Rheumatology is a field of medicine that specializes in the diagnosis and treatment of diseases of the joints, spine and systemic connective tissue diseases. The discipline is considered one of the youngest in medicine - it gained independence only in the middle of the 20th century. However, connective tissue diseases have been known since time immemorial. It is noteworthy that the root “rheum” in the word rheumatology is of Greek origin (1st century BC) and is literally translated as “primary juice”. According to the ancients, rheuma formed in the brain and flowed to different parts of the body, causing systemic diseases.
There is a common belief that rheumatology is only for older people. However, this is not so: rheumatological diseases are rapidly becoming “younger”. Among the patients there are not only 40-year-olds, but also those who have not even reached adulthood.
Orthopedist or rheumatologist: what's the difference?
Rheumatologists treat a broad group of diseases involving degenerative and inflammatory diseases of connective tissue, bones and joints. There are over 200 diseases in their area of competence.
Both an orthopedist and a rheumatologist deal with diseases of the musculoskeletal system, but there are differences in the activities of specialists. The task of a rheumatologist as a specialist in the field of autoimmulology is the treatment of chronic joint diseases, that is, not caused by a sudden injury.
The main task of an orthopedist is the diagnosis and treatment of disorders in the musculoskeletal system. This applies to both congenital and acquired pathologies. While a rheumatologist focuses on connective tissues and joints, an orthopedist studies all the structures that allow a person to move.
The rheumatologist and orthopedist may work closely together. The coordinated actions of two specialists at once help patients quickly regain good shape. Treatment is prescribed individually - it all depends on the type of disease, medical history, age, and condition of the patient. Most often, pharmacological therapy in combination with physiotherapeutic procedures is prescribed for the treatment of rheumatic diseases.
How to treat arthrosis of the jaw?
Treatment for arthrosis of the jaw joint varies depending on the causes of the disease. Its purpose is:
- restoration of mobility of the lower jaw;
- suppression of degenerative and dystrophic processes in the joint.
As a rule, the doctor prescribes analgesics and recommends wearing a splint - an elastic, removable mouth guard that distributes the load on the jaw. The selection of an individual splint (based on an impression), palatal plate or other orthodontic device for arthrosis of the jaw joint is carried out for relaxation in case of muscle hypertonicity or maintaining a healthy position of the TMJ. If the splint is not enough, a specialist may prescribe a Botox injection. Then permanent dentures are created for the patient, which help support the joint affected by arthrosis and correct the bite. Also, with arthrosis of the lower jaw, selective grinding of teeth can be performed.
Treatment of arthrosis of the jaw joint involves a moderate change in habits. Patients should avoid eating solid foods, frequent vocal exercises, and chewing gum. Therapy for arthrosis of the jaw joint requires lifelong limitation of mechanical loads and regular visits to the dentist or gnathologist. Preventive courses of physical and pharmacotherapy are carried out at least 2 times a year. It is important to minimize stress and physical strain. The further the disease progresses, the softer the food should be - until the patient switches to purees, cereals, soups and juices.
It is considered optimal to start treatment at stage 1 or 2. In advanced cases of arthrosis of the jaw joint, only surgical intervention can help the patient.
Osteoarthritis of the jaw joint - which doctor should I contact?
The first step if you suspect arthrosis of the jaw is to consult an orthodontist or gnathologist. They will give the patient a referral for an x-ray, and will also determine whether there are any malocclusions or dental contact problems. You may also need to consult a prosthodontist.
If the cause of the disease is primary diseases, in parallel with a specialized doctor, narrow specialists participate in the treatment of jaw arthrosis - for example, a rheumatologist, endocrinologist, neurologist, psychotherapist or otolaryngologist.
Drug treatment of jaw arthrosis
Treatment of arthrosis of the jaw joint with medications is usually carried out in a hospital setting. At home, patients can take painkillers, use warming and analgesic local drugs, and also take chondroprotectors.
To relieve inflammation and improve jaw mobility, patients take non-steroidal anti-inflammatory drugs (NSAIDs) intravenously or orally - for example, ketoprofen, ibuprofen, paracetamol, nimesulide. For topical use, ointments and gels are recommended - finalgon, nicoflex, voltaren, butadione and indomethacin. In the absence of allergies, preparations based on medical bile and bee venom are used. Muscle relaxants, such as mydocalm, help relieve spasm in arthrosis of the jaw joint.
