Rheumatologist

The well-known term "rheumatism" was introduced by Claudius Galen, one of the leading figures in ancient medicine, who laid down the principles of diagnostics on the basis of anatomy and physiology of the human body. The designation of various diseases of the musculoskeletal system with the concept of rheumatism has come down to our days, although rheumatology became an independent section of internal medicine, that is, therapy, less than 50 years ago. A little later, there were also "narrow" specialists in this field - rheumatologists.

In this case, the quotes are justified: without knowing the fundamental knowledge of virtually all sections of internal medicine and clinical disciplines, the doctor has nothing to do in rheumatology.

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

[1], [2], [3]

Who is a rheumatologist?

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

Because the rheumatologist has a serious responsibility - diagnosis and treatment of more than two hundred different diseases of the musculoskeletal system of man, 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 with rheumatoid arthritis, systemic scleroderma or gout, only a rheumatologist can cope.

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

When should I go to a rheumatologist?

According to the official recommendations of the European Antirheumatic League (EULAR), a person should consult a rheumatologist if:

1. In the morning, after waking up, it seems to you that the joint (in the hands, shoulders or knees) is not moving well and can not be controlled. After 30-40 minutes (during which movement leads to discomfort) everything comes back to normal. If you lie down for an hour for rest, then everything can happen again ... This is a stiffness, which is the first symptom of osteoarthritis, that is, pathological changes in the cartilaginous tissue.
2. You have found that the joint has increased in size, swollen, or swelling. And this is bad, because swelling or puffiness in the area of some joint can be a symptom of the same arthritis.
3. Pain in the joint, which can start toward evening or bother you with every movement. Sometimes the pain becomes very severe, not allowing you to move normally. Such pain can indicate inflammation and the beginning of destruction of intraarticular cartilage - osteoarthritis. You should contact a rheumatologist even if you feel pain in the lateral compression of the hands and feet.

What tests should I take when I visit a rheumatologist?

A good therapist, at the slightest suspicion of any rheumatic disease, should not prescribe the "ointment from pain", but direct the patient to a specialist-a rheumatologist.

If the patient has fresh results of a general blood test, you need to take them. In addition, if you contact a rheumatologist, you will need the following tests:

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

What diagnostic methods does a rheumatologist use?

First of all, the rheumatologist listens to the patient's complaints, examines it and studies the medical history (absolutely all the pathological processes in the body). On the use in the diagnosis of laboratory blood test results eloquently testifies to the list of tests that need to be handled when referring to a rheumatologist. On their basis, the expert draws a conclusion about the activity of the inflammatory process and the state of the immune system of the patient. So, the determination of ESR will help to identify inflammation, rheumatoid arthritis is diagnosed on the basis of rheumatoid factor indices, and an accurate diagnosis in systemic lupus erythematosus guarantees data on antinuclear antibodies.

For an objective assessment of organic changes in the musculoskeletal system of the patient and the establishment of the correct diagnosis, the rheumatologist appoints such diagnostic tests as:

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

What does a rheumatologist do?

Like any other doctor, a rheumatologist conducts an examination of patients who apply to him, diagnoses, prescribes treatment and monitors his effectiveness, making adjustments based on the clinical picture of a specific disease.

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

After improving the condition of patients and relieving pain, a rheumatologist performs therapy aimed at restoring the normal functioning of the joints and connective tissues affected by the disease. To do this, a variety of physiotherapy, massage, a set of therapeutic physical training (classes conducted by special methodologists LFK). The development of joints and the normalization of motor functions can be performed with the use of various rehabilitation equipment (simulators).

What diseases does the rheumatologist treat?

In the field of clinical practice, rheumatologists include such diseases as:

• reactive arthritis (acute, rapidly progressive inflammation of the joints, which arises from the transfer of acute or exacerbation of a chronic infection);
• rheumatoid arthritis (chronic systemic disease of connective tissue with progressive lesion of peripheral joints and internal organs);
• osteoarthritis (pathology of the knee, hip and ankle joints, accompanied by changes in the cartilaginous tissue, develops after mechanical overload and dislocation of the joint surfaces);
• osteochondrosis (degenerative-dystrophic spine disease);
• osteoporosis (progressive systemic skeletal disease, which is expressed in a decrease in bone density);
• gout (acute painful swelling of the joints, associated with increased levels of uric acid in the blood);
• ankylosing spondylitis (or Bechterew's disease, chronic inflammation of the joints of the sacroiliac joints, spine and adjacent soft tissue - with persistent restriction of mobility);
• systemic sclerosis (or systemic sclerosis, a progressive disease caused by inflammation of small vessels throughout the body and leading to fibro-sclerotic changes in the skin, musculoskeletal system and internal organs).

And also: systemic lupus erythematosus, Reiter's disease, granulomatous arteritis, hydroxyapatite arthropathy, multiple reticulogistiocytosis, joint chondromatosis, vinzonodular synovitis, as well as bursitis, tendenitis, periarthritis, etc.

Advices of a rheumatologist

According to WHO, at least 15% of people around the world suffer from arthrosis - a joint disease. This is when in a joint or between vertebrae the cartilaginous layer gradually "wears out" (that is, collapses). At the same time, you hear a distinct "crunch" in the joint, feel pain and can not move freely. What leads to the appearance of arthrosis?

The key role in the appearance of this pathology of joints is played by such factors:

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

If with the last two factors (heredity and age) we are forced to just resign ourselves, then with regard to the first four prerequisites for the onset of arthrosis, we can use the following advice of a rheumatologist:

• avoid injuries (that is, be cautious in the workplace, in the gym, in the country, etc.);
• physical activity is an indispensable condition for maintaining health, but "which is too, it is not healthy";
• extra pounds - an additional burden on the musculoskeletal system and the entire musculoskeletal system: eat rationally and do not overeat. Remember: cartilage wear is irreversible, but it is possible to block it.

[4], [5], [6]