Rheumatology and Rheumatic Diseases

Rheumatic diseases affect your joints tendons, ligaments, bones, and muscles. Among them are many types of arthritis, a term used for conditions that affect your joints.

Sometimes they’re called musculoskeletal diseases. Common symptoms include:

• Joint pain
• Loss of motion in a joint or joints
• Inflammation -- swelling, redness, and warmth in a joint or affected area

The medical field that studies these types of conditions is called rheumatology. If your regular doctor thinks you have a rheumatic disease, they’ll probably send you to a rheumatologist -- a doctor who’s specially trained to treat them.

Your rheumatologist will examine you to diagnose your condition, then oversee a treatment plan for you that will likely include medications, regular exercise, a healthy diet, stress management, and rest.

Common Rheumatic Disorders

Years ago, conditions like this fell under the broad heading of rheumatism. Now there are more than 200 distinct rheumatic diseases. Among the most common ones are:

• Osteoarthritis
• Rheumatoid arthritis (RA)
• Lupus
• Spondyloarthropathies -- ankylosing spondylitis (AS) and psoriatic arthritis (PsA)
• Sjogren’s syndrome
Gout
• Scleroderma
• Infectious arthritis
• Juvenile idiopathic arthritis
• Polymyalgia rheumatica

What Causes Rheumatic Disease?

Most of these conditions happen when your immune system goes awry and attacks your own tissues. Doctors aren’t sure what causes this. Sometimes it’s in your genes. Other times it’s a result of something in the world around you, like cigarette smoke, pollution, or something that causes an infection. Gender also plays a role -- rheumatic diseases seem to affect women more than men.

What to Expect When You Have a Rheumatic Disease

• Osteoarthritis (OA)

What it is: Unlike most rheumatic diseases, osteoarthritis isn’t linked to problems with your immune system. It results from damage to cartilage, the cushiony material on the end of your bones. As it wears down, your joints hurt and become harder to move. It usually affects the knees, hips, lower back, neck, fingers, and feet.

Symptoms:

Pain
• Swelling
• Warmth
• Stiffness

Muscle weakness can make joints unstable. Depending on what parts of the body it affects, OA can make it hard to walk, grip objects, dress, comb your hair, or sit.

Diagnosis: Your doctor will ask about your medical history and symptoms. You’ll also get a physical exam.

Usually by the time someone with OA seeks treatment, there are changes visible on an X-ray of the joint. The X-ray may show narrowing of the joint space or the presence of bone spurs. In some cases, your doctor might request an MRI (magnetic resonance imaging) to provide a picture of the inside of your joint.

• Rheumatoid Arthritis (RA)

What it is: RA happens when the immune system attacks your own tissues and causes joint pain, swelling, and stiffness. It’s not part of normal aging.

Symptoms:

• Pain and swelling in multiple joints (usually the same joints on both sides of your body, like both wrists or both ankles)
• Problems in other organs such as the eyes and lungs
• Joint stiffness, especially in the morning
• Fatigue
• Lumps called rheumatoid nodules

Diagnosis: You’ll get a checkup and tell your doctor about your health history. The doctor may take X-rays and samples of your joint fluid. They’ll do blood tests that look for different signs of inflammation. These include:

• Antinuclear antibody (ANA)
• Anti-cyclic citrullinated peptides (anti- CCP)
• Complete blood count
• C-reactive protein (CRP)
• Erythrocyte sedimentation rate (ESR)
• Rheumatoid factor (RF)

• Lupus

What it is: Lupus (also called SLE or systemic lupus erythematosus) is an autoimmune disease. It can affect many organs in your body.

Symptoms:

• Joint pain
• Fatigue
• Joint stiffness
• Rashes, including a "butterfly" rash across the cheeks
• Sun sensitivity
• Hair loss
• Blue or white fingers or toes when exposed to cold (called Raynaud's phenomenon)
• Problems in other organs such as the kidneys
• Blood disorders, such as anemia and low levels of white blood cells or platelets
• Chest pain from inflammation of the lining of the heart or lungs
• Seizures or strokes

Diagnosis: Your doctor will ask about your medical history, do a physical exam, and order lab tests of blood and urine samples. Blood tests for lupus include:

• Antinuclear antibody test (ANA). Most people with lupus have a positive ANA blood test.
• Anti-double stranded DNA antibody (Anti-dsDNA)
• Anti-Smith antibody (Anti-Sm)

• Ankylosing Spondylitis

What it is: Ankylosing spondylitis usually starts gradually as lower back pain. It usually involves the joints where the spine attaches to the pelvis, known as the sacroiliac joints.

