What is Rheumatology?
It is a pathological specialty that deals with the diagnosis and treatment of a variety of systemic autoimmune diseases, as well as musculoskeletal diseases.
Systemic autoimmune diseases may manifest as prolonged fever, weight loss, unexplained fatigue, with involvement of the eyes/ears/oropharynx/lungs/heart/kidneys/intestines and other abdominal organs/nervous system/skin and nails, vessels and accompanying pathological laboratory findings of blood cell lines (penias), increased inflammatory markers, with or without the presence of autoantibodies.
Diseases of the musculoskeletal system can occur either individually, in the context of degeneration and strain of the human body, or even as adverse drug reactions in special patient populations such as oncology patients, or in combination with systemic autoimmune diseases as inflammation of joints, muscles, implants, and tendons.
Indicatively it includes the following diseases:
Inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, gout, etc.)
Systemic autoimmune diseases (systemic lupus erythematosus, scleroderma, myositis, Sjögren's syndrome, vasculitis, etc.)
Musculoskeletal and metabolic diseases (osteoarthritis, fibromyalgia, soft tissue rheumatism, osteoporosis, etc.)
Why visit a Rheumatologist?
Usually, patients are referred by colleagues from other specialties (Internists, General Practitioners, Pulmonologists, Cardiologists, Orthopedists, etc.), either due to chronic symptoms that require further investigation, or due to specific findings associated with autoimmune diseases.
An autoimmune disease may be suspected, once common causes have been excluded, when presenting with:
-
Joint pain and/or swelling
-
Morning stiffness / difficulty making a fist
-
Low back pain lasting for more than 3 months, at an age <45 years
-
Low-grade fever or fever lasting at least 3 weeks without being attributed to an infection / periodic fever syndromes
-
Rashes associated with sun exposure / psoriasis / periodic rashes not attributed to a cause / skin hardening
-
Aphthous ulcers / genital ulcers
-
Severe hair loss leading to alopecia ("bald patches" on the head)
-
Color change in fingers upon exposure to cold (Raynaud's phenomenon)
-
Severe dry eyes (certified by an Ophthalmologist) with or without dry mouth
-
Unexplained fatigue / muscle weakness in arms and/or legs
-
Elevated inflammatory markers not attributed to a common cause
-
Low white blood cell count and/or platelets and/or anemia
-
History of multiple thromboses
-
History of multiple miscarriages / loss of a morphologically normal fetus / premature delivery / other pregnancy complications, such as preeclampsia or eclampsia
-
Family history of autoimmune disease, alongside the presence of any of the above signs/symptoms
-
Osteopenia / osteoporosis following bone density measurement
More specialized tests should preferably be carried out if the Rheumatologist deems them necessary. Preventive autoantibody testing has no place in routine practice, as the Rheumatologist treats diseases, not incidental laboratory findings.