Rheumatology (from Greek ῥεῦμα (rheûma)'flowing current') is a branch of medicine devoted to the diagnosis and management of disorders whose common feature isinflammation in the bones, muscles, joints, and internal organs.[1] Rheumatology covers more than 100 different complex diseases, collectively known asrheumatic diseases, which includes many forms ofarthritis as well aslupus andSjögren's syndrome.[1]Doctors who have undergone formal training in rheumatology are calledrheumatologists.
Many of these diseases are now known to be disorders of theimmune system, and rheumatology has significant overlap withimmunology, the branch of medicine that studies the immune system.
Arheumatologist is aphysician who specializes in the field of medical sub-specialty called rheumatology. A rheumatologist holds a board certification after specialized training. In the United States, training in this field requires four years of undergraduate school, four years of medical school, and then three years of residency, followed by two or three years of additional Fellowship training. The requirements may vary in other countries. Rheumatologists areinternists who are qualified by additional postgraduate training and experience in the diagnosis and treatment of arthritis and other diseases of the joints, muscles, and bones. Many rheumatologists also conduct research to determine the cause and better treatments for these disabling and sometimes fatal diseases. Treatment modalities are based on scientific research, currently, the practice of rheumatology is largely evidence-based.[2]
Rheumatologists treatarthritis,autoimmune diseases, pain disorders affecting joints, andosteoporosis.[3] There are more than 200 types of these diseases, includingrheumatoid arthritis,osteoarthritis,gout,lupus, back pain, osteoporosis, andtendinitis. Some of these are very serious diseases that can be difficult to diagnose and treat. They treat soft tissue problems related to the musculoskeletal system and sports-related soft tissue disorders.
Pediatric rheumatologist:A pediatric rheumatologist is a pediatrician who specializes in the treatment of children with rheumatic disease.[4] Both specialties are important to address a child's milestone development and disease treatment throughout childhood. However, recognition of this sub-specialty has been slow, which has resulted in a global shortage of pediatric rheumatologists, and as a consequence, the demand for healthcare support far exceeds current service capacities.[5] Raising awareness of this is important to attract more upcoming pediatricians into this rewarding area of healthcare.
Most rheumatic diseases are treated withanalgesics,NSAIDs (nonsteroidal anti-inflammatory drug),steroids (in serious cases),DMARDs (disease-modifying antirheumatic drugs),monoclonal antibodies, such asinfliximab andadalimumab, theTNF inhibitoretanercept, andmethotrexate for moderate to severerheumatoid arthritis.[8] The biologic agentrituximab (anti-B cell therapy) is now licensed for use in refractory rheumatoid arthritis.[9]Physiotherapy is vital in the treatment of many rheumatological disorders.Occupational therapy can help patients find alternative ways for common movements that would otherwise be restricted by their disease. Patients with rheumatoid arthritis often need a long term, coordinated and a multidisciplinary team approach towards management of individual patients. Treatment is often tailored according to the individual needs of each patient which is also dependent on the response and the tolerability of medications.
Rheumasurgery (or rheumatoid surgery) is a subfield oforthopedics occupied with the surgical treatment of patients withrheumatic diseases.[11] The purpose of the interventions is to limit disease activity, soothe pain and improve function.[12]
Rheumasurgical interventions can be divided in two groups. The one is earlysynovectomies, that is the removal of the inflamedsynovia in order to prevent spreading and stop destruction. The other group is the so-called corrective intervention, i.e. an intervention done after destruction has taken place.[13] Among the corrective interventions are joint replacements, removal of loose bone or cartilage fragments, and a variety of interventions aimed at repositioning and/or stabilizing joints,[14] such asarthrodesis.
Recently, a large body of scientific research deals with the background ofautoimmune disease, the cause of many rheumatic disorders. Also, the field ofosteoimmunology has emerged to further examine the interactions between the immune system, joints, and bones. Epidemiological studies and medication trials are also being conducted. TheRheumatology Research Foundation is the largest private funding source of rheumatology research and training in the United States.[citation needed]
Rheum surgery emerged in the cooperation of rheumatologists and orthopedic surgeons inHeinola, Finland, during the 1950s.[15]
In 1970 a Norwegian investigation estimated that at least 50% of patients with rheumatic symptoms needed rheumasurgery as an integrated part of their treatment.[16]
Around the turn of the 21st century, focus for treatment of patients with rheumatic disease shifted, and pharmacological treatment became dominant, while surgical interventions became rarer.[18][19]
^Butler, S., Sculley, D., Santos, D. et al. Paediatric Rheumatology Fails to Meet Current Benchmarks, a Call for Health Equity for Children Living with Juvenile Idiopathic Arthritis, Using Digital Health Technologies. Curr Rheumatol Rep (2024).https://doi.org/10.1007/s11926-024-01145-w
^Nikiphorou E, Carpenter L, Morris S; et al. (2014). "Hand and foot surgery rates in rheumatoid arthritis have declined from 1986 to 2011, but large-joint replacement rates remain unchanged: results from two UK inception cohorts".Arthritis Rheumatol.66 (5):1081–9.doi:10.1002/art.38344.PMID24782174.S2CID25813985.{{cite journal}}: CS1 maint: multiple names: authors list (link)
