Rheumatologist

The well-known term "rheumatism" was introduced by one of the luminaries of ancient medicine, Claudius Galen, who laid down the principles of diagnostics based on the anatomy and physiology of the human body. The designation of various diseases of the musculoskeletal system by the term rheumatism has survived to this day, although rheumatology became an independent section of internal medicine, that is, therapy, not so long ago - less than 50 years ago. A little later, "narrow" specialists in this field appeared - rheumatologists.

The quotation marks are justified in this case: without fundamental knowledge of almost all sections of internal medicine and clinical disciplines, a doctor has no business in rheumatology.

In addition, the spectrum of rheumatic diseases is so wide, and the mechanisms of development of these pathologies are so diverse that a rheumatologist must have sufficient knowledge in such areas as cardiology, nephrology, hematology, and immunology.

Who is a rheumatologist?

This is a doctor who treats "headaches in the legs"... The humorous aphorism "Rheumatism is a headache in the legs" belongs to the famous Spanish writer of the last century, Ramon Gomez de la Serna. And there is also this expression: "Rheumatism licks the joints and bites the heart." And this is without any jokes...

Because the rheumatologist has a serious responsibility - diagnostics and treatment of over two hundred different diseases of the human musculoskeletal system, that is, joints and connective tissues. You will say that for the treatment of diseases of the musculoskeletal system there are traumatologists, surgeons, orthopedists and neurologists, and you will be right. But only a rheumatologist can cope with rheumatoid arthritis, systemic scleroderma or gout.

According to statistics, joint pain affects almost 40% of the population of our planet, and the lack of timely and high-quality treatment of rheumatic pathologies in the vast majority of cases leads to disability...

When should you see a rheumatologist?

According to official guidelines from the European League Against Rheumatism (EULAR), a person should see a rheumatologist if:

1. In the morning, after waking up, it seems to you that the joint (in the arms, shoulders or knees) moves poorly and is uncontrollable. After 30-40 minutes (during which the movements cause discomfort) everything returns to normal. If you lie down for an hour during the day to rest, then everything can repeat itself... This is stiffness, which is the first symptom of osteoarthritis, that is, pathological changes in cartilage tissue.
2. You have discovered that the joint has increased in size, swelled or become edematous. And this is bad, because swelling or edema in the area of a joint can be a symptom of the same arthritis.
3. Joint pain that may begin towards evening or bother you with every movement. Sometimes the pain becomes very strong, preventing normal movement. Such pain may indicate inflammation and the beginning of destruction of intra-articular cartilage – osteoarthritis. You should also see a rheumatologist if you feel pain when squeezing your hands and feet laterally.

What tests should you take when visiting a rheumatologist?

A good therapist, at the slightest suspicion of any rheumatic disease, should not prescribe “pain ointment”, but refer the patient to a specialist – a rheumatologist.

If the patient has recent results of a general blood test, they should be taken. In addition, when contacting a rheumatologist, the following tests will be needed:

• biochemical blood test (carried out on an empty stomach, blood is taken from a vein),
• blood test for ESR (blood is taken from a finger),
• blood test and C-reactive protein (blood is taken from a vein),
• blood test for rheumatoid factor (carried out on an empty stomach),
• blood test for anticitrulline antibodies and antinuclear antibodies (immunological blood test, blood is taken from a vein).

What diagnostic methods does a rheumatologist use?

First of all, the rheumatologist listens to the patient's complaints, examines him and studies the medical history (absolutely all pathological processes in the body). The list of tests that need to be taken when visiting a rheumatologist clearly demonstrates the use of laboratory blood test results in diagnostics. Based on them, the specialist draws a conclusion about the activity of the inflammatory process and the state of the patient's immune system. Thus, determining the ESR will help to identify inflammation, rheumatoid arthritis is diagnosed based on rheumatoid factor indicators, and an accurate diagnosis of systemic lupus erythematosus is guaranteed by data on antinuclear antibodies.

To objectively assess organic changes in the patient's musculoskeletal system and establish a correct diagnosis, a rheumatologist prescribes diagnostic examinations such as:

• electrocardiogram,
• X-ray examination of joints,
• ultrasound examination (ultrasound),
• computed tomography (CT),
• magnetic resonance imaging (MRI),
• densitometry (method of diagnosing osteoporosis),
• electromyogram (study of the electrical activity of muscles).

What does a rheumatologist do?

Like any other doctor, a rheumatologist examines patients who come to him, makes a diagnosis, prescribes treatment and monitors its effectiveness, making adjustments based on the clinical picture of a particular disease.

First of all, the rheumatologist tries to stop the inflammatory process, as well as relieve or at least minimize pain. For this purpose, appropriate medications are prescribed - non-steroidal anti-inflammatory drugs and painkillers.

After the patient's condition improves and the pain syndrome is relieved, the rheumatologist conducts therapy aimed at restoring the normal functioning of the joints and connective tissues affected by the disease. For this purpose, various physiotherapy procedures, massage, and a set of therapeutic physical training (classes are conducted by special therapeutic physical training methodologists) are prescribed. Joint development and normalization of motor functions can be carried out using various rehabilitation equipment (simulators).

What diseases does a rheumatologist treat?

The scope of clinical practice of rheumatologists includes such diseases as:

• reactive arthritis (acute, rapidly progressing inflammation of the joints that occurs as a result of an acute or exacerbation of a chronic infection);
• rheumatoid arthritis (a chronic systemic disease of connective tissue with progressive damage to peripheral joints and internal organs);
• osteoarthritis (a pathology of the knee, hip and ankle joints, accompanied by changes in the cartilaginous tissue, develops after mechanical overload and damage to the joint surfaces);
• osteochondrosis (a degenerative-dystrophic disease of the spine);
• osteoporosis (a progressive systemic skeletal disease that results in decreased bone density);
• gout (acute painful swelling of the joints associated with elevated levels of uric acid in the blood);
• ankylosing spondylitis (or Bechterew's disease, chronic inflammation of the sacroiliac joints, spine and adjacent soft tissues - with persistent limitation of mobility);
• systemic scleroderma (or systemic sclerosis, a progressive disease caused by inflammation of small vessels throughout the body and leading to fibrous-sclerotic changes in the skin, musculoskeletal system and internal organs).

And also: systemic lupus erythematosus, Reiter's disease, granulomatous arteritis, hydroxyapatite arthropathy, multiple reticulohistiocytosis, chondromatosis of the joints, villonodular synovitis, as well as bursitis, tendonitis, periarthritis, etc.

Advice from a rheumatologist

According to WHO, at least 15% of people worldwide suffer from arthrosis - a joint disease. This is when the cartilage layer in a joint or between the vertebrae gradually "wears out" (i.e. is destroyed). At the same time, you hear a distinct "crunch" in the joint, feel pain and cannot move freely. What causes arthrosis?

The following factors play a key role in the development of this joint pathology:

• excessive loads,
• excess weight,
• sedentary lifestyle,
• injuries,
• heredity,
• old age.

If we are forced to simply accept the last two factors (heredity and age), then with regard to the first four prerequisites for the development of arthrosis we can use the following advice from a rheumatologist:

• avoid injuries (i.e. be careful at work, in the gym, at the dacha, etc.);
• physical activity is a prerequisite for maintaining health, but “too much is not healthy”;
• Extra pounds are an additional burden on the musculoskeletal system and the entire musculoskeletal system: eat rationally and do not overeat. Remember: cartilage wear is an irreversible process, but it is possible to block it.

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