Rheumatology (Greek ῥεῦμα, rheûma, flowing current) is a branch of medicine devoted to the diagnosis and management of disorders whose common feature is inflammation in the bones, muscles, joints, and internal organs.[1] Rheumatology covers more than 100 different complex diseases, collectively known as rheumatic diseases, which includes many forms of arthritis as well as lupus and Sjögren's syndrome.[1]Doctors who have undergone formal training in rheumatology are called rheumatologists.
Many of these diseases are now known to be disorders of the immune system, and rheumatology has significant overlap with immunology, the branch of medicine that studies the immune system.
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. 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.
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 inhibitoretanercept, 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.
Rheumasurgery (or rheumatoid surgery) is a subfield of orthopedics occupied with the surgical treatment of patients with rheumatic diseases.[7] The purpose of the interventions is to limit disease activity, soothe pain and improve function.[8]
Rheumasurgical interventions can be divided in two groups. The one is early synovectomies, that is the removal of the inflamed synovia in order to prevent spreading and stop destruction. The other group is the so-called corrective intervention, i.e. an intervention done after destruction has taken place.[9] Among the corrective interventions are joint replacements, removal of loose bone or cartilage fragments, and a variety of interventions aimed at repositioning and/or stabilizing joints,[10] such as arthrodesis.
Research directions
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.
History
Rheumasurgery emerged in the cooperation of rheumatologists and orthopedic surgeons in Heinola, Finland, during the 1950s.[11]
In 1970 a Norwegian investigation estimated that at least 50% of patients with rheumatic symptoms needed rheumasurgery as an integrated part of their treatment.[12]
The European Rheumatoid Arthritis Surgical Society (ERASS) was founded in 1979.[13]
Around the turn of the 21st century, focus for treatment of patients with rheumatic disease shifted, and pharmacological treatment became dominant, while surgical interventions became rarer.[14][15]
^"What is a Rheumatologist?". www.rheumatology.org.
^"Rheumatology Specialty Description". American Medical Association.
^"Methotrexate for rheumatoid arthritis". Arthritis.about.com. Retrieved 2013-06-24.
^Edwards J; Szczepanski L; Szechinski J; Filipowicz-Sosnowska A; et al. (2004). "Efficacy of B-cell-targeted therapy with rituximab in patients with rheumatoid arthritis". N Engl J Med. 350 (25): 2572–2581. doi:10.1056/NEJMoa032534. PMID 15201414.
^Upchurch Katherine S., Kay Jonathan (2012). "Evolution of treatment for rheumatoid arthritis". Rheumatology. 51 (suppl 6): vi28–vi36. doi:10.1093/rheumatology/kes278. PMID 23221584.
^"Norsk forening for revmakirurgi - Med hovedbase på Diakonhjemmet" LB Johannessen Tidsskr Nor Lægeforen 2004; 124:3110 Nr. 23 – 2. December 2004
^Rheumakirurgi 2016-01-18 at the Wayback Machine. Arne Skredderstuen November 2000
^Den sykehusmessige revmatikeromsorgen i Norge (Kåss and Stene 1970), page 24.
^Revmatisme: Gamle plager - ny viten (Munthe and Larsen 1987), page 49.
^Den sykehusmessige revmatikeromsorgen i Norge (Kåss and Stene 1970), pages 24-25.
^Rydholm, U "Reumakirurgiens uppgång, stabilisering og nedgång ur ett sydsvenskt perspektiv" 2013
^Trender i revmakirurgisk behandling av pasienter med leddgikt og andre kronisk inflammatoriske leddsykdommer 2016-01-29 at the Wayback Machine, Norsk Rheumabulletin 4/2012, pages 16-17.
