Rheumatologist

• Juvenile arthritis

  What is juvenile arthritis?

  Juvenile arthritis, otherwise known as paediatric rheumatic disease, is a term used to describe a number of autoimmune and inflammatory diseases that can develop in children. The tissue on the inside of the joints (synovium tissue) can become inflamed due to a fault with the autoimmune system, which usually protects the body, where the immune system attacks the synovium tissue.

  

   

  What are the causes of juvenile arthritis?

  Juvenile arthritis is idiopathic, meaning no cause is known, though it is thought to be genetic, or triggered by certain infections or environmental triggers though no evidence has been discovered to support this.

  What are the symptoms of juvenile arthritis?

  There are a number of different types of juvenile arthritis, each with differing symptoms. Common symptoms include:

  • Stiffness in the joints, which can be felt more in the morning
  • Swelling and tenderness in the joints
  • Fever
  • Rash
  • Fatigue
  • Eye redness or eye pain
  • Limping due to joint pain Irritability

  Types of juvenile arthritis:

  Juvenile idiopathic arthritis (JIA) is the most common form of arthritis found in children. This type of arthritis can appear in five different forms. These are:

  • Systemic arthritis

    Otherwise known as Still’s disease, this form of juvenile arthritis can affect the whole body. The symptoms usually include high fever and rash on the arms, legs and body. It can also affect the heart, liver, spleen and lymph nodes.

  • Oligoarthritis

    This form affects the joints, most commonly the knee, ankle and wrist, but can also affect the eyes, particularly the iris, causing redness in the eyes. This form is more common in girls than in boys.

  • Polyarthritis

    Also attacks the joints, but can feature in more joints in the first six months than in oligoarthritis. The joints affected are usually the same joints on either side of the body, and often affects the head and neck as well as the hands and feet. This form of juvenile is the most similar to adult arthritis, and is more common in boys than in girls.

  • Psoriatic arthritis

    This is linked to the skin condition psoriasis, and presents alongside the skin condition. This can often show in the fingernails, which appear pitted.

  • Enthesitis-related arthritis

    This form of juvenile arthritis affects the spine and hips, as well as the eyes. It attacks the entheses, which are where the tendons join the bones. This form of arthritis is more common in boys over the age of 8.

  Treatment for juvenile arthritis:

  Though there is no cure for juvenile arthritis, it can be treated until it goes into remission, and many forms of juvenile arthritis don’t last into adulthood. Treatment options include medication, physical activity, healthy eating and taking good care of the eyes if they become affected.

• Lupus

  What is lupus?

  Lupus is a disease that damages the immune system; that is, your own immune system mistakenly attacks healthy cells and tissues. This can cause damage to many parts of the body, including the joints, skin, kidneys, heart, lungs, blood vessels, and brain.

  There are different types of lupus:

  • Systemic lupus erythematosus: This is the most common type and it may be mild or acute and can damage many parts of the body.
  • Discoid lupus: This type of lupus causes a rash on the skin that won't go away.
  • Subacute cutaneous lupus: Causes blisters after exposure to the sun.
  • Drug-induced lupus: This is caused by some medications. The disease usually disappears when you stop taking the medication in question.
  • Neonatal lupus: This affects newborns, but it is not common. It may be caused by certain antibodies in the mother’s body.

  

  Prognosis of the disease:

  We have not yet found a cure for lupus; a disease that can still be fatal for some. However, if treatment is successful it is rare for a person to die from lupus. Around 80-90% of people diagnosed with lupus live for more than 10 years after learning they have the disease. In addition, people who have some organs affected by the disease, but whose life is not at risk, usually live a completely normal life if they follow the advice of their specialist, which is to take prescription medications and to seek help if there are undesirable side-effects, or if new symptoms of the disease appear.

  Symptoms of lupus:

  Lupus can have a variety of symptoms depending on the individual. The most common symptoms are:

  • Pain or swelling in the joints
  • Muscle pain
  • Fever
  • Red rashes on the skin, mostly on the face and in the form of a butterfly
  • Chest pain when breathing deeply
  • Hair loss
  • White or purple fingers or toes
  • Sunlight sensitivity
  • Swelling in the legs or eye area
  • Sores in the mouth
  • Swollen glands
  • Feeling of tiredness.

  These symptoms can be intermittent and are referred to as “outbreaks”. These outbreaks may be mild or severe and new symptoms may appear at any time.

