A rheumatologist specializes in the diagnosis, treatment and prevention of the following diseases:
- Rheumatoid arthritis;
- Arthrosis;
- Systemic lupus erythematosus;
- Gout;
- Spondyloarthritis;
- Sclerosis;
- Thrombocytopenic purpura;
- Hereditary diseases of the blood coagulation system;
- Osteoarthritis;
- Vasculitis;
- Idiopathic juvenile arthritis.
When is a consultation with a rheumatologist necessary?
People who notice the following clinical symptoms should consult a rheumatologist:
- Swelling and pain in the joint area;
- Limitation of joint mobility after waking up, stiffness;
- Joint deformity;
- Various pains in the joints;
- Skin rashes with hemorrhages;
- Recent sore throat;
- Pain in the spine, aggravated by stress and exercise;
- Problems with blood clotting, tendency to bleed;
- The presence of congenital connective tissue diseases.
Lack of qualified, timely assistance can lead to damage to the patient’s internal organs, in particular the heart muscle, large blood vessels, lungs, and kidneys.
Where can I find a rheumatologist?
The success of treating diseases of connective tissue and joints largely depends on the competence of the doctor. If you need a good rheumatologist in the capital and you don’t know where to find him, pay attention to our website.
All doctors on the list have extensive experience, a high level of qualifications and a popularity rating among patients. When choosing the best doctor from the list, pay attention to the reviews category, where you can read detailed stories about other people’s appointments with this specialist.
How to get an appointment with a rheumatologist?
You can get a consultation with a rheumatologist by first contacting the clinic administrator by phone or online. Making an appointment in advance will allow you to choose the most suitable time and date, and will also save you from the hassle of waiting in a general queue.
At the appointment, the rheumatologist will conduct an examination, collect an anamnesis of life and illness, and prescribe additional tests. Based on the results obtained, you will be prescribed adequate treatment.
Candidate of Medical Sciences
Specialties: vertebrologist, rheumatologist, physiotherapist, arthrologist
Work experience over 43 years
Moscow, Sirenevy Boulevard, 32a
Metro stations: m Pervomayskaya m Shchelkovskaya m Zhulebino m Kotelniki
Registration Online The cost of admission is 1850 rubles.
Engaged in the diagnosis and treatment of diseases of the joints and spine, systemic connective tissue diseases, osteoporosis. Performs diagnostic and treatment punctures of joints. Author of 13 scientific papers on the problems of osteoporosis in rheumatic diseases.
Specialties: rheumatologist, arthrologist
Work experience over 34 years
Moscow, st. Yaroslavskaya, 4, bldg. 2
Moscow, st. Yartsevskaya, 8
Metro stations: m Alekseevskaya m VDNKh m Voykovskaya m Molodezhnaya
Registration Online The cost of admission is 1800 rubles.
Specializes in the treatment and diagnosis of systemic connective tissue diseases (rheumatoid arthritis, dermatopolymyositis, Shogren's syndrome), systemic vasculitis (hemorrhagic vasculitis, Takayasu arteritis), spondyloarthropathy (ankylosing spondylitis, reactive arthritis), metabolic arthropathy (gout).
Specialties: rheumatologist, physiotherapist, arthrologist
Work experience over 28 years
Moscow, Staropetrovsky proezd, 7A, building 22
Moscow, Simferopolsky blvd., 22
Metro stations: m Varshavskaya m Voykovskaya m Kakhovskaya m Sevastopolskaya m Chertanovskaya
Registration Online The cost of admission is 1800 rubles.
Arthrologist-rheumatologist, physiotherapist. Engaged in the diagnosis and treatment of a range of rheumatological diseases. He has extensive treatment experience in rheumatology and physiotherapy. Applies methods using glucocorticoids, chondroprotectors and other drugs. Proficient in almost all types of intra-articular manipulations and blockades.
Slobodina Galina Aleksandrovna
Candidate of Medical Sciences
Specialties: rheumatologist
Work experience over 41 years
Moscow, 2nd Syromyatnichesky lane, 11
Metro stations: m Kurskaya m Kurskaya m Ploshchad Ilyicha m Chkalovskaya
Registration Online The cost of admission is 2350 rubles.
Rheumatologist of the highest category, Chief physician of the SM-clinic on 2nd Syromyatnichesky lane. knows methods of intra-articular therapy, periarticular administration of drugs, all methods of diagnosis and treatment of rheumatological and arthrological diseases and plasma lifting. She is the author of more than 25 scientific papers in domestic and foreign publications, took part in the testing of more than 50 non-hormonal anti-inflammatory and basic antirheumatic drugs.
