rheumatic drugs), other immunosuppressive drugs, biological therapies, etc. Patients with active joint pain and swelling are offered joint injections to provide quick relief of symptoms. Patients with the same disease can have varying severity, so personalised care and treatment plans are essential.

Frequently Asked Questions About Rheumatology

Q. Why do rheumatology diseases occur?
A. These diseases have multifactorial causes, primarily stemming from a combination of genetic and environmental factors. Environmental factors include infections, pollution, smoking, dietary choices, hormonal fluctuations, etc.

Q. Are rheumatology diseases incurable? Can they be treated? What's the treatment duration and regimen?
A. In a scientific context, "incurable" suggests that certain disease factors may persist in the body and cannot be eradicated, requiring long-term treatment. For instance, conditions like hypertension (high blood pressure) are generally considered incurable. However, this does not imply a hopeless situation. Instead, patients often require long-term treatment, including medication and regular condition monitoring. Similarly, in rheumatic diseases, treatment duration depends on the disease's severity and can be long-term. The specific drugs and treatment duration may vary even among patients with the same condition. Treatment is adjusted based on the individual's response to achieve a symptom-free stage. Even in cases deemed incurable, it is possible to attain a symptom-free period and lead a good quality of life, personally and professionally. Once this stage is reached, treatment can be gradually reduced. It's crucial to follow your treating physician's instructions closely and avoid discontinuing treatment without consulting them.

The term "incurable" also implies that specific tests, such as ANA and HLA B27, may yield positive results even when symptoms improve. This should not be a cause for concern.

Q. Will my child inherit my autoimmune and rheumatoid disease?
A. Most rheumatic diseases have a genetic component, and the risk of inheritance depends on the specific autoimmune disease you have. While the likelihood of certain rheumatic conditions developing in children with an affected parent is generally low, it's essential to recognise that autoimmune diseases tend to run in families. When one family member is diagnosed with an autoimmune disease, the likelihood of another family member developing one also increases, although it may not necessarily be the same autoimmune condition. For example, the most common autoimmune condition seen in a blood relative of a patient with rheumatoid arthritis or lupus is hypothyroidism.

Q. Can I take medications if I'm pregnant or planning to become pregnant?
A. It's advisable to consult your doctor and discuss your pregnancy plans. Planning a pregnancy is recommended once your disease is under control. Some drugs used to treat rheumatic diseases should be discontinued before pregnancy, while others can be safely taken. Your doctor will ensure you are on safe medications during pregnancy and breastfeeding.

Q. What dietary recommendations should I follow?
A. While there isn't a specific "rheumatic" or "autoimmune" diet, it's essential to maintain a healthy diet that includes carbohydrates (with an emphasis on avoiding refined carbohydrates), protein, healthy fats, vegetables, and fruits. Many patients stop consuming protein without a scientific basis, which can be harmful. Most rheumatic diseases are associated with an increased risk of heart disease, so dietary choices should consider this aspect. For specific dietary guidelines related to individual diseases, such as gout, it's advisable to consult with your doctor.