For severe pain, in addition to glucocorticosteroids (hydrocortisone), injections of opioid analgesics are prescribed - for example, tramadol, trimeperidine.
If there are injuries or foci of infection in the body, treatment of arthrosis of the jaw joint is accompanied by antibiotic therapy in the form of injections of cefazolin, metronidazole, cefuroxime.
For better regeneration of cartilage and synovial fluid, it is recommended to take chondroprotectors - for example, artracam, Dona or Movex.
Drug therapy for arthrosis of the jaw joint is carried out 2-3 times a year as prescribed by a doctor. The administration of drugs is often combined with physiotherapeutic techniques - for example, in the form of electrophoresis with novocaine, lidase and iodine, Trilon ointment.
Physiotherapy in the treatment of jaw arthrosis
Physiotherapy in combination with properly selected medications and orthodontic devices helps eliminate pain without surgery, even at the 3rd stage of arthrosis. Therefore, the following physiotherapeutic techniques are used to treat arthrosis of the jaw joint and rehabilitate patients.
- ultrasound (10-20 sessions);
- laser therapy (14 sessions);
- microwave therapy (UHF - 10-12 sessions);
- electrophoresis (10-12 sessions);
- phonophoresis;
- mud therapy;
- myogymnastics;
- massage of masticatory muscles;
- balneotherapy (including paraffin therapy and ozokerite);
These procedures improve nutrition of the affected joint, normalize metabolism and activate the processes of natural regeneration of bone and cartilage tissue. With fibrotic changes in tissues, physical therapy helps to soften them and increase the range of motion of the jaw. Also, this type of treatment relieves inflammation, has an analgesic effect and serves to prevent complications of arthrosis of the jaw joint.
Therapeutic exercise for arthrosis of the jaw joint
Therapeutic exercises for arthrosis of the lower jaw help maintain facial mobility, speech intelligibility, improve innervation of the affected area and reduce the impact of the disease on other organs and systems. With hypertonicity of the masticatory muscles, it helps to stretch the ligaments and relax the jaw, and also strengthens the jaw apparatus. This promotes proper distribution of the load, and therefore slows down the progression and reduces the symptoms of arthrosis of the jaw joint. Myogymnastics does not replace wearing a mouthguard, but significantly enhances its effect.
- Press your tongue against the hard palate and allow your jaw to drop freely as you relax the muscles in your lower face.
- Place your thumb on the affected joint (in front of your ear) and, keeping your tongue against the roof of your mouth, place your index finger on your chin. Lower your jaw halfway, overcoming the gentle resistance of your index finger. Shut your mouth. Repeat 6 times, and then begin to lower your jaw completely (also 6 times).
- Raising your shoulders and chest, tuck your chin in so that a “double chin” forms under it. Hold for 3 seconds, then repeat (10 times).
- Place your thumb under your chin and gradually open your mouth completely, against the gentle resistance of your finger. Then grab your chin with your thumb and index finger and repeat the exercise - this time closing your mouth (10 times).
- With the tip of your tongue in the center of your palate, open and close your mouth.
- Grasp a small object with your front teeth and slowly move your jaw from side to side. Then repeat the exercise with back and forth movements. As your range improves and the exercise becomes easier, increase the thickness of the object.
In what cases should you contact a rheumatologist?
There are signs that indicate that you cannot postpone a visit to the doctor. These symptoms include:
- pain in muscles, joints and bones;
- the pain is periodic and intense, often occurring not only in one, but also in several joints (over time, the disease takes on a symmetrical form - symptoms appear in the joints on both sides of the body);
- pain is accompanied by low-grade fever and/or swelling, and/or rash, redness of the skin;
- ailments in the abdominal cavity, and they are not caused by problems with the stomach or intestines;
- redness of the skin in the joint area;
- a feeling of stiffness in movements (problems with holding objects in the fingers, difficulty bending over, moving);
- joint deformation, swelling;
- weather sensitivity;
- morning stiffness of joints;
- increased sweating;
- pale skin;
- chronic state of drowsiness, fatigue, general weakness
The sooner you see a doctor, the better the prognosis for recovery will be. Remember that relieving pain and refusing to see a specialist can ultimately lead to disability. Timely diagnosis and treatment is the best investment in health and a guarantee of maintaining an active, full life.
What is arthritis?