Candidate of Medical Sciences
Specialties: hirudotherapist, cardiologist, neurologist, pulmonologist, rheumatologist, reflexologist
Work experience over 29 years
Moscow, Rubtsovskaya embankment, 2, bldg. 3
Metro stations: m Baumanskaya
Registration Online The cost of admission is 1500 rubles.
Therapist, cardiologist, acupuncturist. Conducts diagnosis and treatment of acute respiratory diseases, respiratory tract diseases, problems in the gastrointestinal tract, diseases of the cardiovascular system, diseases of the genitourinary system, joint diseases, blood diseases, headaches, back pain, epilepsy, stroke, etc.
A rheumatologist is a specialist who deals with diseases of an inflammatory and dystrophic nature. These pathologies affect joints and connective tissues. The Greek word rheuma, from which the specialty's name comes, literally means "substance that flows." This means that it is the joint fluid that causes certain inflammatory joint diseases.
What do rheumatologists do?
A rheumatologist deals with absolutely all inflammatory pathologies of the joints. Doctors in this specialty are involved in the prevention, diagnosis and treatment of diseases affecting:
- musculoskeletal system,
- heart,
- connective tissues (in this case, pathologies are called systemic),
- joints.
The category of rheumatic pathologies includes more than 100 very diverse diseases that a rheumatologist in Moscow deals with. They manifest themselves in inflammatory lesions:
- joints,
- spine,
- bones,
- muscles.
The most common diseases encountered by rheumatologists in Moscow are:
- osteoporosis,
- osteoarthritis or osteoarthritis,
- systemic lupus erythematosus,
- spondyloarthropathy,
- fibromyalgia,
- rheumatoid arthritis,
- gout, etc.
Two thirds of patients become disabled as a result of such diseases. Restriction in movement also leads to a loss of mental balance, so rheumatologists in Moscow often have to deal with completely lost people whose work and family life are collapsing. All this occurs against the background of constant pain during exacerbations of pathologies or chronic diseases.
What symptoms are referred to rheumatologists?
The main indications for visiting a rheumatologist are frequent sore throats and infectious diseases. It is especially important to see a specialist in Moscow if you have a hereditary history of joint diseases. You should definitely be examined by a rheumatologist if you experience:
- pain in the joints, neck, lower back;
- stiffness upon awakening;
- swelling in the joint area;
- crunching sound when moving;
- changes in joint configuration;
- repeated symptoms;
- chronic limitation of movement and so on.
In addition to general tests, rheumatologists in Moscow send patients for examination using radiography. Other diagnostic methods are also used, such as:
- densitometry, etc.
How to become a rheumatologist?
On a functional basis, the Department of Rheumatology of the FPDO is part of the MGMSU NUPC “Diseases of the Joints and Spine”. In addition, they offer training in the departments of rheumatology of such large metropolitan medical institutions as:
- MONIKI,
- RNIMU named after. N. I. Pirogova,
- RUDN University,
- MMA im. I. M. Sechenova,
- Institute of Traumatology and Orthopedics named after. N. N. Priorova,
- FPPOV First Moscow State Medical University named after. Sechenov,
- Institute GUN TsNIITO im. Priorov and other universities in Moscow.
Famous Moscow specialists
Scientists discovered the first traces of rheumatoid arthritis on the remains of Indian skeletons dating back to 4500 BC. e. The skeletons were discovered in Tennessee (USA), and the first handwritten document that contained a description of symptoms reminiscent of this disease dates back to the year 123. It was only in 1800 that Augustine-Jacob Landre-Beauvais gave the first clinical description of this pathology.
Russian scientists and doctors took an active part in the development of rheumatology. At the end of the 19th century, the Russian doctor Bekhterev, together with the French Strumpell and Pierre Marie, described ankylosing spondylitis. In 1908, Tregubov was the first to introduce oxygen into the cavity of a patient’s joint affected by tuberculosis. Doctor Sokolov began using oxygen administration for preventive purposes in the fight against post-traumatic joint contracture. Vessel, Baykulova and many others made a huge contribution to this direction.
Rheumatology is a branch of medicine devoted to pathologies of connective tissue and joints, bones and muscles. A rheumatologist diagnoses, treats and prevents these diseases. A more familiar definition for such conditions is “rheumatism.” Diseases of the musculoskeletal system can also be treated by other specialized specialists - surgeon, orthopedist, neurologist, but there is a list of diagnoses that only a rheumatologist can treat: gout, arthritis, systemic scleroderma.
