A rheumatologist deals with the diagnosis, treatment and prevention of joint diseases, studies disorders of the musculoskeletal system and pathologies of infectious, autoimmune and inflammatory nature. Leading rheumatologists in Moscow work at the Yusupov Hospital. They deal in depth with problems of joints and blood vessels, as well as heart diseases associated with rheumatological processes in the body. A good rheumatologist addresses the following issues:
- Applies the most modern methods of instrumental and laboratory diagnosis of rheumatological diseases;
- Selects highly effective treatment;
- Develops individual preventive measures aimed at eliminating connective tissue pathology.
Finding a good rheumatologist in Moscow is not easy. The specialists at the Yusupov Hospital have thoroughly studied all the fundamental principles of medicine and understand all sorts of complex clinical situations. Rheumatology includes a wide range of many diseases, the manifestation of which is quite diverse. A specialist in this field must have an excellent understanding of cardiology, kidney diseases, immunology and blood diseases.
Why are joint diseases so common?
According to WHO statistics, about 20% of the world's population suffers from joint diseases. In Russia this is every fourth. And among people over 60 years old - almost everyone is the first. The situation has the character of an epidemic, albeit a hidden one, because they don’t talk about it as often as cardiovascular diseases. Why did the problem with joint diseases get out of control?
The reason is that many people refuse medical help and self-medicate. Few people go for diagnostics when symptoms appear. Most people simply turn a blind eye to periodic pain and miss the “therapeutic window” period when the treatment of osteoarthritis and other diseases would be most effective.
What are we treating?
The number of rheumatological diseases reaches hundreds, but only a few of them are quite common. The difficulty of diagnosing them is that the same disease can have many different manifestations, and different diseases can have similar symptoms. Every rheumatology patient is a mystery, and the correct placement of accents is directly related to the experience and qualifications of the doctor.
The most common symptom (not disease!) that patients present with is arthritis, a general name for joint pain and swelling. There are more than a hundred different types of arthritis and, accordingly, associated pathological conditions. It is important to distinguish between lesions of the joint itself and the periarticular tissues, since pain, swelling and stiffness are often the result of injuries that rheumatology does not directly treat.
Bones and cartilage are supporting connective tissue. This tissue mainly consists of collagen fibers, which give it rigidity, and the strength of bone tissue is given by deposits of calcium salts. On the picture:
X-ray of the hand, showing areas of bone affected by osteoporosis (
darker areas
) near the inflamed joints
“Our” disease is osteoarthritis, it is based on the thinning of cartilage, which normally performs a shock-absorbing function: in the presence of synovial (intra-articular) fluid, the coefficient of friction of two cartilaginous surfaces is 15 times lower than between two ice cubes.
The main factors in the development of osteoarthritis are old age, injury, and performing similar, frequently repetitive movements. Damage to cartilage leads to “scratching” of the periosteum by osteophytes (pathological bone growths) and stretching of the joint capsule, which causes aching pain that increases with load. Interestingly, the degree of pain does not always correspond to the degree of joint damage: 90% of people over 40 years of age have radiological evidence of osteoarthritis, but only a third of them complain of pain (Harrison, 2005). In most cases, constant treatment by a rheumatologist is not even required: it is enough to be observed by a therapist and follow the recommendations. Previously, it was believed that osteoarthritis was a completely degenerative disease, but in recent years, evidence has been obtained of the role of inflammation in the development of this pathology.
How does excessive physical activity affect the development of rheumatological diseases?
Excessive load leads to joint injury and cell damage, the “release” of various cellular antigens. And because the immune system is activated when the body tries to heal an injury, immune cells can “recognize” these antigens as “foreign.” This can trigger an autoimmune disease if there is a predisposition.
However, there are also true inflammatory arthritis. Their typical representative is rheumatoid arthritis - an autoimmune disease of connective tissue that affects mainly small joints (sometimes the lungs, hematopoietic system, and blood vessels can be involved in the process). This disease has the features of an oncological process, since it is based on the uncontrolled proliferation of the tissue of the synovial membrane lining the joints, which leads to irreversible damage to the joint.
In rheumatoid arthritis, the small joints of both hands usually become inflamed first, with simultaneous damage to the wrist joints ( above
).
