Rheumatology is the study of rheumatic disease, arthritis and disorders of the joints, muscles and ligaments. Many types of rheumatic disease affect the organs of the body as well as the joints, including the skin, mucous membranes, internal organs, the circulation and nervous system.
The term ‘arthritis’ means ‘joint inflammation’ and refers to disease of a joint, or often multiple joints. There are many forms of arthritis, and in turn, specific treatment and medication for those individual types. A Rheumatologist is a doctor with specific skills that allow him or her to differentiate between the different kinds of arthritis and prescribe the relevant course of treatment, with the aim of maximizing joint function and health.
Rheumatologists will determine if a patient’s arthritis is one of many different types, such as osteoarthritis, inflammatory arthritis (e.g. rheumatoid arthritis), crystalline arthritis (e.g. gout), connective tissue disease (e.g. lupus or SLE) or fibromyalgia. Differentiating between the different arthritides is important because each type carries its own specific prognosis and will require different therapeutic approaches
Osteoarthritis (OA) is also referred to as ‘degenerative’ arthritis, ‘wear-and-tear’ arthritis, or arthritis ‘of advancing age’. The lay term ‘rheumatism’ refers to OA. It is the most prevalent arthritis worldwide, with 10 to 20% of the adult population suffering from symptoms of OA.
This condition can affect a single large joint such as a hip or a knee, but commonly affects multiple joints, including those of the spine, the thumb base and wrist, the joints in the fingers closest to the nails (manifesting as bony lumps) and that of the ‘big toe’.
A joint with osteoarthritis is typically more painful during or immediately after activity, it may be stiff for a short time after sitting or resting it, and may intermittently swell or even develop permanent deformity.
Inflammatory arthritis (IA) is that which is caused by, or involves, aberrancy in the immune system such that a system that ordinarily is used by the body to fight infections, turns on specific components of the body, in this case the joints, and attacks them. This results in joint inflammation, which manifests as pain, swelling and morning stiffness. Characteristically, these symptoms of inflammatory arthritis improve with movement or exercising the joint.
There are a variety of specific types of inflammatory arthritis, including Rheumatoid Arthritis (RA), Psoriatic Arthritis and Ankylosing Spondylitis.
Rheumatoid arthritis is the most prevalent IA in the community and, left undiagnosed and untreated, results in joint deformity and disability, particularly in the hands and feet.
Psoriatic arthritis and ankylosing spondylitis belong to a group of IA conditions called ‘Spondyloarthritis’. The spondyloarthropathies (‘spondylo’ refers to the spine) have common features which can include psoriasis, bowel and/or eye inflammation (e.g. Crohn’s disease, ulcerative colitis and uveitis). Both diseases can affect the joints of the limbs and of the spine. As with rheumatoid arthritis, left untreated, joint deformity and disability is a significant risk for sufferers.
Psoriatic arthritis more commonly affects the peripheral joints, while ankylosing spondylitis primarily affects the joints of the spine, from the neck down, including the joints of the rib-cage. ‘Ankylosis’ means ‘fusion’ and ‘spondylitis’ refers to inflammation of the spine. Through this process of inflammation, the many articulations of the spine fuse, which can cause severe restrictions in movement for a patient.
Treatment Advances in Inflammatory Arthritis
Enormous strides in understanding the genetics and immunology of IA have been made in the last three decades, culminating in an expanding repertoire of highly effective medications and treatment strategies that target and block specific problematic components of the immune system. This modern approach has helped to restore many patients’ independence and quality of life.