Ankylosing spondylitis is more common in young men, especially from the teenage years to age 30.

Symptoms:

• Gradual pain in the lower back and buttocks
• Lower back pain that worsens and works its way up the spine
• Pain felt between the shoulder blades and in the neck
• Pain and stiffness in the back, especially at rest and when getting up
• Pain and stiffness that get better after activity
• Pain in the middle back and then upper back and neck (after 5-10 years)

If the condition worsens, your spine may become stiffer. It may become hard to bend for everyday activities.

Diagnosis: Your doctor will give you a physical exam and ask you about your medical history. You may get X-rays of your back, looking at the sacroiliac joints. A blood test for a protein called HLA-B27 may help confirm a diagnosis.

Get more information on ankylosing spondylitis symptoms, causes, and treatment.

• Sjogren's Syndrome

What it is: Sjogren's syndrome causes parts of your body to dry out, like the eyes or mouth. Some people also have RA and lupus. Others just have Sjogren’s. The cause is unknown, but it happens when your immune system attacks those body parts. It's more common in women than men.

Symptoms:

• Dry eyes (the glands in your eyes don’t make enough tears)
• Eye irritation and burning
• Dry mouth (the glands in your mouth don’t make enough saliva)
• Tooth decay, gum disease, or thrush
• Swollen glands on the sides of your face
• Joint pain and stiffness (rarely)
• Internal organ diseases (rarely)

Diagnosis: Your doctor will do a physical exam and ask about your medical history. You may also get other tests. To confirm the diagnosis, the doctor may do a biopsy, taking tissue from your inner lip to check in a lab.

• Psoriatic Arthritis

What is it? A form of autoimmune arthritis sometimes linked with skin symptoms of psoriasis. There are 5 types:

• Symmetric affects joints on both sides of your body. It’s the most common, and it’s similar to RA.
• Asymmetric doesn’t affect the same joints on either side. It may be milder than other forms.
• Distal affects the ends of your fingers and toes, along with your nails.
• Spondylitis affects your spine and neck.
• Arthritis mutilans attacks the small joints at the ends of your fingers and toes. It may be the most severe kind.

Symptoms: They mimic other forms or arthritis:

• Painful swollen joints
• Stiffness -- loss or range of motion
• Swollen fingers and toes -- they’re often called sausage fingers or toes
• Tendon or ligament pain
Rash
• Changes to fingernails and toenails
• Fatigue
• Inflamed eyes
• Flares -- periods of high disease activity and symptoms

Most people may have skin symptoms before they get joint symptoms. Sometimes it affects the joints first. Some people never have skin symptoms.

Diagnosis: It’s a hard disease to pin down. It can resemble RA, gout, and even osteoarthritis.

Genes play a role in this disease, so your doctor will ask about your medical history and that of your relatives. They’ll look at your joints to see if they’re swollen and inflamed, and might draw fluid from one to make sure gout or infectious arthritis isn’t the cause of your problems. They’ll also check your skin for signs of psoriasis. Imaging tests can show if you have joint damage. Blood tests for psoriatic arthritis that look for signs of inflammation include:

• C-reactive protein
• Erythrocyte sedimentation rate
• Rheumatoid factor -- people with psoriatic arthritis almost always test negative

• Gout

What is it? A buildup of uric acid crystals in a joint. Most of the time, it’s your big toe or another part of your foot.

Symptoms: They almost always come on quickly. You’ll notice:

• Intense joint pain: It’ll probably be in your big toe, but it could also be in your ankles, knees, elbows, wrists, or fingers.
• Discomfort: Even after the sharp pain goes away, your joint will still hurt.
• Inflammation and redness: The joint will be red, swollen, and tender.
• Trouble moving: Your joint will be stiff.

Diagnosis: Gout can look like a lot of other diseases. Your doctor will ask if you have:

• Sudden joint pain, often at night
• One or two joints affected
• Pain-free times between attacks

Lab tests for gout include:

• Synovial fluid analysis -- to check for uric acid crystals in your joint
• Uric acid -- looks for high levels in your blood
• Basic metabolic panel -- checks how well your kidneys work
• Complete blood count (CBC) -- looks for white blood cells to rule out other conditions
• Tests for inflammation like rheumatoid factor and anti-nuclear antibodies

Find out more about gout symptoms, causes, and treatment.

• Scleroderma

What is it? It means hard skin. There are two conditions:

Localized scleroderma is the most common type affecting children. About 90% of children are diagnosed between the ages of 2 - 14. About the same number of adults also get this type of scleroderma. They are typically diagnosed in their forties. This type can harden skin and everything beneath it, including fat, connective tissue, muscle, and bone.