Gradually, the disease leads to deformation of the fingers, as a result of which they are fixed in a half-bent position, losing the ability to straighten - a contracture is formed ( below
).
Red arrow
- contracture,
yellow arrows
- “flipper” deformation of the hands
Rheumatoid arthritis develops when there is a loss of immunological tolerance to the body's own tissues. The provoking factor is unknown, and the appearance of autoantibodies and a gradual increase in C-reactive protein, a characteristic marker of the inflammatory process, are noted several years before the first visit to the doctor. The disease begins at a young age (30–35 years), and women suffer 3 times more often than men. Genetic markers indicating a predisposition to the development of this disease are known, but they are not clearly associated with it. The mechanism of development of the disease is still unclear and is being actively studied all over the world.
After the first symptoms appear, within about six months, it is possible, if not to completely reverse the process, then at least to “suppress” it and prevent tissue destruction. Success depends on early and sufficiently serious treatment. For timely diagnosis, it is very important to pay special attention to the following signs that indicate an urgent need to visit a rheumatologist: morning stiffness for more than half an hour, swelling or tenderness of three or more joints, weakness in the hands and pain during the transverse compression test of the hand.
Rheumatoid arthritis causes extensive damage to many joints. An x-ray of the patient’s hands at a late stage of the disease shows that almost all the bones in the wrist joint have collapsed, uneven contours, deformation and narrowing of the joint spaces of the remaining joints are noticeable
Who is a rheumatologist and why is he needed?
Along with an orthopedist, a rheumatologist also deals with joint problems. The specialist examines joints and connective tissues, refers for diagnostics and develops a treatment plan. The doctor helps eliminate acute or chronic inflammation, treats arthrosis and arthritis, synovitis and tenosynovitis, and other diseases of the musculoskeletal system.
The problem is that not all clinics have a specialist in this category. With complaints of joint pain, patients often turn to a therapist or surgeon, as well as a traumatologist. If pain is present in the back or cervical region, a person may be sent to a neurologist, but rarely to a rheumatologist, where he really should be.
Even the most experienced therapist is not able to correctly diagnose chronic or rheumatic joint diseases, or determine coxarthrosis by gait. Many of them are accompanied by ambiguous symptoms - skin rash, high fever, weight loss. Only a specialist with experience in managing such patients can comprehensively assess the clinical picture and make a diagnosis.
Only a rheumatologist or orthopedist can correctly diagnose joint disease.
Rheumatologist: general specialist
Rheumatology was identified as a separate branch of medicine only about 50 years ago. Today it exists in close connection with traumatology, orthopedics, endocrinology, cardiology, nephrology, immunology, hematology, oncology, etc.
Indeed, a rheumatologist must have extensive knowledge in many medical fields - only in this case will he be able to provide comprehensive care to his patients.
One can recall the humorous aphorisms of writers of the past. For example: “Rheumatism is a headache in the legs.” Or: “Rheumatism licks the joints and bites the heart.” They are absolutely true and reflect the serious nature of rheumatological pathologies.
There is another interesting saying: “Life begins after forty, and then rheumatism begins.” However, you should not think that with the onset of adulthood, joint diseases necessarily begin. You just need to go to an appointment with a rheumatologist in advance, especially if you notice one of the unpleasant and frightening symptoms.
Are joint problems always arthrosis?
Very often, joint pain is associated in patients with arthrosis. The diagnosis is considered universal: if the joints hurt, it means that the cartilage has worn out. In fact, other diseases have similar symptoms. It manifests itself in pathologies of ligaments and tendons, and in injuries to periarticular tissues, for example due to a meniscus tear.
Almost all people over 40 have degenerative changes in cartilage tissue to one degree or another. They do not always lead to arthrosis in full. Therefore, symptoms can indicate anything, even serious systemic diseases. Only an experienced specialist - a rheumatologist or orthopedist - can determine the cause based on the diagnostic results.
Arthrosis is not the only cause of joint pain
What to look for when choosing a rheumatologist
Rheumatic diseases affect the functioning of vital organs and systems. That is why, when choosing a doctor, you should pay attention to the capabilities of the clinic.
