Rheumatology

Rheumatology is the branch of internal medicine concerned with the study and treatment of diseases affecting the musculoskeletal system and connective tissues; these diseases may be mechanical-degenerative, inflammatory-autoimmune or metabolic in nature.

• Arthritis: inflammation of joints that can be acute or chronic; there are different types of arthritis (rheumatoid, psoriatic, reactive, crystal).
• Osteoarthritis: disease due to wear and tear/aging of joints; mainly affects hips, knees, spine, more rarely hands and feet.
• Connectivitis: autoimmune-type disease characterized by inflammation of connective tissue (e.g., Lupus, scleroderma, Sjögren's, nondifferentiated connectivitis).
• Osteomuscular pain: caused by disorders of bones, joints, muscles, tendons, ligaments, bursae; trauma is the most common cause of pain.
• Hemochromatosis: hereditary disease that causes excessive iron absorption by the body, resulting in accumulation and organic damage.
• Osteoporosis: a metabolic disorder in which a reduction in density weakens the bone, which becomes more prone to fractures.
• Systemic sclerosis: Sclerosis or scleroderma refers to a group of diseases that occur when the skin or organs harden due to an increase in connective tissue.
• Behçet's syndrome: chronic inflammation of blood vessels that can cause mouth and genital ulcers, skin lesions and eye problems.
• Sjoegren's syndrome: Dry eye causes a feeling of roughness and discomfort. One feels the need to constantly rub the eye.
• Autoinflammatory syndromes: group of rare diseases characterized by recurrent episodes of fever and inflammation.
• Ankylosing spondylitis: is an increasing stiffening of parts of the vertebrae due to progressive inflammation.
• Spondyloarthropathy: group of connective tissue diseases that affect joints and spine and cause significant joint inflammation.
• Vasculitis: disorders caused by inflammation of blood vessels; may affect arteries, capillaries, veins, a combination of them (e.g., Horton's arteritis, Takayasu).
• Thromboangiitis obliterans: Peripheral arterial occlusive disease is a circulatory disorder that primarily affects the legs and much less frequently the arms.

Diagnosis

Diagnosis, crucial if early, is made on the basis of one of the following tests or through a combination of them:

• Blood tests.
• Urine tests.
• Synovial fluid examinations.
• Imaging examinations (X-rays, MRI, joint and musculoskeletal ultrasound).

Treatments

Therapies for the treatment of rheumatic diseases vary greatly depending on the type of disease; therapies include:

• Drug therapy for pain control: taking pain-relieving and anti-inflammatory drugs (both cortisone and non-cortisone NSAIDs) to relieve pain.
• "Background" therapy for inflammatory rheumatism: taking drugs that stop the pathophysiological mechanisms that support the disease; these drugs are intended to slow, or at best stop, the natural evolution of the disease.
• Rehabilitation: to be performed to restore joint function wherever possible.
• Surgery: to correct particularly compromised joints by, e.g., tendon reconstructions and arthroplasty.

First visit

What to expect:

• Medical history: assessment of the patient's medical history and any familiarity with rheumatic diseases.
• Objective examination: internist examination to assess the patient's overall health status, neurological evaluation if needed, and, most importantly, evaluation of the musculoskeletal system.