What is Rheumatology? Who is a Rheumatologist?

Rheumatology is the science dealing 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 orthopedic surgeon. This is a mistake. Orthopedic 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. Orthopedic surgeons are NOT trained in dealing with arthritis or osteoporosis etc. These disorders are dealt with by Rheumatologists, who are specialists trained in dealing with and managing these Rheumatic diseases, which are essentially “Auto-Immune” in nature. “Auto” meaning “Self” and “Immune” relates to “Immunity” (“Rog Prati-kaarak Shakti”).  Rheumatic 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 intense worldwide research. 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.

We know that there is a genetic predisposition for rheumatic diseases. Why only certain members in a family are affected and not all the family, is not well understood. Studies are ongoing.

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: 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.

Notice that most of the terms end with the word “…itis”. This 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 autoimmune 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, yes, 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 you live, you should be independent and live well. A good quality of life is very important. Since your immunity is a part of your constitution itself, it cannot be just cut out of your body and thrown away. If we do so, theoretically, the disease might go away but how will you stay alive? Hence these diseases have to be treated in such a way that your immunity is suppressed to the extent that it does not harm you. It is a delicate balancing act because the suppression cannot be allowed to become so low that you succumb to other infections.

There is no permanent cure to these diseases in any branch of medicine. These diseases can only be controlled, and controlled well. So well that you can lead a near-normal life. These diseases are not like Malaria, Typhoid etc. that can be cured with a few days of treatment. It will help to understand that the treatment of these diseases is similar to treatment of chronic medical conditions such as diabetes, 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??

NO!  Do not fall into traps of quacks who make such false claims. They are ruthlessly taking innocent patients for a ride. Millions of people desperately hoping for the promised ‘permanent cure’ have realised, only too late, that organ damage has already occurred and once an organ is damaged, it can never be restored 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, be it allopathy, ayurveda or homeopathy. Newer and more effective medications are being discovered, and better regimens of treatment are being learnt and refined from past experiences, but as yet the ‘CURE” for rheumatic diseases has not been found or created.  IN FACT, MEDICINE IS NOWHERE NEAR A CURE.

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 aims to demystify these illnesses and to aid anyone to understand them.  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 EXCLUSIVE  purview of a rheumatologist.