^Nikiphorou E, Carpenter L, Morris S; et al. (2014). "Hand and foot surgery rates in rheumatoid arthritis have declined from 1986 to 2011, but large-joint replacement rates remain unchanged: results from two UK inception cohorts". Arthritis Rheumatol. 66 (5): 1081–9. doi:10.1002/art.38344. PMID 24782174. S2CID 25813985.{{cite journal}}: CS1 maint: multiple names: authors list (link)
External links
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
German Society for Rheumatology
January 26, 2023
rheumatology, journal, journal, greek, ῥεῦμα, rheûma, flowing, current, branch, medicine, devoted, diagnosis, management, disorders, whose, common, feature, inflammation, bones, muscles, joints, internal, organs, covers, more, than, different, complex, disease. For the journal see Rheumatology journal Rheumatology Greek ῥeῦma rheuma flowing current is a branch of medicine devoted to the diagnosis and management of disorders whose common feature is inflammation in the bones muscles joints and internal organs 1 Rheumatology covers more than 100 different complex diseases collectively known as rheumatic diseases which includes many forms of arthritis as well as lupus and Sjogren s syndrome 1 Doctors who have undergone formal training in rheumatology are called rheumatologists RheumatologySystemMusculoskeletal ImmuneSignificant diseasesAutoimmune disease Inflammation Rheumatoid arthritis Lupus Osteoarthritis Psoriatic arthritis Ankylosing spondylitis Gout OsteoporosisSignificant testsJoint aspirate Musculoskeletal exam X raySpecialistRheumatologistMany of these diseases are now known to be disorders of the immune system and rheumatology has significant overlap with immunology the branch of medicine that studies the immune system Contents 1 Rheumatologist 2 Diseases 2 1 Degenerative arthropathies 2 2 Inflammatory arthropathies 2 3 Systemic conditions and connective tissue diseases 2 4 Soft tissue rheumatism 3 Diagnosis 3 1 Physical examination 3 2 Specialized 4 Treatment 4 1 Rheumasurgery 5 Research directions 6 History 7 References 8 External linksRheumatologist EditRheumatologistOccupationNamesDoctor Medical SpecialistOccupation typeSpecialtyActivity sectorsMedicineDescriptionEducation requiredDoctor of Medicine M D Doctor of Osteopathic Medicine D O Bachelor of Medicine Bachelor of Surgery MBBS MBChB Fields ofemploymentHospitals ClinicsA rheumatologist is a physician who specializes in the field of medical sub specialty called rheumatology A rheumatologist holds a board certification after specialized training 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 EditMain article Rheumatism Diseases diagnosed or managed by rheumatologists include Degenerative arthropathies Edit OsteoarthritisInflammatory arthropathies Edit Rheumatoid arthritis Spondyloarthropathies Ankylosing spondylitis Reactive arthritis reactive arthropathy Psoriatic arthropathy Enteropathic arthropathy Juvenile Idiopathic Arthritis JIA Crystal arthropathies gout pseudogout Septic arthritisSystemic conditions and connective tissue diseases Edit Medical laser for the treatment of rheumatism Lupus Ehlers Danlos syndrome Sjogren 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 Schonlein purpura Serum sickness Giant cell arteritis Temporal arteritis Takayasu s arteritis Behcet s disease Kawasaki disease mucocutaneous lymph node syndrome Thromboangiitis obliterans Hereditary periodic fever syndromesSoft tissue rheumatism Edit Local diseases and lesions affecting the joints and structures around the joints including tendons ligaments capsules bursae stress fractures muscles nerve entrapment vascular lesions and ganglia For example Low back pain Tennis elbow Golfer s elbow Olecranon bursitisDiagnosis EditPhysical examination Edit Following are examples of methods of diagnosis able to be performed in a normal physical examination Schober s test tests the flexion of the lower back Multiple joint inspection Musculoskeletal Examination Screening Musculoskeletal Exam SMSE a rapid assessment of structure and function General Musculoskeletal Exam GMSE a comprehensive assessment of joint inflammation Regional Musculoskeletal Exam RMSE focused assessments of structure function and inflammation combined with