Find out:
- Are consultations with related specialists provided?
- Does the medical institution have a modern diagnostic facility?
- If a rheumatic disease is diagnosed, are there opportunities for physiotherapeutic procedures?
Our Clinic fully meets all requirements and standards in the field of diagnosis and treatment of rheumatic diseases. The team consists of experienced doctors with extensive experience. There is all the necessary diagnostic equipment and facilities for laboratory tests and physiotherapy.
The dangers of visiting a rheumatologist late
If there is no rheumatologist in the clinic, a person complaining of joint pain often has no choice but to treat himself. Few people make additional attempts to find a specialist and simply trust either the Internet, or a neighbor, or, at best, a family doctor. Moreover, it is very difficult to independently assess the degree of such need, especially in the initial stages.
What does this mean? A person misses the period when treatment would be most effective, and the “therapeutic window” closes. With age, the processes get worse, and the patient is suddenly unexpectedly informed that it is too late, that old age has set in, and at this age problems with the joints cannot be treated.
In fact, the level of modern medicine makes it possible to improve the quality of life in case of joint diseases at any age. All you need to do is ask for help in time. The sooner a person shows up to a rheumatologist with a complaint of joint pain, the higher his chances of resisting the disease.
Rheumatologists are able to treat a wide variety of joint diseases
Broad front
Systemic connective tissue diseases are so named due to the lack of “favorite” sites that the disease affects and the nonspecificity of damage to connective tissue and its derivatives. One of the most famous and common diseases of this group is systemic lupus erythematosus, which received its name for the characteristic lesion on the skin of the face, similar to a wolf bite. This is an extremely multifaceted disease, truly rheumatological, since it affects all organs and systems of the body due to the production of organ-nonspecific autoantibodies and immune complexes. Young women, including teenagers, are most often affected. Genetic determinants have also been discovered (genes HLA B 8, DR 2, DR 3, etc.), which suggest predisposition to the disease.
Systemic lupus erythematosus is not so rare (1 case per 20 thousand people), so it is important to know the symptoms that allow you to suspect this pathology: reaction to the sun (photosensitivity) in the form of a rash, mouth ulcers, hair loss, Raynaud's syndrome ( paroxysmal spasm of the blood vessels of the extremities, when, under the influence of cold or stress, the fingers successively turn white, blue and red). But it also happens that the only manifestation of the disease may be constant weakness and fatigue. In the absence of treatment, the prognosis depends on the activity of the process.
Another formidable disease in this group is systemic scleroderma, a multiorgan disease of unknown etiology, characterized by fibrosis of the skin, blood vessels and internal organs, including the gastrointestinal tract, lungs, heart and kidneys (Harrison, 2005). Alas, sufficiently effective methods for treating this disease do not yet exist: we can only partially slow down the process that has begun, partially preventing and correcting complications. The first symptoms of the disease include Raynaud's syndrome, dense swelling of the skin, arthritis and arthralgia. As the disease progresses, the skin thickens and atrophies, vascular and trophic disorders worsen, and internal organs are affected. Diagnosis of the disease is based on characteristic clinical manifestations, as well as the detection of immunological markers in the blood.
Systemic scleroderma is characterized by skin changes, first in the form of swelling and edema ( right
), and then in the form of thinning and thickening.
Peripheral circulatory disorders manifest themselves at the initial stage by increased cold sensitivity, and may result in necrosis ( left
)
But not all connective tissue diseases are associated with an autoimmune process: metabolic disorders are “to blame” for the occurrence of some of them. The most famous and common such disease is gout. The clinical signs of its most striking manifestation - gouty arthritis - were described in his time by the famous Hippocrates. The disease is based on metabolic disorders and increased levels of uric acid in the blood. This leads to the accumulation of uric acid in the tissues, primarily in the joints (most often the big toe), where it is deposited in the form of sodium salt crystals. “Scavenger” macrophages are drawn to this place, and the inflammatory process begins.
It is not for nothing that gout is called the “disease of aristocrats”: the main cause of the development of the disease is an incorrect diet, primarily an excess of meat foods, and it is provoked by alcohol abuse, a sedentary lifestyle, or, on the contrary, excessive physical activity. Without following a diet, effective treatment of gout is impossible! Although there are drugs that reduce uric acid levels, if you break your diet while taking them, symptoms will still develop.
