ABOUT RHEUMATOLOGY

Rheumatology covers diseases where the immune system becomes over-active leading to generalised inflammation in the body.  This leads to people experiencing, often severe, joint and muscle pain with stiffness, which is generally much worse at night and first thing in the morning. Some people develop joint swelling, heat, and tenderness. Others have rashes brought on by sunshine, some have very dry mouths and eyes, most experience considerable fatigue.

 

The commonest conditions seen by Rheumatologists include Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis, Gout, Polymyalgia Rheumatica and Temporal Arteritis. Connective Tissue Diseases such as SLE (Systemic Lupus Erythematosis), Scleroderma, Sjogrens Syndrome and Vasculitis are also covered. 

 

Other problems Rheumatologists deal with include back and neck pain, shoulder pain, knee pain, foot and ankle pain, elbow, wrist and hand pain. Rheumatologists also work in sports medicine and treat people with Fibromyalgia.  They also inject joints and tendon sheaths to settle pain and reduce swelling and inflammation

WHAT IS RHEUMATOLOGY?
What is Rheumatoid Arthritis?

This is an inflammatory joint condition where the immune system has become overactive leading to joint pain, stiffness and swelling, generally much worse at night and early morning. 

 

Matters often improve with movement and also as the day goes on. Anti-inflammatory medications such as Ibuprofen can be helpful.

 

It can affect people at any age but occurs more frequently in women, especially after giving birth, around the time of the menopause but also increases with age. It is far more common in men after the age of 60. 

 

It does run in families to a small degree. It is thought that certain factors can trigger it, including smoking, extreme physical or mental stress and other illnesses such as a chest infection or an episode of diarrhoea and vomiting.

 

There are many new treatments for Rheumatoid arthritis that can settle down most of the symptoms and in many cases put the disease into remission.

Many of the symptoms of Psoriatic Arthritis are similar to Rheumatoid Arthritis including joint pain, stiffness and swelling, generally much worse at night and early morning. Psoriatic Arthritis is also thought to be related to an overactive immune system.

 

Most people with Psoriatic Arthritis also have Psoriasis (a scaly skin rash) or alternatively a close family relative has Psoriasis. 

 

Some people with Psoriatic Arthritis also have a very stiff and painful back that is much worse at night and first thing in the morning and much better with movement. 

 

Some people have a close relative with Ankylosing Spondylitis and sometimes a relative with inflammatory bowel disease such as Crohn’s Disease or Ulcerative Colitis.

 

It can affect people at any age; men and women are affected fairly equally.

 

Symptoms often improve with movement and also as the day goes on. Anti-inflammatory medications such as Ibuprofen can be helpful.

 

Psoriatic Arthritis does run in families to a small degree. It is thought that certain factors can trigger it, including smoking, extreme physical or mental stress and other illnesses such as a chest infection or an episode of diarrhoea and vomiting.

 

There are many new treatments for Psoriatic arthritis that can settle down most of the symptoms and in many cases put the disease into remission.

What is Psoriatic Arthritis?
What is Ankylosing Spondylitis?

Most people with Ankylosing Spondylitis have a very stiff and painful back that is much worse at night and first thing in the morning and much better with movement. 

 

Symptoms often improve with movement and also as the day goes on. Anti-inflammatory medications such as Ibuprofen can be helpful.

 

It often comes on in late teens or twenties/early thirties but can occasionally occur when over 40.

 

Some people have Psoriasis (a scaly skin rash) or alternatively a close family relative has Psoriasis. Others have a close relative with inflammatory bowel disease such as Crohn’s Disease or Ulcerative Colitis. 

 

Ankylosing Spondylitis does run in families and it is thought that certain factors can trigger it, including smoking, physical injury or stress and other illnesses such an episode of diarrhoea and vomiting.

What is SLE (or Lupus or Systemic Lupus Erythematosis)?

SLE is rare condition where the immune system malfunctions that may lead to:

 

  • Muscle and joint pain

  • Tiredness

  • Rashes, especially on the face, coming on in sunshine

  • Raynaud’s Syndrome

  • dry eyes and dry mouth

  • sometimes the heart, lungs, kidneys or gut can be involved

  • occasionally muscles or nerves can be affected

 

This condition cannot be cured but can be helped by treatments so it is important to diagnose it as soon as possible

Scleroderma is rare condition where the immune system malfunctions leading to:

 

  • skin thickening, especially of fingers / hands

  • sometimes calcium deposits over the fingertips

  • Raynaud’s Syndrome leading, occasionally, to fingertip ulcers,

  • facial skin rash (called telangiectasia)

  • dry eyes and dry mouth

  • occasionally the heart, lungs, kidneys or gut can be involved

 

 

This condition cannot be cured but can be helped by treatments so it is important to diagnose it as soon as possible

What is Scleroderma?
What is Sjogren’s Syndrome?

Sjogren’s Syndrome is rare condition where the immune system malfunctions leading to:

 

  • Muscle and joint pain

  • Tiredness

  • Raynaud’s Syndrome

  • dry eyes and dry mouth

  • occasionally enlarged lymph nodes

  • sometimes the heart, lungs, kidneys or gut can be involved

  • occasionally muscles or nerves can be affected

  • sometimes rashes on the lower legs can occur

What is Myositis (including Dermatomyositis or Polymyositis)?

Myositis is rare condition and causes inflammation of muscles, generally leading to muscle pain, stiffness and most importantly, weakness that can get worse and worse if treatment is not started.  It is usually caused by an over active immune system.  There are two main types of immune mediated myositis called:

 

  • Polymyositis (i.e. myositis in many muscles)

  • Dermatomyositis – muscle inflammation and a rash

 

Both types need to be diagnosed and treated quickly. Initial treatment is with steroids.

What is Gout?

Gout causes joint inflammation leading to severe pain, swelling, heat and redness.  The inflammation is caused by uric acid crystals in the joints.  The joint inflammation generally lasts for up to 10 days but is usually at its worst for 2 -3 days.  The commonest joints involved are big toe joints, although many other joints can be affected including ankles, knees, finger joints, wrists, elbows etc.

What is Pseudogout?

Pseudogout is very like gout but caused by different crystals (Calcium Pyrophosphate) in the joints. The crystals cause inflammation in the joints and this leads to severe pain, swelling, heat and redness. This generally lasts for up to 10 days but is usually at its worst for 2 -3 days. It is often wrist, shoulder and knee joints that are affected and joints with osteoarthritis.

What is Osteoarthritis (or OA)?

Almost all of us develop Osteoarthritis as we get a little older. It can affect many joints and also the back and neck.

 

It is not always painful and often occurs gradually and may not be noticed.  Only some joints need to be replaced or have surgery.

 

Osteoarthritis occurs as the joint wears out a little, then tries to repair itself and as a result often lays down extra bone around the joint. This can be seen very clearly in Osteoarthritis of finger joints. This is often described as ‘Nodal Osteoarthritis’ because of the extra bone around these joints look like ‘nodes’.

 

People who have damaged joints in the past (such as damage to the cartilage of a knee joint) are more prone to develop Osteoarthritis in that particular joint. However, many people develop Osteoarthritis ‘out of the blue’; it is not always about joint damage

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@2018 Devon Rheumatology

Dr. Kirsten Mackay MD FRCP

Consultant Rheumatologist and Physician