  Medical tests for lupus:

  As with the symptoms, there is no single test to diagnose lupus, because it can sometimes be confused with other diseases. It can take months or years for a specialist to diagnose lupus. Some of the medical tests that the specialist may use to diagnose lupus include:

  • A detailed evaluation of someone’s medical history
  • Full physical examination
  • Blood tests
  • Skin biopsy
  • Kidney biopsy

  What causes lupus?

  The cause of lupus and its risk factors are currently unknown. Anyone can get lupus, but women are at a higher risk for the disease. Lupus is two to three times more common in African-American women than in white women. Hispanic, Asian and Native American women are also more likely to develop lupus. African-American and Hispanic women are more susceptible to the most severe types of lupus.

  Can lupus be prevented?

  Lupus can occur without any symptoms, so it is difficult to know if it can be completely prevented during a person's lifetime. The best thing you can do to reduce the chances of developing lupus is to follow a balanced diet and to exercise regularly, i.e. have a healthy lifestyle.

  • Taking care of your diet: By eating the right foods and eating a healthy diet you can prevent inflammation of the organs, which is one of the main symptoms of lupus.
  • Exercise: Staying active and avoiding a sedentary lifestyle can help you build strength, control your weight and even improve your mood. Check with your specialist about the type of exercise you can do, because the organs affected by lupus could complicate the practice of some exercises.
  • Take supplements: These can add nutritional value to your diet and can also help reduce inflammation throughout your body. Krill oil, for example, contains nutrients that can improve your cardiovascular health if taken regularly.

  Treatments for lupus:

  There is no treatment to cure lupus, but medication and lifestyle changes can help control the disease. The aims of each treatment are to:

  • Prevent outbreaks
  • Treat symptoms as soon as they appear
  • Reduce organ damage and other problems.

  Treatments may be accompanied by medication for:

  • Reducing inflammation and pain
  • Preventing or reducing outbreaks
  • Boosting the immune system
  • Preventing or reducing joint damage
  • Balancing hormones.

  In addition to taking medicine for lupus, you may need to take medicine for other problems related to lupus, such as high cholesterol levels, high blood pressure, or infections. There are alternative treatments that take a completely different path to conventional treatments. However, there is currently no medical research regarding current, useful alternative therapies to combat lupus. Some alternative or complementary approaches may help improve the quality of life of those with a chronic illness like this. Before undertaking any alternative treatment, you should consult a specialist.

  Which specialist treats lupus?

  People with lupus will see several different doctors. Including, a primary care doctor, dermatologists, cardiologists, pain specialists, to name a few.

• Dermatomyositis

  Dermatomyositis is a disease characterized by inflammation of the muscles and the presence of skin rashes. Symptoms may include pain and stiffness in muscles, muscle weakness, difficulty breathing, difficulty swallowing food, and rashes. The treatment includes taking corticosteroids and drugs that suppress the immune system, as well as doing moderate exercise. If the condition is associated with cancer, known as paraneoplastic dermatomyositis, the solution is to remove the tumour. There is also a version of this disease that affects children, called juvenile dermatomyositis.

• Arthritis

  What is arthritis?

  Arthritis is a disease that causes inflammation of the membrane that covers the joints. There are more than 100 different types of arthritis, but the most common are:

  • Osteoarthritis: the most common type of arthritis. It usually starts with age and affects the fingers, knees and hips. In some cases, it develops in areas where there was a previous hit or injury.
  • Inflammatory arthritis: There are many types of inflammatory arthritis, the most common of which is rheumatoid arthritis, which occurs when the body's defenses do not work properly. It affects both joints and bones, often in the hands and feet.

   

  What are the symptoms of arthritis?

  The symptoms of arthritis can be:

  • Joint pain
  • Joint inflammation
  • Redness and heat of the skin around the joint
  • Decreased ability to move the joint
  • Joint stiffness, especially in the morning

   

  What are the causes of arthritis?

  This pathology can be a consequence of:

  • Bone fracture
  • Autoimmune disease
  • Infection by bacteria or viruses
  • Joint wear
  • Crystals (such as uric acid or calcium pyrophosphate dihydrate)

   

  Can arthritis be prevented?

  Joint damage can be prevented with timely and adequate diagnosis and treatment. Also, if someone has a family history it is important to talk with the doctor, even if s/he does not have any symptoms. It is also recommended to avoid repetitive and excessive movements to prevent osteoarthritis.

