When should we visit a rheumatologist?

Rheumatology is a branch of medicine within internal medicine that deals with the diagnosis and treatment of various joint diseases. Rheumatologic diseases are broadly split into several major groups: inflammatory, degenerative, connective tissue disorders, bone pathology, and metabolic diseases.

Inflammatory joint diseases are characterised by pain at rest, prolonged morning stiffness lasting more than 1 hour, and swelling in the affected joint. Such diseases include rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, also known as Bechterew’s disease.

Degenerative joint disease is osteoarthritis, also known as osteoarthrosis. Older patients often refer to it as “spikes.” A characteristic manifestation of osteoarthritic pain is discomfort that arises after physical exertion but diminishes during rest. Another symptom of the condition is brief morning stiffness. Swelling in the joints is rarely observed. Osteoarthritis occurs in almost everyone after a certain age, typically above 45-50 years old.

Connective tissue disorders affect various organs and systems such as joints, skin, heart, lungs, kidneys, and others. Depending on the stage at which are diagnosed, these disorders can progress mildly, moderately, severely, or life-threateningly. They are called autoimmune diseases because the body produces antibodies that are directed against its own tissues. Diseases in this group include systemic lupus erythematosus, scleroderma, polymyositis, various vasculitides, and others.

One of the most commonly encountered bone pathologies is osteoporosis. This disease is treated by several medical specialties including rheumatology, endocrinology, obstetrics, and gynaecology. Osteoporosis is primarily observed among elderly women who have been in menopause for at least three years. Patients with this condition are typically slender, with fair skin, hair, and eyes. Often, osteoporosis may be accompanied by a thyroid gland disorder. These patients usually do not complain of symptoms. When a patient reports bone pain and loss of height in their medical history, the diagnosis is almost certain. Osteoporosis is a condition where there is a reduction in the quantity of bone cells, leading to decreased bone mass. Patients with this disease are at risk of fractures (breaks) from falls, carrying heavy objects, and sometimes even from sneezing. Osteoporosis can occur due to prolonged treatment with corticosteroids for another condition.

A commonly encountered metabolic disorder treated by rheumatologists is gout. It involves a disturbance in purine metabolism, resulting in increased production of uric acid. Elevated levels of uric acid are known as hyperuricemia. When a patient experiences sudden onset pain, swelling, and redness in a specific joint, it is called a gout flare-up or attack. During an attack, any joint in the body can be affected but it typically starts in the big toe. Gout is not life-threatening but can be very uncomfortable for the patient, especially during attacks.
It’s important for patients with gout to consult a rheumatologist, who can prescribe appropriate treatment and provide recommendations for a suitable diet.

In summary: if you experience symptoms such as joint pain, swelling, limited movement, stiffness, seek medical help. Each patient’s treatment is individual, and it is not advisable to borrow therapies from similar cases. If necessary, share your specific complaints with your personal doctor so that they can refer you to a specialist like a rheumatologist.

At Medical Center Hera, Sofia branch, you can be examined by Dr. Sarita Kostova, a rheumatologist.