- Rheumatic diseases
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Rheumatology is a branch of medicine that studies the diagnostics, treatment and prophylaxis of rheumatic diseases that include systemic autoimmune diseases and musculoskeletal pathology excluding those caused by trauma.
The main group rheumatic disease are as follows:
Connective tissue diseases
Rheumatoid arthritis (RA), systemic lupus erythematosus, systemic sclerosis, polymyositis/dermatomyositis, Sjögren syndrome, mixed connective tissue disease, undifferentiated connective tissue disease, systemic vasculitis (Wegener‘s granulomatosis, polyarteritis nodosa, microscopic polyangitis, Behçet disease, giant cell (or temporal) arteritis with or without polymyalgia rheumatic), etc.
Ankylosing spondylitis/Bechterew’s disease, psoriatic arthritis, Reiter’s syndrome, etc.
Osteoporosis, osteomalacia, avascular necrosis, Paget’s disease, etc.
Soft-tissue rheumatism (extraarticular disorders)
Fibromyalgia, soft tissue periarticular pathology such as tendinitis, tenosynovitis, bursitis, enthesits, etc.
Metabolic diseaseas associated with rheumatic states
Gout, crystal artropathy associated with calcium pyrophosphate dihydrate crystals, etc.
Rheumatic diseases are the most common cause of chronic pain in clinical practice and main cause for temporary disability and absence from work as well as for permanent disability and early retirement. Rheumatic diseases have high prevalence and most of them are chronic conditions. Thus, they have a major impact on individuals, and societies as well as high economic costs in all countries.
They may affect people of all ages, but some of the most common such as оsteoarthritis (OA) and osteoporosis are most common in the elderly. The demographic structure of the population indicates tendency toward older population. Thus, the management of these conditions in this age group receives greater attention.
OA is a degenerative joint disorder, characterized by progressive loss of cartilage, new bone formation in the joint margins (osteophytes) and subchondral sclerosis. It affects weight-bearing joints (knee and hip joints), spine, hand joints. The prevalence of OA increases with age. It is estimated that the prevalence of knee OA is > 30% after the age of 65.
The osteoporosis is a disease characterized by decreased bone mineral density, compromised bone microarchitecture and increased risk of fractures, vertebral, hip and distal radius fractures being the most common. The diagnosis and treatment of osteoporosis is of crucial importance as consequences of verterbral fractures include loss of height, chronic back pain, thorax deformation and reduced quality of life. Moreover, hip fractures are with worse prognosis and are associated with high mortality rate. It is estimated that one in two women and one in five men over the age of 50 years are at risk of sustaining osteoporotic fractures.
RA is a chronic multisystem, autoimmune disorder with major feature symmetrical and erosive arthritis that may affect also lung, eye, blood vessels, etc. Its prevalence is between 0.5 and 1%.
Some of the rheumatic diseases such as systemic sclerosis, polymyositis/dermatomyositis, vasculitis, etc. are rare diseases that are not well-known and the diagnosis is often delayed.
In the recent years, great progress has been achieved in rheumatology in the field of understanding the pathogenesis of autoimmune disease as well as in enrichment of the therapeutic armamentarium. Biologic drugs represent a new era in the treatment of RA and other inflammatory arthropathies and this group enriches with new molecules. In RA, it has been proved that early diagnosis and early initiation of disease-modifying treatment prevents or slows the development of joint erosions and permanent structural damage. Analogous studies for therapeutic effect of drug intervention in the early stages of the disease are ongoing in systemic sclerosis.
Patients with chronic rheumatic disease need education for coping with their disorder, to keep proper hygienic-dietetic regimen and regular follow-up in order to achieve best therapeutic outcome, to preserve their work ability and quality of life.
The treatment of the chronic rheumatic disease is a shared process between the rheumatologist and the patient. The rheumatologist should provide the opportunity for most appropriate current approach to the patients who itself should participate actively in the treatment. This may be achieved through close co-operation and adequate communication.
Dr Sevdalina Lambova, MD, PhD