Arthritis is inflammation of one or more joints.
An orthopedic surgeon treats arthritis.
In acute arthritis, as a rule, there is pain and a feeling of stiffness during movement. In addition, pain may occur at certain intervals (for example, in the evenings, during sleep at night, or upon awakening).
With chronic arthritis, pain can become constant.
In the absence of adequate treatment for a long time, the following occur:
- joint redness,
- swelling and/or deformation of the joint,
- impaired mobility (up to complete immobilization of the joint).
Which doctor should I see for arthritis?
If you have been diagnosed with rheumatoid arthritis, you need to see a rheumatologist. With a rheumatological profile, in addition to the joints, internal organs (heart, kidneys, etc.) may also suffer, so rheumatoid arthritis should be treated by a rheumatologist.
The treatment of allergic, gouty and infectious arthritis is carried out by specialists of the relevant profile (allergists, rheumatologists and cardio-rheumatologists).
Orthopedic doctors successfully treat all other types of arthritis in children and adults (caused by sports and household injuries, excess body weight, age-related changes in joints).
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.
How is the first appointment and diagnosis carried out?
No special preparation is required to visit a doctor. It is enough to take with you a medical card and the results of the latest studies, if available (urinalysis, blood tests, ultrasound, etc.).
A visit to a rheumatologist consists of several stages. The first of them is a detailed interview, that is, obtaining information about the declared ailments.
The rheumatologist may ask:
- Where exactly is the pain concentrated (for example, which joints hurt, maybe the pain affects the entire limb or several fingers)?
- Is the pain worst at night or during the day?
- Is morning stiffness accompanied by morning stiffness and how long does it last?
- Was there swelling of the joints or redness?
- Are the symptoms episodic or chronic?
- Does the pain get worse when you are immobile?
- How intense is the pain?
- Was the symptoms preceded by an infection (eg, urinary tract infection, pharyngitis)?
The survey may focus on other symptoms, comorbidities, or even illnesses that run in family members. Questions that seem to be unrelated to the problem that is the reason for consultation (for example, bad habits or intestinal diseases in parents) should not come as a surprise.
The next step is an examination, and the doctor evaluates not only the condition of the joints. Depending on your symptoms, your rheumatologist may also examine your skin, nails, lymph nodes, or abdomen.
Unfortunately, it happens that the first visit does not provide grounds for making a final diagnosis and drawing up a treatment plan. Sometimes, even with the efforts of the doctor and painstaking preparation on the part of the patient, there is not enough information to make decisions. This is due to the fact that some rheumatic diseases take years to develop, and the full picture appears only with time. In any case, you cannot do without additional examinations.
Who treats joint pain?
A number of specialists—traumatologist, surgeon, and neurologist—are involved in the treatment of joint pain. In some cases, a cardiologist and a chiropractor are involved in the process.
It is impossible to cure joint pathologies on your own. Advertised ointments only relieve pain and improve blood supply to the joint, but do not help cope with the cause of the disease. Self-medication can result in chronic disease and aggravation of the existing problem, especially if it is a consequence of other diseases that occur in the background or are not fully treated at the time.
For diagnosis, modern methods are used: ultrasound, MRI, CT, radiography, endoscopy and arthroscopy, examination of blood and fluid obtained as a result of joint puncture. The attending physician decides which research methods the patient needs after examining and studying the patient’s medical history.
If you or your loved ones are concerned about joint pain, contact qualified specialists at a medical clinic in Moscow. Our surgeons and neurologists treat joint pain that occurs at any age and help patients overcome the disease. Don't wait, make an appointment and get examined by professionals with extensive experience.
Treatment methods and follow-up features
The course of treatment by a rheumatologist depends on the specific disease and its severity. Unfortunately, in the case of degenerative and inflammatory diseases of bones, joints and connective tissue, treatment is usually long-term.
In most cases, non-steroidal anti-inflammatory drugs are used to relieve rheumatic pain. Sometimes antibiotics and stronger analgesics may be prescribed. In severe cases, glucocorticosteroids are used, which suppress the immune system and have a powerful anti-inflammatory effect.
These and other drugs, which in addition to alleviating the symptoms of the disease, also inhibit the destruction of joints. Reception should be started as early as possible to avoid unpleasant complications and degenerative changes. It should be remembered that the nature of most rheumatic diseases is such that the pills must be taken constantly; withdrawal may cause a relapse.