When should you go for an appointment?
Inflammatory processes in the joints are a common phenomenon today. On the Internet you can find many ways to get rid of these manifestations. At best, they will provide temporary relief, at worst, the problem will worsen. Only a rheumatologist can make the correct diagnosis and create an effective treatment program.
You urgently need advice if:
- The color of the limbs has changed;
- Swelling of the joints is noticeable;
- There is pain and discomfort in the joint area.
- Waking up in the morning, you feel that the joint is uncontrollable, and after half an hour the situation returns to normal.
Traditionally, treatment is carried out without surgery, using massage, special exercises and injections.
What diseases does a rheumatologist treat?
It deals with more than two hundred diseases, including:
- Rheumatic heart defects;
- Joint diseases associated with connective tissue pathology;
- Systemic diseases that are accompanied by diseases of internal organs;
- Connective tissue diseases.
People who often suffer from infectious diseases and sore throats, with complaints of swelling and changes in the shape of the joints, should not postpone a visit to a rheumatologist, as they are at risk.
Diagnostic methods
Rheumatology uses several reliable methods:
- Tomography – computer and resonance;
- X-ray.
In addition, patients undergo extensive urine and blood tests.
Initial appointment with a rheumatologist
The first visit is an examination and conversation.
The doctor is interested in:
- What symptoms have you been worrying about lately?
- What health problems exist in the family;
- What medications are being taken;
- What x-rays were taken recently (show).
You need to tell how rheumatism complicates your life and answer a number of questions. Not all of them will relate specifically to arthritis, but if the doctor wants to know the answer, then there is a reason for this.
How is the examination carried out?
The doctor conducts a complete examination of the patient. The rheumatologist will ask you to bend and straighten the joints and compare them. If the examination is painful, you must inform your doctor.
The doctor can give an injection to take material for testing, or send the patient to the laboratory for this.
The results of the study will show the problem, and an echogram, x-ray and MRI will help determine the cause of the pathology.
After diagnosis, drug treatment is prescribed. If joint pain is severe, a blockade is performed to relieve pain and preserve the patient’s ability to work.
Depending on the patient’s condition, the doctor will give recommendations on diet and prescribe medication. Physiotherapy, reflexology and massage will be prescribed as additional activities. A repeat appointment is carried out after 3 months so that the effectiveness of therapy is clear.
Known factors lead to joint problems:
- Excess weight;
- Increased physical activity;
- Physical inactivity;
- Injuries;
- Venerable age;
- Heredity.
Patients with rheumatic diseases should take into account the following nutritional recommendations:
- Cooked foods in the diet should be limited; they should account for no more than a third of the weight of raw foods;
- The consumption of meat and fish dishes, chicken meat and animal fats also needs correction - they can be eaten no more than twice a week;
- The amount of clean water you drink should be increased to three liters per day;
- You should fast one day a week (fasting days).
Troubles can be minimized using simple tips:
- Be careful and avoid injury;
- Give the body moderate physical activity;
- Monitor your weight;
- Create a balanced diet;
- You should try to walk and move a lot.
Cartilage wear cannot be restored, but this process can be blocked.
Make an appointment with a rheumatologist
Signs of rheumatoid diseases should be a reason for immediate contact with a specialist. Take advantage of the services of doctors at the Central Clinical Hospital of the Russian Academy of Sciences in Moscow by making an appointment with a rheumatologist by phone or online.
Rheumatologist - what kind of doctor is this? What diseases does it treat? What tests can he order?
Thank you
The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!
Make an appointment with a Rheumatologist
To make an appointment with a doctor or diagnostics, you just need to call a single phone number
+7 495 488-20-52 in Moscow
+7 812 416-38-96 in St. Petersburg
The operator will listen to you and redirect the call to the desired clinic, or accept an order for an appointment with the specialist you need.
Or you can click the green “Register Online” button and leave your phone number. The operator will call you back within 15 minutes and select a specialist who meets your request.
At the moment, appointments are being made to specialists and clinics in Moscow and St. Petersburg.
Who is a rheumatologist?
