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Saturday, March 2, 2013

Basic concepts of Rheumatology

Rheumatology is a branch of medicine that deals with the diagnosis and treatment of a variety of rheumatic disorders involving the joints, muscles, blood vessels and other connective tissues.

Some people think that rheumatology is a part of physical medicine which is not correct. Rheumatology and physical medicine do overlap but they both are separate specialties.

Very simply the diseases that rheumatology is concerned with can be classified as:

1. Inflammatory diseases:

    a. Immune mediated:

  • Rheumatoid arthritis (can be both acute and chronic)
  • Spondylotic arthritis (can be both acute and chronic)
  • Others (see below)

    b. Infective:

  • Monoarticular
    Acute – Septic arthritis
    Chronic – Tubercular arthritis
  • Polyarticular

2. Degenerative diseases: 

Osteo-arthritis. Even though the term -itis (inflammation) is involved here there is little to no inflammation in osteoarthritis. It is more correct to call it osteo-arthropathy but we will stick to the old name for now. These are always chronic and can be:
  • Monoarticular
  • Oligoarticular
  • Polyarticular

3. Metabolic diseases: 

Gout (due to deposition of urate crystals in joints). Can be both acute and chronic
  • Acute: Monoarticular
  • Chronic: Polyarticular
The above classification is a very generalized one and does not include all the diseases under rheumatology, but it is a good starting point.

What do you mean by mono, oligo and poly-articular?

Monoarticular: 1 joint is involved
Oligoarticular: 2 to 4 joints are involved
Polyarticular: 5 or more joints are involved.

Let's elaborate the immune mediated diseases slightly:

Immune-mediated arthritis:

  1. Spondylotic arthritis
  2. Rheumatoid arthritis
  3. Connective tissue disorder
  4. Vasculitis
  5. Others:
    • Acute Rheumatic fever
    • Sarcoidosis

1. Spondylotic arthritis:

Here the spine (axial joints) and peripheral joints are involved. The peripheral joints are usually the proximal ones, for examples, the hip joints as they are close to the spine.

Spondylotic arthritis usually involved 2-4 joints, ie, it is a type of oligoarthritis.

Spondylotic arthritis is sero negative,which means that no antibody representing the disease  is found in the blood.

2. Rheumatoid arthritis:

Here distal joints (away from the spin), for example, the small joints of the hand and feet are usually involved. But involvent of proximal joints may also occur. 

It is polyarticular (> 5 joints are involved) and usually sero positive as Rheumatoid factor (antibody) is found in blood.

Both rheumatoid arthritis and spondylotic arthritis normally involves only joints. But in some rare cases they may also involve other connective tissue of the body.

3. Connective tissue disorders:

Here rheumatologists are concerned with a group of disorders that not only involves joints but also other connective tissues of the body. Here the involvement of joints and other connective tissues of the body is equal.

Some examples are systemic lupus erythematosus, scleroderma, polymyositis.

So here joints are the not the only problem that rheumatologists have to deal with.

4. Vasculitis:

An example would be Polyarteritis Nodosa: a vasculitis of medium-sized arteries, which become swollen and damaged from attack by rogue immune cells. Polyarteritis nodosa is also called Kussmaul disease or Kussmaul-Maier disease. 

5. Others:

  • Acute Rheumatic Fever: an inflammatory disease that occurs following a Group A streptococcal infection, (such as strep throat or scarlet fever).
  • Sarcoidosis: a disease of unknown cause in which abnormal collections of inflammatory cells (granulomas) form as nodules in many organs of the body

That's all for today!
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