What is Rheumatology and who is a Rheumatologist?

The dictionary defines Rheumatology as the science that deals with muscles, bones, joints and the skin. Thus it is the speciality of medicine dedicated to disorders of the musculoskeletal system. Rheumatological disorders range from chronically disabling arthritis and critical illnesses involving multiple organs of the body down to milder but nagging and persistent illnesses such as chronic back aches and neck aches due to occupational hazards such as teaching, farming or long hours on the computer.

 

Most people with any kind of joint pains go to an orthopaedic surgeon however this is a mistaken belief. Orthopaedic surgeons as the name indicates are surgeons. They operate on fractures and perform joint replacements and cartilage tears. Their training is in repair of broken or damaged bony structures and they are not trained in dealing with arthritis or osteoporosis etc. These disorders are dealt with by Rheumatologists who are specialists trained to deal with and manage these Rheumatic diseases which are essentially “Auto-Immune” in nature. “Auto” means “Self” and “Immune” relates to “Immunity” (“Rog Prati-kaarak Shakti”). These diseases result from malfunction of your own body’s immunity. Your immunity which is designed to protect you “malfunctions” and instead starts harming you. Why this happens and that too only in some people is still not well understood and is a subject of research.

We know that there is a genetic predisposition for these diseases but why only certain members in a family are affected and not all, is not well understood.The part or organ of the body, where the Immune system “attacks”, becomes inflamed and if not treated on time, the inflammation causes damage of that particular organ of the body. Any organ of the body can be affected by auto immune disease.

A few examples of such Auto-Immune diseases are:

  1. The joints (e.g. “Arthritis”. Again there are different varieties of Arthritis such as Rheumatoid Arthritis, Ankylosing Spondylitis or Psoriatic Arthritis etc)
  2. Skin (e.g. Scleroderma or Systemic Sclerosis)
  3. Muscles (e.g. Dermatomyositis/Polymyositis)
  4. Eyes (e.g. Uveitis)
  5. Lungs (e.g. Interstitial Lung Disease)
  6. Kidneys (e.g. Glomerulonephritis)
  7. Intestine (e.g. Ulcerative Colitis)
  8. Blood vessels namely arteries and veins (e.g. Vasculitis)
  9. The Brain (e.g. Encephalitis, CNS Vasculitis)

In certain diseases many of the organs may be affected simultaneously such as the skin, joints, hair, kidneys, brain and even the heart (e.g. Systemic Lupus Erythematosus). There are many more diseases however this was only to drive home the point that any organ of the body can be affected.

You may notice that most of the terms end with the word “…itis”. The term stands for “inflammation”. So Inflammation of the Appendix is called “Appendicitis” and inflammation of the stomach due to hyperacidity is called “Gastritis”. Likewise “Arth” means “joint” and “itis” means “inflammation” so “Arthritis” is inflammation in the joint. Likewise “Myo” means muscle so “Myositis” means inflammation of the Muscle and so on.

This does not mean that Rheumatologists only deal with inflammatory diseases, there are rheumatic conditions causing joint pains without inflammation as well. Chronic muscle pains along with fatigue may well be a sign of fibromyalgia and if associated with certain other symptoms such as dry eyes or mouth may even be indicative of an auto-immune disease such as Sjogrens Syndrome. Some women may have recurrent miscarriages which may indicate another autoimmune disease called Anti-phospholipid syndrome. YES, you read correctly! Recurrent miscarriages may also be indicative of a rheumatic disease. Hence any chronic joint or muscle pain and even recurrent fever may fall into the purview of a rheumatologist.

 

Now a word on how Rheumatologists treat these diseases: These medical conditions are treated with a combination of medicines which are often Immunosuppressants (Often but not always),sometimes dietary modifications (in some diseases not all), exercises (sometimes along with support of splints/footwear modification). The idea is to control the disease and improve the patient’s “quality of life”. However long one lives, he should be independent and live well. A good quality of life is very important. Since your immunity is a part of your constitution itself we cannot just cut it out of your body and throw it out. If we do so the disease might go away but how will you live? Hence these diseases have to be treated such that your immunity is suppressed to a certain extent  that it does not harm you. However it should not be allowed to become so low that you get other infections from outside.

For the same reason these diseases can be well controlled so that you can live well but there is no permanent cure to these diseases in any branch of medicine. These diseases are not like Malaria, Typhoid etc. that they will be cured with a few days of treatment. Hence consider treatment of these diseases similar to treatment of chronic medical conditions such as diabetes and Hypertension and cardiac ailments. You want to control the blood sugar so it does not remain high and cause eye, kidney or nerve damage while at the same time you do not want the blood sugar to become so low that you become giddy or fall down and black out. However treatment needs to continue for long periods maybe even life-long because your Immunity is with you for life, Right?

Do not fall into traps of Quacks who make false claims of providing a permanent cure for these diseases. Whoever promises you that is effectively taking you for a ride. By the time you realize this harsh reality, organ damage would occur and once an organ is damaged it can never be brought back to normal. What is lost is lost forever! These diseases can be controlled and you can live well but there is no permanent cure as yet in any branch of medical science. Newer and more effective medications are being discovered and better regimens of treatment learnt from past experiences are now available but as yet we are nowhere near a cure for these illnesses.

 

Rheumatology is a vast speciality and a plethora of illnesses come under its umbrella since no part of the body is spared from the ramifications of the Autoimmune Phenomena. This website is a humble attempt to demystify these illnesses for the understanding of the common man in simple words and paraphrases. While we will address most of the arthritis one by one in the subsequent sections what needs to be clearly understood here is that joint pains of any kind whether or not associated with swelling or systemic symptoms such as fever, rash, hair loss etc. come under the purview of a rheumatologist.

What is Rheumatology and who is a Rheumatologist?