Rheumatologist is a doctor whose competence includes the diagnosis and treatment of rheumatic diseases. The subject of study of this specialist is joints and systemic diseases. Systemic diseases are those that occur with simultaneous damage to several organs and systems. The basis of pathogenesis ( development mechanism) are inflammatory and immune mechanisms. Facts and statistics
The prevalence of rheumatic diseases today is very high. Its frequency is largely influenced by the factor of urbanization, so the frequency of connective tissue diseases among the urban population is significantly higher than the frequency among residents of villages and suburbs.According to the latest data, the incidence of rheumatism ranges between 1 and 2 percent, and rheumatoid arthritis accounts for 0.5 percent. The prevalence of ankylosing spondylitis ranges from 0.01 to 0.09 percent, with the incidence being 6.5 times higher among men than among women. The prevalence of systemic lupus erythematosus is 7.5 cases per 100,000 population.
The structure of the joints
A joint is a movable connection between bones. A joint is characterized by the presence of several articular surfaces, which are connected to each other through various devices ( for example, with the help of ligaments and cartilage). On top, the articulating surfaces are covered with an articular capsule, thus forming an articular cavity. The cavity also contains synovial ( articular) fluid, the amount of which varies depending on the concomitant disease.Types of joints include:
- Synarthrosis- are continuous joints of bones. Examples of such articular joints are the joints of the skull bones, as well as the costosternal joints. The main function of such a connection is the formation of the skeleton.
- Symphyses- These are low-moving joints, an example of which are the articulations between the vertebrae. The function of such joints is to provide support and stability to the skeleton.
- Diarthrosis- these are typical movable joints, which are characterized by the presence of an articular cavity filled with fluid.
Ligaments are important structures that provide stability and mobility to a joint. They are represented by dense connective tissue cords, consisting mainly of elastic collagen fibers. Ligaments have the ability to stretch, thereby protecting the joint from injury. In addition to muscles and ligaments, joint structures include tendons. A tendon is an intermediate part between a muscle and a ligament and represents the transition of a muscle into connective tissue, which provides fixation for the muscle. In other words, this is the part of the muscle that is attached to the bone or joint.
What does a rheumatologist treat?
A rheumatologist treats diseases that involve connective tissue. This is a wide range of diseases that are becoming widespread these days. Most of these diseases are autoimmune in nature, which means that the body’s own production of antibodies against the body’s “native” cells. It should be immediately noted that a rheumatologist does not treat joints exclusively. It treats chronic diseases that affect joints and other organs. So, in addition to joints, connective tissue diseases affect the lungs, kidneys and other internal organs.
Diseases treated by a rheumatologist
Many people believe that a rheumatologist treats exclusively rheumatism or rheumatoid arthritis, which is incorrect. The list of diseases affecting connective tissue has been growing, especially in recent years. The prevalence of already known diseases that were previously considered rare is also significantly increasing.Diseases treated by a rheumatologist include:
- rheumatoid arthritis;
- rheumatism;
- systemic lupus erythematosus;
Rheumatoid arthritis
Rheumatoid arthritis is a central problem in rheumatology and the main disease faced by rheumatologists. It is a chronic, progressive and symmetrical inflammatory process leading to gradual destruction of the joints. However, in addition to destruction ( joint destruction) rheumatoid arthritis is also characterized by extra-articular lesions. It should immediately be noted that rheumatoid arthritis and rheumatism are different diseases, and not one as many people think.This disease is characterized by significant and widespread prevalence, and also by the fact that it occurs among people of all age categories. However, the most severe forms develop among people of working age. Rheumatoid arthritis is characterized by a steady progression of symptoms up to the point of disability. The prevalence of the disease is high and amounts to about one percent of the population.
Reasons
The causes of rheumatoid arthritis are still unknown, and therefore the origin of the disease remains unclear. There are many theories in support of the bacterial, viral, toxic origin of rheumatoid arthritis, but none fully reveals the mechanism of development of the pathology. However, it is known that rheumatoid arthritis is a polyetiological disease, that is, several factors are simultaneously involved in its origin.
Also indisputable proof is the participation of urbanization factors - industrialization of society, overcrowding of the population, constant contact with chemicals, poor ecology.
The main risk factors for developing rheumatoid arthritis include bacteria and viruses. Today, a number of rheumatologists speak out in favor of the infectious theory of rheumatoid arthritis. However, the role of infection in this disease is not as great as in rheumatism. It is noted that infectious agents help to increase vascular permeability and activation of complement, that is, they “catalyze” those reactions that underlie the pathogenesis of rheumatoid arthritis. Thus, infections do not have any specific role, but rather a sensitizing one.