Physiotherapy is also very important, thanks to which you can stop the progression of the disease, and sometimes even restore some motor functions of damaged joints. The doctor may prescribe procedures such as:
- Kinesitherapy . The technique is based on performing active and passive exercises that are designed to improve the functioning of diseased joints.
- Medical massage . Reduces muscle tension and stiffness, improves local blood circulation and blood supply to tissues.
- Electrophoresis . The procedure is a method of delivering drugs directly to the affected organ. The technology is based on the use of weak electric current discharges and injections. Electrophoresis helps reduce swelling, reduce pain, and speed up cellular metabolism.
- Ultrasound therapy . The method promotes the resorption of swelling and helps in the restoration of damaged tissue.
- Acupuncture . The technique helps to get rid of pain and accelerates regeneration processes.
Along with therapy, the doctor will give recommendations regarding lifestyle. The topic of proper nutrition with limited salt and maintaining a healthy body weight, as well as other preventive measures will be discussed: quitting smoking, maintaining a drinking regime, minimizing stress, etc.
Joint diseases
- Arthritis and its types - osteoarthritis, post-traumatic, reactive, rheumatoid, psoriatic. Arthritis manifests itself as acute pain in different parts of the body - feet, hands, elbow joints. Symptoms include swelling, redness, increased body temperature, limited joint mobility and deformation. Most often develops against the background of infectious diseases and injuries.
- Arthrosis. An age-related pathology that manifests itself as crunching, sharp pain in the hip, wrist and knee joints. The pain intensifies with exercise.
- Gout. A hereditary disease accompanied by disturbances in the functioning of the heart and kidneys. Symptoms are acute pain, swelling, redness and peeling of the skin in the affected joints.
- Rheumatism. A disease of the joints and connective tissues, which in its symptoms resembles ARVI - the patient’s body temperature rises, aches, joint pain, and tissue swelling are observed. Often found in older people.
Additional diagnostic methods
Despite the enormous progress in medicine, the importance of traditional X-ray examinations of bones and joints cannot be overestimated. If in doubt, more extensive imaging, such as a CT scan or magnetic resonance imaging, may be needed. Ultrasound examination is becoming increasingly important. The study allows us to evaluate early inflammatory changes in joints, periarticular tissues and peripheral nerves.
In some cases, histopathological examination of biopsied tissue may be required to make a diagnosis. In this case, hospitalization may be required because some procedures involving tissue collection can only be performed in a hospital setting.
The doctor will also order laboratory tests. Along with a traditional general blood test, a proteinogram (analysis of the protein composition of the blood) and rheumatic tests may be required. In some cases, consultations with specialists in other fields of medicine may be required: pulmonologist, endocrinologist, cardiologist, hepatologist and others.
What diseases does a rheumatologist treat?
A specialist in rheumatology treats many diseases. Among them:
- rheumatoid arthritis;
- psoriatic arthritis;
- rheumatic fever;
- vasculitis;
- gout;
- ankylosing spondylitis;
- osteoarthritis;
- chronic inflammation of connective tissue: systemic lupus erythematosus, systemic sclerosis, dermatomyositis, polymyositis, Sjogren's syndrome;
- osteoporosis;
- sarcoidosis;
- fibromyalgia, etc.
Many joint problems are temporary, but when rheumatic disease sets in, it makes sense to act early before permanent changes occur. Modern rheumatology is moving in such a direction that images of joints deformed by the inflammatory process can only be found in archival photographs in textbooks.
Causes of arthrosis and arthritis
As we have already said, primary arthrosis appears as a result of age-related changes occurring in the body. They begin at different ages for all people. Arthrosis is usually diagnosed in patients aged 50-60 years, although in recent years experts have noted that people aged 30 to 40 are also affected by the disease. Secondary arthrosis can also develop after a joint injury at any, even very early, age.
The early appearance of arthrosis can be promoted by:
- heredity;
- injuries and congenital pathologies of cartilage and joints;
- features of work and lifestyle (increased load on joints);
- hormonal disorders;
- improper metabolism;
- excess weight, etc.
Arthritis appears at any age; it can be triggered by certain reasons:
- injury;
- dystrophic changes in tissues;
- fungal or viral infection;
- allergic reactions;
- metabolic disorders, vitamin deficiency;
- malfunctions of the nervous system.