The medical specialty of rheumatology classically covers problems with joints, but has really expanded to include other problems over the last two decades. The expanded problems that rheumatologists cover include bone problems such as osteoporosis and often includes problems with persistent pain, which other specialties may have struggled to deal with for patients.
Broadly speaking, joints problems fall into two categories. Inflammatory types of joint pain and mechanical type of joint pain. We all, to a greater or lesser extent, suffer with mechanical joint pain as because our joints deteriorate with age. However, some individuals and populations may suffer with mechanical joint pain in differing extents and in different distributions throughout the body.
However, the primary condition that rheumatology expertise is required for is inflammatory joint disease. These group of conditions are really a disease rather than a process. The classical example is rheumatoid arthritis (RA) but there are many other forms of inflammatory diseases which affect joints, skin, muscles and other vital organs. Examples of diseases that tend to come the way of rheumatologists include psoriatic arthritis, inflammatory muscle disease, scleroderma and lupus.
The treatment of rheumatoid arthritis and other inflammatory joint disease was really revolutionized in the last twenty to thirty years. Members of the public may have a notion that people who suffer with these inflammatory joint processes develop very disabling symptoms due to swelling, pain and deformity as the disease progresses. Fortunately, this is a very rare occurrence these days due to new types of medication and modern treatments.
Disease modifying anti rheumatic medications (DMARDS) and biological therapies are groups of medications that are able to suppress parts of an individual’s immune system and suppress the body’s inflammatory response. More recently medications known as janus kinase inhibitors (JAK inhibitors) have also been developed for patients who do not respond to, or get side effects from DMARDs and biological therapies. Long term courses of these medications are often able to significantly reduce symptoms and, therefore, limit deterioration of joints over time. Due to their broad effect, these medications are also used to control other systemic rheumatologic symptoms.
Treatment for mechanical, local problems, such as carpal tunnel syndrome, tennis elbow, golfer's elbow, neck pain and back pain may involve a combination of lifestyle changes and rehabilitation exercises, splints or local injections where symptoms dictate. When it comes on to bone disease such as osteoporosis, under a rheumatologists expertise and monitoring, treatment may include exercise and specialist medication to maintain healthy bone density.