   

  What is the treatment for arthritis?

  The treatment aims to alleviate the symptoms and prevent the disease from getting worse. The treatment can be covered by several aspects:

  • Lifestyle changes: this is the preferred treatment, since exercises help to reduce pain and fatigue, relieve stiffness and improve muscle and bone strength. The doctor can also recommend physiotherapy. Other measures may include sleeping 8-10 hours a day, not staying in the same position for a long time, eating a healthy diet, avoiding alcohol and tobacco, among others.
  • Medicine: can be added to the changes in lifestyle.
  • Surgery: is performed if the other treatment methods have not worked. The main intervention is arthroplasty, which consists of replacing the affected joint with an artificial one.
• Hypermobility

  What is joint hypermobility?

  Joint hypermobility, also called hypermobility or Ehlers-Danlos syndrome is a hereditary disorder that occurs when a person has greater flexibility in joints, tendons, muscles and cartilage.

  

  What are the symptoms?

  This disorder can produce symptoms such as the following:

  • Backaches and scoliosis
  • Pain in muscles and joints, such as the knees, fingers, hips and elbows
  • Muscle stiffness and spasms
  • Easy predisposition to bruising
  • Dislocations
  • Symptoms outside the joints, such as varicose veins, hernias or stretchy skin

  Why does hypermobility occur?

  The exact cause of joint hypermobility is unknown, however, it has been confirmed that genetics play a major role. It is thought that a genetic mutation in the collagen fibres that affect the elasticity of tendons, ligaments, the skin and blood vessels causes the condition. Hypermobile joints are often referred to as loose joints and those with the condition are referred to as being “double jointed”.

  Can it be prevented?

  As the disorder is genetic in nature, it cannot be prevented, but complications can be avoided. Exaggerated flexion of the wrists or joints in the fingers should be avoided, that is, the fingers and the wrists shouldn’t be overextended or cracked. High-impact exercises should also be avoided.

  What is the treatment?

  Currently, there is no specific cure, but the effects can be mitigated with drugs (analgesics and non-steroidal anti-inflammatory drugs) and low-impact exercises, such as yoga or swimming. Improving muscle strength to protect the joints is vital, so your doctor may recommend occupational therapy or physiotherapy sessions to help with symptoms. You can also take home measures to reduce pain and stiffness by keeping joints warm, such as having warm baths and using deep heat creams.

• Pain treatment

  What is pain management?

  Pain management is an interdisciplinary branch of medicine, which aims to improve quality of life for patients with chronic pain by reducing their suffering. It aims to relieve long-term pain, and may be administered by a single doctor, or a pain management team, consisting of different specialists. It can involve pharmacological or psychological treatments, or a combination of both.

  

  Why would you need pain management?

  While many branches of medicine focus on diagnosing and treating injuries and pathologies and treating the symptoms and pain during the healing process, pain management is needed when the pain persists after the injury or disease has healed. If the cause of the pain is not clear, relieving it becomes the objective. Patients with chronic (long-term) pain are the usual recipients. Types of pain that often require management include chronic back pain and headaches.

   

  What does it involve?

  There are many types of treatments to manage pain, which can be roughly divided into three categories: physical, psychological, and medicinal.

  Physical treatments include physiotherapy, therapeutic physical exercise, the application of heat and/or ice, acupuncture, electrotherapy, and various interventional procedures, such as facet joint injections and spinal cord stimulation. Different sufferers may find different things help relieve their pain, such as massage therapy. Some treatments may have a psychological element, including the placebo effect.

  Psychological treatments, such as cognitive behavioural therapy (CBT) and hypnosis have been used to treat pain, with varying reports on the efficacy. Studies have shown a small improvement in mood after CBT, but there is insufficient evidence to definitively say that it relieves pain. Similarly, studies on the effects of hypnosis have been limited, but shows signs of improvement. Some believe it the effectiveness of psychological treatments may be based on the placebo effect.

  Medicinal treatments involves different kinds of drugs – mainly painkillers and anti-inflammatories. The type of drug depends on the location, severity, and probable cause of the pain. For example, mild pain can be managed with over-the-counter painkillers, while severe pain (after injury or surgery, for example) may be treated with opioids. Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used, and for conditions like fibromyalgia, antidepressants may be prescribed.

  Due to the multi-disciplinary nature of the specialty, a pain management team can consist of medical practitioners, nurse practitioners, physiotherapists, psychologists, and other mental health therapists.