Many rheumatologists note a relationship between rheumatoid arthritis and mycoplasma, herpes virus, rubella virus, measles and chickenpox. Most viral arthritis is acute and ends within 4 weeks. However, chronic viral arthritis also occurs. The most commonly affected joints are the knee, wrist, ankle, and interphalangeal and phalangeal joints. The main risk group in this case are women and children.
Particular attention is drawn to viral diseases, which themselves occur with damage to the joints. The rubella virus has a direct effect on the joints. It has a direct arthrotropic ( "articular") action. Other viruses have an indirect effect through activation of the compliment system and other mechanisms.
Clinical picture
The clinical picture of rheumatoid arthritis consists of articular and extra-articular lesions. Its diversity is influenced by such factors as the severity of the disease, the rate of progression of the pathological process, localization, and involvement of internal organs. Among the main symptoms of the disease, there are also prodromal signs, that is, those that bother the patient long before the onset of the disease.
The first symptoms of rheumatoid arthritis appear more often during the cold season. In advance, patients often note previous factors that trigger the disease. It could be an infection viral or bacterial), injuries, surgical interventions, allergies. These factors do not directly affect the disease, but only accelerate the pathogenetic processes of rheumatoid arthritis.
Arthritis usually begins slowly. Gradual onset is typical for 60–70 percent of patients. The first signs of the disease are disturbing pain in the joints ( arthralgia) and a feeling of morning stiffness in them. Over the course of several days or weeks, the pain becomes symmetrical ( marked on both sides). Thus, symmetrical arthritis develops, initially in small joints. Arthralgia is often accompanied by low-grade fever ( within 37 degrees), general malaise, loss of appetite and, as a result, weight loss. However, in 15 percent of cases, fulminant development of the disease is observed. In these cases, a person goes to bed feeling absolutely healthy, but the next morning, due to severe pain, he has difficulty getting out of bed. With acutely developing rheumatoid arthritis, morning stiffness, swelling and pain in the joints are also noted, but the temperature rises to 38 degrees and above.
Thus, all symptoms of the disease can be divided into articular and extra-articular manifestations.
Characteristics of articular syndrome
Joint manifestations are the main manifestation of rheumatoid arthritis. The features of this syndrome depend on the stage of the disease, the age of the patient, and concomitant diseases.
The main manifestations of articular syndrome are:
- Localization. With this disease, any joints can become inflamed, but in the early stages of the disease, damage to the small joints of the hand is typical. These include metacarpophalangeal, interphalangeal and carpal. Damage to these joints is the initial sign of the disease in 70–90 percent of patients. If large joints are involved in the pathological process, then the knee, elbow and ankle joints come first.
- Number of joints involved. Rheumatoid arthritis is characterized by polyarthritis, that is, simultaneous inflammation of five or more joints. However, initially 2 or 3 joints may be affected, and as it progresses, others become involved.
- Symmetry. The symmetry of arthritis is a specific feature for this disease. However, inflammation is not always synchronous, that is, initially one joint becomes inflamed, and after a few days a similar joint but on the other side.
Extra-articular syndrome is characterized by damage to internal organs and systems. The lungs, heart and muscles are most often affected.
Lung damage
There are four main pulmonary syndromes associated with rheumatoid arthritis - pleurisy, pneumonitis, rheumatoid nodules and Kaplan's syndrome. The most common is pleurisy, which is manifested by the accumulation of inflammatory fluid in the pleural cavity. This symptom can be recorded at different stages of the disease. Pleurisy is characterized by pain associated with breathing and a moderate increase in temperature. During a medical examination, a pleural friction noise and decreased breathing are heard. Pneumonitis is characterized by the development of an inflammatory process in the lung tissue itself.
Muscle damage
Muscle damage is also one of the common extra-articular syndromes in rheumatoid arthritis. This symptom is characterized by increasing muscle weakness and atrophy, which is observed in at least 75 percent of patients. The cause of muscle damage in rheumatoid arthritis is an initial decrease in muscle activity due to severe pain. Another reason is the metabolic changes characteristic of the disease.
Heart damage
Heart damage occurs in 50 percent of patients with rheumatoid arthritis. The main complaints are pain in the heart area, frequent heartbeats, and weakness. Due to pronounced metabolic changes in arthritis, the development of myocardial dystrophy is noted in the early stages. In addition to rheumatoid myocarditis, rheumatoid pericarditis is also recorded. Clinically, rheumatoid pericarditis is manifested by shortness of breath, rapid heartbeat, and weakness. However, laboratory parameters show high titers of rheumatoid factor, anemia and a significantly increased erythrocyte sedimentation rate ( ESR) .
