Rheumatology

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Rheumatology is a specialised domain within the field of medicine that focuses on diagnosing and treating rheumatic diseases, which primarily affect the joints, muscles, and connective tissues. Often characterised by inflammation and pain, these conditions can severely impact a patient's quality of life, mobility, and overall health.

Rheumatoid Arthritis (RA)

RA is a chronic inflammatory disorder that primarily affects the joints. It presents symmetrically and is characterised by painful swelling, which can lead to joint deformity. Early diagnosis and aggressive management are crucial to minimise joint damage.

OSTEOARTHRITIS

The most common form of arthritis, OA is a degenerative joint disease that results from the wear and tear of cartilage. It typically affects older adults and is characterised by joint pain, stiffness, and loss of mobility.

1What are the symptoms?

• Pain in the joints
• Joint stiffness and swelling
• Poor flexibility

2What does treatment involve?

Although there is no specific cure for osteoarthritis, your doctor can prescribe several medications, including pain relief medicine. It also helps to increase your physical activity and strength training exercises during your physical therapy sessions. You may also require an assistive device such as a cane, crutch or walker. If all else fails, your doctor will discuss surgical options.

3When should you see your doctor?

You need to see your doctor regularly to manage your condition, especially if you have another chronic ailment such as diabetes or cardiovascular disease. It is especially important to see your doctor when joint pain and stiffness last longer than three days or recur after a few months.
You also need to visit your doctor when you experience any one of the following symptoms:
• Swelling of your joints
• Trouble moving
• Hearing a click or cracking sound (crepitus) when you bend the joint

Systemic Lupus Erythematosus (SLE)

An autoimmune condition, SLE affects various organ systems, including the skin, kidneys, and joints. Symptoms are widely variable, ranging from fatigue and joint pain to more severe complications, necessitating a multidisciplinary approach to management.

1What are the symptoms?

• Fatigue
• Rash
• Fever
• Swollen joints
• Pain in the joints
• Sensitivity to the sun
• Mouth ulcers
• Problems with your lungs and heart
• Psychosis
• Seizures

2What does treatment involve?

Lupus has a long-term impact on your life, meaning you have to learn to manage your condition to prevent uncomfortable flare-ups. By diagnosing lupus early, your doctor can decide on an appropriate treatment plan.
Your doctor will prescribe anti-inflammatories and steroid injections to reduce swelling, warmth and pain, which are common lupus symptoms.
There are other treatments such as:

• Immune suppressant medications are used to help control your overactive and aggressive immune system. Originally, immune suppressors were used in people with organ transplants but are just as effective in rheumatoid arthritis and lupus patients.
• DHEA is a mild form of a male hormone that relieves hair loss, pain in your joints and tiredness.

3How often should you see your doctor?

It will help to attend regular follow-ups with your doctor. However, you need to see your doctor as soon as you develop a high temperature, discomfort in your chest, stomach pain and swelling in your arms or legs.

4What if you want to fall pregnant?

Generally, a pregnancy while managing lupus symptoms is often considered high-risk. However, by attending regular follow-ups with your doctor and obstetrician, you can have a comfortable and safe birth.

5What other autoimmune conditions should you be aware of?

Autoimmune disorders are a collection of ailments that occurs when your immune system turns hostile and attacks healthy tissue and organs.
These types of conditions include:
• Diabetes type 1 is a life-long condition that occurs when your immune system terminates pancreatic cells responsible for secreting insulin. Insulin is a vital hormone because it helps control your blood sugar levels.
• Multiple sclerosiscauses injury to the myelin sheath, the coating of your nerve cells. As a result, the transfer of messages from your brain and spinal cord to other parts of your body becomes slow. Issues with your gait, numbness and muscle weakness soon occur.
• Inflammatory bowel diseases are conditions that target your intestinal lining. For example, ulcerative colitis and Crohn’s disease are types of IBD that inflame your gastrointestinal tract. As a result, you will not be allowed to eat certain types of foods.
• Autoimmune vasculitisis an autoimmune condition that affects your blood vessels, preventing a free flow of blood.
• Pernicious anaemiaarises from a protein deficiencythat is needed for your small intestine to process vitamin B-12 from the food you eat. A lack of this vitamin can lead to you developing anaemia.
• Psoriasisoccurs when skin cells develop rapidly, and the excess cells look like red clumps that appear as patches on areas of your skin. As a result, parts of your skin may appear white, patchy and scaly, which we refer to as plaque-like matter on your skin.

6What does treatment involve?

Each of our treatment plans varies, depending on your diagnostic report as well as your prior history of medical conditions and procedures you have chosen to undergo. Based on your evaluation, we will determine the best treatment for you. This often involves managing your condition through medication, holistic medical therapies, healthy living practices and good lifestyle choices.

Gout

Gout is characterised by recurrent episodes of acute arthritis, typically affecting the big toe, due to the deposition of urate crystals. Prompt treatment of acute attacks is essential to prevent future flares and long-term joint damage.

Ankylosing Spondylitis (AS)

This inflammatory disease primarily affects the spine and can lead to fusion of the vertebrae, severely impacting mobility. Early recognition and effective treatment can help manage symptoms and improve the quality of life.

Psoriatic Arthritis

Associated with psoriasis, this condition manifests as both skin lesions and joint pain and inflammation. Like RA, it can lead to significant disability if not managed appropriately.

FAQ

1Are women at higher risk of getting lupus than men?

Lupus, an autoimmune condition, is more common in women than men. Women with lupus are also at risk of chronic issues such as loss of bone density due to osteoporosis as well as heart disease.

2Is psoriasis an autoimmune condition?

Psoriasis occurs due to your body's immune response, which leads to an attack on your own healthy tissue. This can be mistaken for a rash, but this is much more than this. Unfortunately, there is no over-the-counter cream to treat psoriasis because, unlike any other skin condition, this is not surface deep. Psoriasis is an incurable condition, meaning you need to manage your condition, especially when flare-ups occur. You may undergo light therapy and take prescribed creams to relieve skin inflammation.

3How do you treat autoimmune vasculitis?

Your doctor will prescribe a corticosteroid (prednisone) that reduces inflammation as a result of your condition. However, using corticosteroids over a long time may lead to a loss in bone density, weight gain and diabetes. Not every patient responds well to prednisone which is why your doctor can help confirm whether this is a suitable option for you.

"It all starts by caring enough to engage the patient in the decision-making. Many people argue that 'We don't have time for this in the consultation. I'd rather just tell people what I think is best for them, and then, they can decide whether they want it or not.' Well, that's not very caring. This might be efficient, but it does not reflect the best that we can offer.'"

Dr Victor Montori, on shared decision-making