Arthritis of the wrist joint due to gout is accompanied by severe pain, swelling and redness ( left
). It is characterized by an acute course and significantly reduces the patient’s physical activity
The reasons for the accumulation of uric acid salts, which normally should be excreted through the kidneys, remain completely unclear. It is only known that most gout people have a hereditary predisposition to this disease. Interesting fact: back in 1955, the Englishman E. Orvan pointed out the structural molecular similarity of uric acid with caffeine and theobromine, which are known to serve as stimulants of mental activity. The researcher even suggested that it was the absence in primates of the enzyme uricase, which breaks down uric acid in other mammals, that became one of the prerequisites for the emergence of the human mind among them. To this we can only add that the number of gout cases among recognized talents and geniuses is much greater than among ordinary people.
Is it possible to treat rheumatological diseases using thermal springs and mud baths?
Yes, but only with stable remission: during an exacerbation, such treatment is strictly prohibited.
A little about drug blockades
There is a period when basic therapy for the disease is most effective. It is called the “therapeutic window”. With arthritis, for example, it lasts about three months. The inflammatory process is in the primary phase. Sometimes at this stage it is enough to make one blockade and the pain syndrome will disappear forever.
Unfortunately, there is a strong opinion that the body gets used to drug blockades. There are doctors who convey a biased attitude towards this treatment method. The argument is that once you get used to it, the medications won't help anymore. Guided by this opinion, many people who have shoulder or knee pain refuse joint therapy at the initial stage and miss a very important period. The disease is progressing.
In fact, a timely and correctly performed blockade gives positive results. The technique is successfully used in Europe and Israel, and you should not be afraid of it if you trust your specialist. But only a few people trust it, because there are not many specialists in joint diseases.
In what cases should you consult a rheumatologist? We present the TOP 10 reasons in the video below:
Diagnostics
As practice shows, a patient does not get an appointment with a rheumatologist directly, but through a referral from related specialists.
Considering the fact that rheumatology is closely related to other areas of medicine, the symptoms of rheumatological diseases are very similar to the manifestations of other diseases. First of all, these are infectious, cardiac, oncological and hematological diseases. The first stage of instrumental diagnosis of rheumatological diseases is radiography. Rheumatologists use MRI (magnetic resonance imaging) and CT (computed tomography) as additional methods. MRI is a method by which the doctor scans the patient’s body layer by layer using a magnetic field and radio waves. MRI images help clarify the condition of the soft tissues surrounding the affected area. It is used to clarify the diagnosis and further treatment tactics for rheumatic diseases of the intervertebral discs, nerve fibers and ligaments. CT (computed tomography) is performed using x-rays, which provide information about the physical properties of the affected organ.
At the Yusupov Hospital, rheumatologists use a modern diagnostic method - densitometry. It consists of a thorough study of the characteristics of bone tissue density. This method plays an important role in the diagnosis of osteoporosis. A general blood test is also routinely performed, which allows one to determine the inflammatory process in the body or other specific signs of the inflammatory process. Specialists at the Yusupov Hospital follow the recommendations approved by the chief rheumatologist of Russia and international protocols. To diagnose and treat patients, they use the latest equipment from leading European manufacturers, innovative treatment regimens with modern drugs in accordance with current protocols. A good rheumatologist is also a general practitioner, a nephrologist, and a cardiologist. Autoimmune diseases can affect the nervous, endocrine system, and digestive tract. Therefore, at the Yusupov Hospital, related specialists take part in the treatment process.
Are you looking for a rheumatologist in Moscow and don’t know who to make an appointment with? At the Yusupov Hospital, each patient undergoes a comprehensive examination. This is the first step on the road to recovery. Thanks to an individual approach to the treatment of each patient, doctors at the Yusupov Hospital manage to achieve remarkable, lasting results. You can make an appointment or consultation with a rheumatologist in Moscow by calling the contact center of the Yusupov Hospital.
Make an appointment
So when should you go to a rheumatologist?