Systemic sclerosis can affect many body parts, from skin and blood vessels to organs, muscles, and joints.

Symptoms depend on the type you have. They can include:

• Calcium lumps under your skin
• Digestive trouble
• Dry mouth, eyes, skin, or vagina
• Heart, kidney, or lung problems
• Stiff, swollen, warm, or tender joints
• Weak muscles
• Thickened skin on your fingers
• Raynaud’s phenomenon -- low blood flow to fingers and toes that may make them turn blue
• Telangiectasia, small dilated blood vessels you can see through your skin

Diagnosis: The doctor will ask about your medical history and your current symptoms. They’ll probably do blood tests to look for antibodies (proteins) linked to scleroderma. These include:

• Antinuclear antibody (ANA)
• Centromere antibody (ACA)/centromere pattern
• Scl-70 antibody

Get more information on scleroderma diagnosis and treatment.

• Infectious Arthritis

What is it? Arthritis caused by an infection in a joint.

Symptoms: They start quickly. Look for:

• Intense joint swelling and pain
• Usually only one joint affected
• Most likely in your knee, but it can also affect your hips, ankles, and wrists

Diagnosis:

Your doctor will do a complete physical exam and ask about your medical history. They might take a sample of fluid from the joint to figure out what’s causing the infection. They might also X-ray the joint or do other imaging tests, like an MRI or ultrasound, to see if there’s any damage.

Learn what to expect during a joint fluid test.

• Juvenile Idiopathic Arthritis

What is it? The most common form of arthritis in children. The child’s immune system mistakenly attacks its own tissues, causing inflammation in joints and other organs and systems.

Symptoms: The most common joint symptoms include:

• Joint pain
• Swollen joints
• Fever
Rash

Diagnosis: The doctor will ask about your child’s health history to figure out how long they have been having symptoms. Then they will check the child's joints for swelling, redness, and range of motion. They’ll probably do blood tests that look for different signs of inflammation. These include:

• Anti-cyclic citrullinated peptides (anti-CCP)
• Antinuclear antibody (ANA)
• Complete blood count
• Erythrocyte sedimentation rate (ESR)
• HLA-B27
• Rheumatoid factor (RF)

• Polymyalgia Rheumatica

What is it? An inflammatory condition that mostly affects older adults.

Symptoms: They can come on slowly or suddenly:

• Stiffness that’s worse in the morning and after sitting or lying still
• Fever
• Poor appetite
• Weight loss
• Pain and stiffness in at least two of the following body parts: ButtocksHipsNeckThighsUpper arms and shoulders

• Buttocks
HipsNeck
• Thighs
• Upper arms and shoulders

Diagnosis: It isn’t easy. The doctor will ask about medical history and do a physical exam. Then they’ll do blood tests to look for different signs of inflammation. The goal is to rule out other autoimmune conditions like lupus and rheumatoid arthritis. Tests include:

• Anti-cyclic citrullinated peptides (anti-CCP)
• Antinuclear antibody (ANA)
• Complete blood count
• C-reactive protein
• Erythrocyte sedimentation rate (ESR)
• Rheumatoid factor (RF)

• Reactive Arthritis

What is it? Arthritis caused by an infection in another part of your body, like your intestines, genitals, or urinary tract.

Symptoms: Are usually mild at first. You may not notice them for a few weeks. They can come and go for weeks or months.

The urinary tract is often the first place affected, though women may or may not notice symptoms here. They include:

• Pain when you pee
• The need to go more often

Eyes are the next place symptoms appear. You’ll notice:

• Redness
Pain
• Irritation
• Blurry vision

Joints are often the last affected area. Watch for:

• Painful, swollen knees, ankles, feet, or wrists
• Swollen tendons (tendinitis)
• Swelling where tendons attach to bones (enthesitis)
• Pain in your lower back or buttocks
• Inflammation in your spine (spondylitis) or the spot where your pelvis and spine connect (sacroiliitis)

Diagnosis: Your doctor will discuss your medical history and current symptoms. They’ll look for signs of joint inflammation and test your range of motion. They’ll look at your eyes, skin, and pelvic/genital area. They’ll take X- rays of your joints, pelvis, and spine to check for swelling, joint damage, and other signs of reactive arthritis. They’ll also take a swab from your urethra (if you’re a man) or your cervix (if you’re a woman) to help spot signs of the disease. A sample of fluid from your joint can help rule out other conditions. So can lab tests on your pee and poop. Blood tests can show signs of inflammation, including:

• Erythrocyte sedimentation rate
• C-reactive protein
• Complete blood count
• HLA-B27

Read more on: rheumatoid arthritis