Wikipedia

Rheumatology

For the journal, see Rheumatology (journal).

Rheumatology (from Greek ῥεῦμα (rheûma) 'flowing current') is a branch of medicine devoted to the diagnosis and management of disorders whose common feature is inflammation in the bones, muscles, joints, and internal organs.[1] Rheumatology covers more than 100 different complex diseases, collectively known as rheumatic diseases, which includes many forms of arthritis as well as lupus and Sjögren's syndrome.[1] Doctors who have undergone formal training in rheumatology are called rheumatologists.

Rheumatology
SystemMusculoskeletal, Immune
Significant diseasesAutoimmune disease Inflammation, Rheumatoid arthritis, Lupus, Osteoarthritis, Psoriatic arthritis, Ankylosing spondylitis, Gout, Osteoporosis
Significant testsJoint aspirate, Musculoskeletal exam, X-ray
SpecialistRheumatologist

Many of these diseases are now known to be disorders of the immune system, and rheumatology has significant overlap with immunology, the branch of medicine that studies the immune system.

Rheumatologist

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Rheumatologist
Occupation
NamesDoctor, Medical Specialist
Occupation type
Specialty
Activity sectors
Medicine
Description
Education required
Fields of
employment
Hospitals, Clinics

A rheumatologist is a physician who specializes in the field of medical sub-specialty called rheumatology. A rheumatologist holds a board certification after specialized training. In the United States, training in this field requires four years undergraduate school, four years of medical school, and then three years of residency, followed by two or three years additional Fellowship training. The requirements may vary in other countries. Rheumatologists are internists who are qualified by additional postgraduate training and experience in the diagnosis and treatment of arthritis and other diseases of the joints, muscles and bones. Many rheumatologists also conduct research to determine the cause and better treatments for these disabling and sometimes fatal diseases. Treatment modalities are based on scientific research, currently, practice of rheumatology is largely evidence based.[2]

Rheumatologists treat arthritis, autoimmune diseases, pain disorders affecting joints, and osteoporosis.[3] There are more than 200 types of these diseases, including rheumatoid arthritis, osteoarthritis, gout, lupus, back pain, osteoporosis, and tendinitis. Some of these are very serious diseases that can be difficult to diagnose and treat. They treat soft tissue problems related to the musculoskeletal system, and sports related soft tissue disorders.

Pediatrics rheumatologist: A pediatric rheumatologist is a pediatrician who has specialized in the treatment of children with rheumatic disease.[4] Both specialties are important to address a child's milestone development and disease treatment throughout childhood. However, recognition of this sub-specialty has been slow, which has resulted in a global shortage of pediatric rheumatologists, and as a consequence, the demand for healthcare support far exceeds current service capacities.[5] Raising awareness of this is important to attract more upcoming pediatricians into this rewarding area of healthcare.

Diseases

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Main article: Rheumatism

Diseases diagnosed or managed by rheumatologists include:

Degenerative arthropathies

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Inflammatory arthropathies

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Systemic conditions and connective tissue diseases

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Medical laser for the treatment of rheumatism.

Soft tissue rheumatism

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Local diseases and lesions affecting the joints and structures around the joints including tendons, ligaments capsules, bursae, stress fractures, muscles, nerve entrapment, vascular lesions, and ganglia. For example:

Diagnosis

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Synovial fluid examination[6][7]
Type WBC (per mm3) % neutrophils Viscosity Appearance
Normal <200 0 High Transparent
Osteoarthritis <5000 <25 High Clear yellow
Trauma <10,000 <50 Variable Bloody
Inflammatory 2,000–50,000 50–80 Low Cloudy yellow
Septic arthritis >50,000 >75 Low Cloudy yellow
Gonorrhea ~10,000 60 Low Cloudy yellow
Tuberculosis ~20,000 70 Low Cloudy yellow
Inflammatory: Arthritis, gout, rheumatoid arthritis, rheumatic fever

Physical examination

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Following are examples of methods of diagnosis able to be performed in a normal physical examination.

  • Schober's test tests the flexion of the lower back.
  • Multiple joint inspection
  • Musculoskeletal Examination
    • Screening Musculoskeletal Exam (SMSE) - a rapid assessment of structure and function
    • General Musculoskeletal Exam (GMSE) - a comprehensive assessment of joint inflammation
    • Regional Musculoskeletal Exam (RMSE) - focused assessments of structure, function and inflammation combined with special testing

Specialized

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Treatment

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See also: Outcome Measures in Rheumatology

Most rheumatic diseases are treated with analgesics, NSAIDs (nonsteroidal anti-inflammatory drug), steroids (in serious cases), DMARDs (disease-modifying antirheumatic drugs), monoclonal antibodies, such as infliximab and adalimumab, the TNF inhibitor etanercept, and methotrexate for moderate to severe rheumatoid arthritis.[8] The biologic agent rituximab (anti-B cell therapy) is now licensed for use in refractory rheumatoid arthritis.[9] Physiotherapy is vital in the treatment of many rheumatological disorders. Occupational therapy can help patients find alternative ways for common movements that would otherwise be restricted by their disease. Patients with rheumatoid arthritis often need a long term, coordinated and a multidisciplinary team approach towards management of individual patients. Treatment is often tailored according to the individual needs of each patient which is also dependent on the response and the tolerability of medications.

