Who Is A Rheumatologist
A Rheumatologist is an internist who has received further training in the diagnosis and management of musculoskeletal diseases and systemic autoimmune conditions commonly called as Rheumatic Diseases.
These diseases usually affect the joints, muscles and bones causing pain, swelling, stiffness and deformity.
The immune system is the army of our body and its role is to protect us from any harmful agent that enters it, when this army turns against us it results in an Autoimmune Disease.
Most common autoimmune diseases that rheumatologist encounters are Rheumatoidarthritis and spondyloarthritis (Ankylosing spondylitis) with a global prevalence of 0.8% to 1% and 0.2 % respectively.
Other common conditions treated by a rheumatologist are chronic back pain, osteoarthritis, fibromyalgia (chronic pain syndrome), gout (high uric acid associated inflammatory arthritis) osteoporosis and tendonitis, etc.
A Rheumatologist is also an expert in managing systemic autoimmune rheumatic disease such as:
- Systemic Lupus Erythmatosus (SLE) commonly called Lupus characterized bymucocutaneouslesions photosensitivity rash, alopecia, oral ulcers, arthritis, fever, serositis, etc.
- Scleroderma/primar y systemic sclerosis which presents with skin thickening and tightening bluish discoloration of fingers on exposure to cold or change in temperature
- Sjogren's syndrome characterized by dryness in eyes and mouth fatigue and arthralgia
- Idiopathic inflammatory myositis (Dermatomyositis/ Polymyositis)
- Sarcoidosis or Vasculitis etc.
Why do you need to see a rheumatologist?
Most of us often consume over the counter medications called pain killers for aches and pain. Although these medications do help in reducing the pains and swelling, unsupervised intake of NSAIDs over long period of time can result in gastrointestinal bleeding, kidney damage, increase risk of cardiovascular disease and hypertension.
A rheumatologist is able to differentiate between mechanical pains and inflammatory pains.
You must be thinking what are these two types of pains
Mechanical pains are musculoskeletal pains which worsen with activity, they are usually perceived after a period of work and / or at the end of the day, whereas inflammatory pains are perceived after a period of prolonged rest and occur due to 'gelling' phenomenon. Patients with inflammatory musculoskeletal pains are worse during the night and early morning hours and experience what we commonly call as early morning stiffness, their pain and stiffness usually improve with activity and exercises.
Mechanical pains require little help of NSAIDs and muscle relaxants and mainly resolves with exercises, physical and occupational therapy whereas inflammatory pains require appropriate treatment under the supervision of a rheumatologist.
When should you consult a rheumatologist?
Everyone in normal day to day life experiences muscle and joint pains. When these pains do not resolve as one would expect, additional evaluation may be required for which you should see a rheumatologist or your primary care physician may refer you to a rheumatologist. Earlier referral should be made for those with a family history of autoimmune or rheumatic diseases (as these conditions run in families) or if the symptoms are significantly worsening over a short period of time.
What should you expect from a rheumatology visit?
Rheumatic diseases are sometimes complex in nature and difficult to diagnose, so rheumatologists will gather complete medical history and perform a physical examination to look for signs and symptoms of inflammation throughout the body and musculoskeletal system. Family history and treatment history are also a very important part of the assessment.The rheumatologist will also review results of your prior testing and may order additional laboratory tests to assess inflammation and / or extra antibody production within the bloodstream and order radiographic imaging to look for musculoskeletal abnormalities . A rheumatologist may involve a dermatologist, pulmonologist, cardiologist, neurologist and physiotherapist if needed in case of multisystem involvement.
The aim of the rheumatologist while managing patient with any of the above rheumatic disease is to bring the disease state under remission and continue to keep it in this phase with as minimum medications as possible to help the patient live a normal and productive life.
Dr. Shubha Bhalla
MBBS, DNB(Medicine), Rheumatalogy fellowship (ISIC) EULAR Fellowship