A rheumatologist treats several dozen diseases. At any age, the reason to visit this specialist is pain, discomfort in the joint, changes in its shape and structure. Especially if these symptoms are accompanied by fever, weight loss for no reason, and changes in test results.
If you are predisposed to viral diseases and often have a sore throat, think about it: the problem may have a rheumatological cause. The sooner you get to a rheumatologist, the higher the chance of getting into the “therapeutic window” and stopping the disease before it deals a crushing blow to your body.
Pediatric rheumatology is a separate area of the healthcare industry
Despite the fact that most rheumatoid diseases manifest themselves in adults, the prerequisites for their appearance can be detected in childhood. In addition, inflammatory processes in connective tissues, especially those that have hereditary preconditions, begin to cause concern even in childhood. Such lesions are extremely dangerous, since, if not detected at a very young age, in adult life they can cause serious inconvenience to a person, and sometimes even cause disability.
It is for this reason that a pediatric rheumatologist must be a highly qualified specialist who is well versed in the problem and the characteristics of the child’s body. For example, diseases such as sore throat in children are one of the decisive factors in the development of rheumatism, which a pediatrician must know about.
There are frequent cases of a child being affected by rheumatic fever - such a disease requires the prescription of appropriate antibiotics, otherwise there is a risk of developing heart defects in the form of complications after the disease.
What diagnostic methods and laboratory tests may be required?
In most cases, it is impossible to establish an accurate diagnosis without instrumental diagnostic procedures and laboratory tests. This can be explained by the similarity of manifestations of various rheumatological diseases.
- UAC;
- Blood test for inflammation and autoimmune activity (rheumatoid factor;
- Radiography. This procedure is primary during diagnosis and allows you to assess the condition of various tissues;
- TANK;
- Blood test for ESR;
- Some methods of ultrasound examination (ECHOCG, for example);
- MRI is considered an additional diagnostic method in rheumatology, however, it is desirable as information for comparison;
- Densitometry;
- Blood test for antibodies to native DNA (if systemic lupus is suspected)
- Blood test for CRP;
- Blood test for uric acid, total protein;
- CT;
- Neopterin;
- Blood test for antinuclear and anticitrullinated factor;
History of the profession
Christopher Columbus suffered from reactive arthritis, formerly called Reiter's syndrome, and Benjamin Franklin suffered from gout. Historical paintings depict joint diseases, most often showing hand deformities due to rheumatoid arthritis and osteoarthritis.
Rheumatic diseases of the joints have been known to mankind since the first century AD, but they were first systematized and described by the French physician Guillaume de Bayu, who was the personal physician of Henry IV, King of France. The doctor argued that joint disease manifests itself against the background of general health.
In 1845, Alfred Garro first described rheumatoid arthritis, and in 1895, William Osler made important discoveries about the form and manifestations of systemic lupus erythematosus. In 1928, the first council on the systematic treatment of rheumatism was organized, and a little later in 1988, a society of rheumatologists was opened on the basis of the council.
Officially, the term “rheumatologist” entered medical practice in 1940 thanks to the American doctor B. Comrie, and already in 1949 the first textbook on rheumatology was published.
In the 21st century, a number of scientific breakthroughs have been made in the field of immunology, which has brought rheumatology to a new stage of research: diagnostics have been improved, new drug groups are being synthesized. However, scientific research still does not provide an exact answer as to what causes the pathologies.
"Old age" is being treated
However, a person may remain exposed to ineffective therapy for a very long time. He has “arthrosis”, everyone has it and it’s “too early” to go to a rheumatologist. This may be explained by the fact that, as a rule, regional clinics do not have their own rheumatologist specialists, and in regional clinics their appointment is limited by the availability of appropriate quotas or the availability of the corresponding doctors. The patient is simply not referred to a rheumatologist. It is quite difficult to determine the need to see a rheumatologist. Although such cases also occur in practice, when patients themselves “find” their way to a rheumatologist.
The process is delayed, the “therapeutic window” is closing. And at some point, a person, especially in old age, is informed that now it is supposedly “too late” to see a rheumatologist and in general “old age cannot be cured.” It is not true. Even if the therapeutic window has been missed, regardless of age, modern medicine has answers to many challenges. The modern level of medicine makes it possible to improve the quality of life at any age.