special testingSpecialized Edit Laboratory tests e g Erythrocyte Sedimentation Rate Rheumatoid Factor Anti CCP Anti citrullinated protein antibody ANA Anti Nuclear Antibody X rays Ultrasounds and other imaging methods of affected joints Cytopathology and chemical pathology of fluid aspirated from affected joints e g to differentiate between septic arthritis and gout Treatment EditMost 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 Beginning in the 2000s the incorporation of biopharmaceuticals which include inhibitors of TNF alpha certain interleukins and the JAK STAT signaling pathway into standards of care is one of the paramount developments in modern rheumatology 6 Rheumasurgery Edit Rheumasurgery or rheumatoid surgery is a subfield of orthopedics occupied with the surgical treatment of patients with rheumatic diseases 7 The purpose of the interventions is to limit disease activity soothe pain and improve function 8 Rheumasurgical interventions can be divided in two groups The one is early synovectomies that is the removal of the inflamed synovia in order to prevent spreading and stop destruction The other group is the so called corrective intervention i e an intervention done after destruction has taken place 9 Among the corrective interventions are joint replacements removal of loose bone or cartilage fragments and a variety of interventions aimed at repositioning and or stabilizing joints 10 such as arthrodesis Research directions EditRecently 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 History EditRheumasurgery emerged in the cooperation of rheumatologists and orthopedic surgeons in Heinola Finland during the 1950s 11 In 1970 a Norwegian investigation estimated that at least 50 of patients with rheumatic symptoms needed rheumasurgery as an integrated part of their treatment 12 The European Rheumatoid Arthritis Surgical Society ERASS was founded in 1979 13 Around the turn of the 21st century focus for treatment of patients with rheumatic disease shifted and pharmacological treatment became dominant while surgical interventions became rarer 14 15 References Edit a b Explore Rheumatology www rheumatology org Retrieved 2022 09 28 What is a Rheumatologist www rheumatology org Rheumatology Specialty Description American Medical Association Methotrexate for rheumatoid arthritis Arthritis about com Retrieved 2013 06 24 Edwards J Szczepanski L Szechinski J Filipowicz Sosnowska A et al 2004 Efficacy of B cell targeted therapy with rituximab in patients with rheumatoid arthritis N Engl J Med 350 25 2572 2581 doi 10 1056 NEJMoa032534 PMID 15201414 Upchurch Katherine S Kay Jonathan 2012 Evolution of treatment for rheumatoid arthritis Rheumatology 51 suppl 6 vi28 vi36 doi 10 1093 rheumatology kes278 PMID 23221584 Norsk forening for revmakirurgi Med hovedbase pa Diakonhjemmet LB Johannessen Tidsskr Nor Laegeforen 2004 124 3110 Nr 23 2 December 2004 Rheumakirurgi Archived 2016 01 18 at the Wayback Machine Arne Skredderstuen November 2000 Den sykehusmessige revmatikeromsorgen i Norge Kass and Stene 1970 page 24 Surgery for Rheumatic Diseases Cedars Sinai http www cedars sinai edu Revmatisme Gamle plager ny viten Munthe and Larsen 1987 page 49 Den sykehusmessige revmatikeromsorgen i Norge Kass and Stene 1970 pages 24 25 Rydholm U Reumakirurgiens uppgang stabilisering og nedgang ur ett sydsvenskt perspektiv 2013 Trender i revmakirurgisk behandling av pasienter med leddgikt og andre kronisk inflammatoriske leddsykdommer Archived 2016 01 29 at the Wayback Machine Norsk Rheumabulletin 4 2012 pages 16 17 Nikiphorou E Carpenter L Morris S et al 2014 Hand and foot surgery rates in rheumatoid arthritis have declined from 1986 to 2011 but large joint replacement rates remain unchanged results from two UK inception cohorts Arthritis Rheumatol 66 5 1081 9 doi 10 1002 art 38344 PMID 24782174 S2CID 25813985 a href Template Cite journal html title Template Cite journal cite journal a CS1 maint multiple names authors list link External links EditAssociation 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 German Society for Rheumatology Retrieved from https en wikipedia org w index php title Rheumatology amp oldid 1133023041, wikipedia, wiki, book, books, library,
