what is rheumatology?

Rheumatology is the study of musculoskeletal (MSK) and systemic autoimmune conditions which are commonly referred to as "rheumatic diseases." Autoimmunity occurs when the immune system is overactive and starts to attack its own body. Very commonly this presents as painful arthritis, however, many of these conditions not only effect the MSK system but can also affect other parts of body from head to toe (eg. brain, heart, lungs, liver, kidney and skin). 

what are some examples of rheumatic diseases?

Osteoarthritis (OA) is the most common type of arthritis and is caused by breakdown of the cartilage, which is the cushion between the joints. As there is more wear and tear, the bones begin to rub on each other causing pain and stiffness. Common sites include the hands, knees and hips. 

Rheumatoid Arthritis (RA) is a condition which affects about 1% of the population. Patients are typically between the ages of 30-50 and are predominantly female. RA is an autoimmune disease where the body attacks itself, causing painful joint swelling. It is a more severe type of arthritis in comparison to OA and typically needs medical treatment. 

Psoriatic Arthritis is another type of autoimmune arthritis which typically affects patients who have psoriasis, which is a scaling skin condition. Although psoriasis is quite common, only about 25% of patients with psoriasis will develop psoriatic arthritis. Family history is also very important as it psoriatic arthritis runs in families. Patients not only develop arthritis, but can also have involvement of the tendons and connective tissues in the feet, knees, hips and rib cage. 

Ankylosing Spondylitis (AS) is an inflammatory condition that often affects young men. Patients present with lower back pain and morning stiffness. Symptoms commonly begin in the teenage years and the diagnosis is usually delayed by many years thereafter, between the ages of 20-30. Pain is generally improved with exercise and NSAIDs, however, with longstanding uncontrolled disease, there can be spinal fusion and limitation of movement. 

Systemic Lupus Erythematous (SLE) or lupus is an autoimmune disorder which typically affects women of childbearing age. Patients can develop inflammation and damage to the joints, skin, kidneys, heart, lungs, blood vessels, and brain. SLE may be localized to the skin and joints, or it can have more serious complications. It is a difficult condition to diagnose and is a great mimicker of other diseases.

Sjogren's syndrome is an autoimmune disease which usually affects the tear glands in the eyes and salivary glands. Patients will often report fatigue, dryness and itchiness in their eyes and dry mouth. Most of the time, the disease is localized to the glandular tissues and the treatment is symptomatic (eg. eye drops and frequent water consumption). However, Sjogren's syndrome can affect other organs and can cause joint pain, skin rashes, numbness and tingling, etc.

Gout is a very common inflammatory arthritis which affects men more often than women. It results from the buildup of uric acid in the body which is normally formed from the breakdown of cells. When uric acid levels become too high, it can crystallize and cause painful inflamed joint(s). Certain foods are known to increase uric acid levels including red meat, shell fish, alcohol and sugary drinks. The most common site of involvement is the big toe, but other joints can also be involved. 

Fibromyalgia is a chronic, non-inflammatory condition which more commonly affects women. Patients present with widespread pain and fatigue. It is NOT an autoimmune condition and the etiology is unknown but it seems to run in families. All diagnostic tests are typically normal, making it a diagnosis of exclusion. The condition is a disorder of pain processing where light touch and normal stimuli are processed as pain. It is not dangerous but can be very debilitating. Common triggers and associations include anxiety, depression, lack of sleep and exercise. 

Polymyalgia Rheumatica (PMR) is an inflammatory condition seen in patients 50 years old and up (average age around 70) and is more common in women. Patients present with pain over the neck, shoulders, hips and buttocks. Patients may also complain of morning stiffness in these areas. Occasionally, PMR is associated with another disease called Giant Cell Arteritis (GCA) or Temporal Arteritis.

Giant Cell Arteritis (GCA) or Temporal Arteritis is seen in those greater than 50 years old (average age around 70) where patients develop new-onset, constant, temporal headaches. It is a type of vasculitis, in which there is inflammation in the blood vessels. GCA is associated with PMR in about 50% of the cases. Patients may present with headaches, jaw pain, fatigue and rarely vision loss. Any patients with GCA who experience sudden vision change should seek medical care immediately, as this is a medical emergency.  

Vasculitis is a broad term that means inflammation of the blood vessels. It is an autoimmune disease that is not well understood with no clear etiology. There are many different types of vasculitis and these can affect blood vessels of any size. Some examples include ANCA-associated vasculitis, polyarteritis nodosa (PAN), Takayasu and GCA. The presentation can be quite variable and may affect a number of different organ systems. Prompt diagnosis and aggressive treatment is usually necessary. 

Myositis is a disease that presents with inflammation in the muscles and leads to muscle weakness. Large muscle groups such as shoulders and hips are usually involved. Examples include polymyositis or dermatomyositis. In dermatomyositis, patients may also get a characteristic rash in addition to weakness. In severe cases of myositis, swallowing can be affected along with inflammation and scarring of the lungs. 

There are many other rheumatic diseases which are not listed, please speak with your doctor for more information. Additional resources can be found at the following websites below.