Rheumatology is a branch of internal medicine dedicated to autoimmune diseases or, in other words, to joint and muscle diseases and systemic connective tissue diseases caused by the immune system of the organism itself. Human bones, joints, muscles, tendons and ligaments form a support system for the organs, also called the support and movement apparatus. This support system includes also connective tissue around the organs. Inflammatory diseases of the support structure and connective tissue are also called rheumatic diseases. Rheumatologists are specialized physicians who deal with the treatment and diagnostics of inflammatory bone and joint diseases, and also autoimmune diseases affecting the blood vessels and connective tissue. The most common rheumatic diseases are rheumatoid arthritis (RA), muscle rheumatism, fibromyalgia, ankylosing spondyloarthritis, iritis, and temporal arteritis.
Diagnostics of rheumatic diseases
The diagnostic process usually starts at the rheumatologist’s consultation where the patient has come due to his or her symptoms. The most frequent symptoms are various joint problems, such as pain or swelling, and morning stiffness, which is relieved by activity. The diagnostic methods of rheumatic diseases include X-ray of joints, laboratory tests, computed tomography, magnet resonance imaging, physical examination by a rheumatologist and anamnesis.
The most frequent rheumatic diseases
Rheumatoid arthritis (RA) is a chronic joint inflammation, which most often affects small joints of hands and feet, but may damage other joints as well, and cause inflammation in the internal organs. Rheumatoid arthritis damages joints, causing problems with coping in life and leading to rapid loss of working ability. Joint changes characteristic of rheumatoid arthritis become apparent up to six months after the beginning of inflammatory processes in the joints. The disease causes pain, swelling and stiffness in joints and leads to progressive loss of function.
Fibromyalgia is composed of the words fibro, which means “connective tissue”, and myalgia, which means „muscle pain”. Fibromyalgia is a condition where the patient has unexplained pain in muscles, tendons and other structures of connective tissue. Most often, fibromyalgia affects middle-aged women – in this group the prevalence of the disease is 5%. In elderly people, fibromyalgia is much less common and in children and adolescents it is rare. The disease is benign, but causes serious discomfort to the patients. The treatment of fibromyalgia is directed at alleviating the symptoms as there is no curative treatment. Fibromyalgia is a disease, which is diagnosed by means of clinical examination and excluding other pain-causing diseases.
Systemic lupus erythematosus (lupus, SLE) is an autoimmune disease whereby the immune system is misdirected and attacks healthy cells, tissues and organs. The results are visible almost all over the body. The reasons for lupus are not known, but genetic predisposition surely plays a role. Most often, SLE affects fertile women; in many cases the disease becomes apparent or gets worse during pregnancy.
Ankylosing spondyloarthritis is a long-lasting joint inflammation in the vertebral column, but often also in limb joints. Furthermore, this disease causes inflammation at the connection points of tendons and sometimes in the anterior part of the eye, too. The cause of the disease is not known. Spondyloarthritis affects men and women equally, but in men the disease tends to be much more severe. If a woman has a mild form of spondyloarthritis, she is almost never aware of the disease. Very many patients with ankylosing spondyloarthritis are HLA-B27 positive, which indicates that there is a hereditary component.
Treatment of rheumatic diseases
Medications for rheumatic diseases include nonsteroid anti-inflammatory drugs (NSAID), disease-modifying antirheumatic drugs (DMARD), glukocorticosteroids, biological drugs and intra-articular hormone injections.
Biological drugs are protein molecules that are biotechnologically produced in cell cultures. These protein molecules usually contain a human immunoglobulin or a part of it. These medications have very specific targets and they exert their influence by binding to these targets. The target can be a cytokine (a signaling substance) or its receptor, which floats freely in the plasma or is attached to the surface of inflammatory cells. By binding to the targets, biological drugs block the inflammatory signaling and through this reduce inflammation. Biological treatment is most often indicated in case of rheumatoid arthritis, psoriatic arthropathy, ankylosing spondyloarthritis, juvenile idiopathic arthritis, various forms of vasculitis and severe nephritis accompanying SLE.
Rheumatologist’s consultation4 clinics
A rheumatologist is a specialized physician in the field of internal medicine who focuses specifically on the diagnosis, treatment and monitoring of autoimmune inflammatory processes in the bones, joints, connective tissue, muscles and blood vessels. During the first outpatient visit, the rheumatologist examines the patient and prescribes necessary tests and analyses. The treatment of rheumatic diseases is long-term or even life-long, requiring regular monitoring and a holistic approach to the patient. A timely consultation with a rheumatologist, accurate diagnosis of the disease and early treatment help to avoid the development of severe complications.