Beginning in the 2000s, the incorporation of biopharmaceuticals (which include inhibitors of TNF-alpha, certain interleukins, and the JAK-STAT signaling pathway) into standards of care is one of the paramount developments in modern rheumatology.[10]

Rheumasurgery

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Rheumasurgery (or rheumatoid surgery) is a subfield of orthopedics occupied with the surgical treatment of patients with rheumatic diseases.[11] The purpose of the interventions is to limit disease activity, soothe pain and improve function.[12]

Rheumasurgical interventions can be divided in two groups. The one is early synovectomies, that is the removal of the inflamed synovia in order to prevent spreading and stop destruction. The other group is the so-called corrective intervention, i.e. an intervention done after destruction has taken place.[13] Among the corrective interventions are joint replacements, removal of loose bone or cartilage fragments, and a variety of interventions aimed at repositioning and/or stabilizing joints,[14] such as arthrodesis.

Research directions

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Recently, a large body of scientific research deals with the background of autoimmune disease, the cause of many rheumatic disorders. Also, the field of osteoimmunology has emerged to further examine the interactions between the immune system, joints, and bones. Epidemiological studies and medication trials are also being conducted. The Rheumatology Research Foundation is the largest private funding source of rheumatology research and training in the United States.[citation needed]

History

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Rheum surgery emerged in the cooperation of rheumatologists and orthopedic surgeons in Heinola, Finland, during the 1950s.[15]

In 1970 a Norwegian investigation estimated that at least 50% of patients with rheumatic symptoms needed rheumasurgery as an integrated part of their treatment.[16]

The European Rheumatoid Arthritis Surgical Society (ERASS) was founded in 1979.[17]

Around the turn of the 21st century, focus for treatment of patients with rheumatic disease shifted, and pharmacological treatment became dominant, while surgical interventions became rarer.[18][19]

References

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  1. ^ a b "Explore Rheumatology". www.rheumatology.org. Retrieved 2022-09-28.
  2. ^ "What is a Rheumatologist?". www.rheumatology.org.
  3. ^ "Rheumatology Specialty Description". American Medical Association.
  4. ^ Australian Rheumatology Association. (2024). What is a Paediatric Rheumatologist? Accessed 24 March 2024 from https://rheumatology.org.au/For-Patients/Your-Rheumatology-Healthcare-Team/What-is-a-Paediatric-Rheumatologist
  5. ^ Butler, S., Sculley, D., Santos, D. et al. Paediatric Rheumatology Fails to Meet Current Benchmarks, a Call for Health Equity for Children Living with Juvenile Idiopathic Arthritis, Using Digital Health Technologies. Curr Rheumatol Rep (2024). https://doi.org/10.1007/s11926-024-01145-w
  6. ^ Flynn JA, Choi MJ, Wooster DL (2013). Oxford American Handbook of Clinical Medicine. US: OUP. p. 400. ISBN 978-0-19-991494-4.
  7. ^ Seidman AJ, Limaiem F (2019). "Synovial Fluid Analysis". StatPearls. StatPearls Publishing. PMID 30725799. Retrieved 2019-12-19.
  8. ^ "Methotrexate for rheumatoid arthritis". Arthritis.about.com. Retrieved 2013-06-24.
  9. ^ Edwards J; Szczepanski L; Szechinski J; Filipowicz-Sosnowska A; et al. (2004). "Efficacy of B-cell-_targeted therapy with rituximab in patients with rheumatoid arthritis". N Engl J Med. 350 (25): 2572–2581. doi:10.1056/NEJMoa032534. PMID 15201414.
  10. ^ Upchurch Katherine S., Kay Jonathan (2012). "Evolution of treatment for rheumatoid arthritis". Rheumatology. 51 (suppl 6): vi28–vi36. doi:10.1093/rheumatology/kes278. PMID 23221584.
  11. ^ "Norsk forening for revmakirurgi - Med hovedbase på Diakonhjemmet" LB Johannessen Tidsskr Nor Lægeforen 2004; 124:3110 Nr. 23 – 2. December 2004
  12. ^ Rheumakirurgi Archived 2016-01-18 at the Wayback Machine. Arne Skredderstuen November 2000
  13. ^ Den sykehusmessige revmatikeromsorgen i Norge (Kåss and Stene 1970), page 24.
  14. ^ "Surgery for Rheumatic Diseases" Cedars Sinai (http://www.cedars-sinai.edu)
  15. ^ Revmatisme: Gamle plager - ny viten (Munthe and Larsen 1987), page 49.
  16. ^ Den sykehusmessige revmatikeromsorgen i Norge (Kåss and Stene 1970), pages 24-25.
  17. ^ Rydholm, U "Reumakirurgiens uppgång, stabilisering og nedgång ur ett sydsvenskt perspektiv" 2013
  18. ^ Trender i revmakirurgisk behandling av pasienter med leddgikt og andre kronisk inflammatoriske leddsykdommer Archived 2016-01-29 at the Wayback Machine, Norsk Rheumabulletin 4/2012, pages 16-17.
  19. ^ Nikiphorou E, Carpenter L, Morris S; et al. (2014). "Hand and foot surgery rates in rheumatoid arthritis have declined from 1986 to 2011, but large-joint replacement rates remain unchanged: results from two UK inception cohorts". Arthritis Rheumatol. 66 (5): 1081–9. doi:10.1002/art.38344. PMID 24782174. S2CID 25813985.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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