Rheumatology

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 after attaining a medical degree through fellowship programs in the United States, or specialist registrar positions in the United Kingdom, Pakistan or DM in India or equivalent programs elsewhere in the world. 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 musculoskeletal system sports related soft tissue disorders.

Diseases diagnosed or managed by rheumatologists include:

Systemic conditions and connective tissue diseases

Medical laser for the treatment of rheumatism.

• Lupus
• Ehlers-Danlos syndrome
• Sjögren's syndrome
• Scleroderma (systemic sclerosis)
• Polymyositis
• Dermatomyositis
• Polymyalgia rheumatica
• Mixed connective tissue disease
• Relapsing polychondritis
• Adult-onset Still's disease
• Sarcoidosis
• Fibromyalgia
• Myofascial pain syndrome
• Vasculitis
  • Microscopic polyangiitis
  • Eosinophilic granulomatosis with polyangiitis
  • Granulomatosis with polyangiitis
  • Polyarteritis nodosa
  • Henoch–Schönlein purpura
  • Serum sickness
  • Giant cell arteritis, Temporal arteritis
  • Takayasu's arteritis
  • Behçet's disease
  • Kawasaki disease (mucocutaneous lymph node syndrome)
  • Thromboangiitis obliterans
• Hereditary periodic fever syndromes

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.[4] The biologic agent rituximab (anti-B cell therapy) is now licensed for use in refractory rheumatoid arthritis.[5] 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.

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.

Rheumasurgery emerged in the cooperation of rheumatologists and orthopedic surgeons in Heinola, Finland, during the 1950s.[10]

In 1970 a Norwegian investigation estimated that at least 50% of patients with rheumatic symptoms needed rheumasurgery as an integrated part of their treatment.[11]

The European Rheumatoid Arthritis Surgical Society (ERASS) was founded in 1979.[12]

Around the turn of the century, focus for treatment of patients with rheumatic disease shifted, and pharmacological treatment became dominant, while surgical interventions became rarer.[13][14]

• Association des medecins rhumatologues du Quebec
• American College of Rheumatology
• European League Against Rheumatism
• Consortium of Rheumatology Researchers of North America, Inc.
• British Society for Rheumatology
• Canadian Rheumatology Association
• Association of Rheumatology Health Professionals