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By Jonathan D. Krant, M.D., M.P.H., F.A.C.P.
What kinds of diseases do Rheumatologists treat?
Rheumatologists manage a spectrum of illnesses ranging from simple mechanical osteoarthritis (with wear and tear changes to the large weight-bearing joints) to acute, inflammatory conditions such as systemic lupus erythematosus with multiple organ system involvement. We work closely with our colleagues in orthopedics when treating patients with osteoarthritis and are closely allied to our internal medicine colleagues in such disciplines as hematology, nephrology, pulmonary medicine and infectious disease.
With respect to osteoarthritis, rheumatologists are frequently asked to evaluate the extent to which osteoarthritis can be managed medically, with local injection to the painful knee, oral analgesic medications and dietary manipulation. We utilize physical therapy, occupational therapy, hydrotherapy, and nutrition in efforts to manage the multiple complex events of patients suffering from wear and tear arthritis. In recent years, the addition of articular injection with viscoelastic supplements (Hyalgan and Synvisc) has transformed our ability to medically manage osteoarthritis. We combined analgesic medications, ranging from Tylenol to stronger analgesic therapies in efforts to control pain and forestall total joint replacement when possible. Weight loss, aerobic activity, use of glucosomine to strengthen articular cartilage and careful attention to diet, have proven beneficial to our patients with osteoarthritis.
Inflammatory arthritis has benefitted tremendously from the recent developments in interventional rhematology. Rheumatoid arthritis has seen the addition of a class of medications which target one specific inflammatory mediator (tumor necrosis factor), inhibiting inflammation while sparing nontargeted cells and tissues. Remicaide, and infusion-based therapy taken every eight weeks in an office-based protocol, is one example of targeted therapy for rheumatoid disease. Further developments, including therapies which involve running patient serum over absorption columns (which remove inflammatory antibodies), ne infusion-based protocols targeting other inflammatory proteins, and the aggressive use of chemotherapy, borrowed from our oncology colleagues, are good examples of the new imperatives in rheumatology.
Finally, enhanced recognition of symptoms which may represent rheumotologic disease, is one of the hallmarks of the new era in rheumatology. Internists, family practice physicians, gynecologists, and pediatricians are now quick to recognize the association between fever, proximal muscle weakness, inspiratory chest pain and even recurrent urinary tract infection as features compatible with inflammatory arthritis. Children who cannot bear weight, or who complain of chronic extremity pain with swollen joints are frequently evaluated by rheumatology and found to have juvenile arthritis or inflammatory muscle disease. Adults with hair loss, eye redness, mouth ulceration or rash may also have inflammatory arthritis, including such entities as systemic lupus erythematosus, dermatomyositis or the arthritis of psoriasis. Fortunately, the addition of medications such as methotrexate, azulfidine, and the TNF inhibitors have transformed our ability to care for such patients. In the future, it is hoped that further development of therapies which target specific inflammatory cell types may help patients with rheumatologic diagnosis while sparing the complications of therapy.
Dr. Krant is a diplomate of the American Board of Internal Medicine, Certified in Internal Medicine and Rheumatology, and is a Fellow of both the American College of Physicians and the American College of Rhematology.