Rheumatism
Rheumatism is a systemic disease of connective tissue of an immunoinflammatory nature, which is based on damage to the cardiovascular system.The main role in the origin of rheumatism is played by a previous infection of the upper respiratory tract in the form of sore throat. To date, numerous studies have established a connection between the onset of the disease and a previous streptococcal infection. The infection can also be localized in other places, manifesting itself in the form of sinusitis, otitis media, nasopharyngitis. However, it is not the place, but the source of infection that is of primary importance. In 9 out of 10 cases, it is group B streptococcus. Repeated streptococcal infections sensitize the body - a large number of immune complexes accumulate in it ( antibodies and antigens), which settle on the joints and membranes of the heart.
The occurrence of rheumatism is facilitated by risk factors in the form of unfavorable living conditions.
Risk factors for rheumatism are:
- physical activity;
- previous diseases;
- damp and cold rooms;
- mental trauma and stress;
- unbalanced diet ( abundance of carbohydrates, deficiency of proteins and vitamins).
Clinical picture
The disease debuts 3 to 4 weeks after a streptococcal infection. The child becomes lethargic, apathetic, and his appetite disappears. The main classic manifestations of rheumatism are rheumatic carditis and polyarthritis.
Rheumatic carditis is a lesion of the heart and is the main manifestation of the disease, determining its outcome. Manifested by damage to all membranes of the heart, but to a greater extent to the myocardium ( heart muscles). The main symptoms are rapid heartbeat, shortness of breath, and decreased blood pressure. Arrhythmias and blockades often develop. The classic consequence of rheumatic carditis is aortic valve regurgitation or mitral stenosis. These heart defects develop in every fifth child.
The damage to the joints is of the nature of polyarthritis, which is noted in 60 percent of cases or more. Against the background of increased body temperature, symmetrical pain and swelling of large and medium joints appear. Damage to joints in rheumatism is characterized by its reversibility, without signs of destruction ( destruction). Thus, as recovery progresses, a rapid and reverse development of the process is noted.
A characteristic symptom of rheumatism in children is damage to the central nervous system, which is called minor chorea.
Signs of damage to the nervous system due to rheumatism are:
- emotional disorders – tearfulness, irritability, mood lability;
- general weakness, apathy, loss of appetite;
- motor restlessness ( hyperkinesis) - erratic, uncontrolled, violent movements in individual muscle groups.
The course of rheumatism can be acute - up to 2 months, subacute - up to 4 months, prolonged up to 5 months, recurrent ( periodically aggravated), which lasts from a year or more.
Systemic lupus erythematosus
Systemic lupus erythematosus is another disease that a rheumatologist encounters. It belongs to the group of diffuse connective tissue diseases, which are based on a genetic defect in immunoregulatory processes. Subsequently, these defects lead to the formation of many antibodies to one’s own cells, the connective tissue cells that make up the internal organs and joints.The prevalence of the disease is relatively high and amounts to approximately 1 person per thousand of the population. More than 100 cases per million population are recorded annually worldwide. This increase in incidence is most likely due to new diagnostic methods.
Clinical picture
Systemic lupus erythematosus is a polysyndromic disease. This means that the clinical picture simultaneously includes many syndromes, each of which is characterized by typical symptoms. The main manifestation of this disease is skin changes, which are of paramount diagnostic importance.
The first symptoms of the disease are increasing weakness, progressive weight loss and increased body temperature. These symptoms may precede the appearance of skin changes, which, in turn, may be completely absent. Thus, systemic lupus erythematosus without skin symptoms occurs in 10 percent of cases. In one fifth of patients, skin changes are the initial sign, while in the remaining patients they appear at various stages of the disease.
Skin manifestations of systemic lupus erythematosus include:
- local erythema ( redness);
- infiltration - the appearance of immunoinflammatory cells in the skin;
- hyperkeratosis - thickening of the stratum corneum of the skin, as a result of which the skin area looks thick;
- atrophy – thinning of the skin.
Systemic lupus erythematosus is also characterized by damage to the scalp and lip borders. The disease is chronic, with periods of remission ( subsidence of the disease).
Other symptoms of systemic lupus include:
- Cheilitis- persistent redness with dry grayish crusts along the periphery of the lips.
- Capillarite- swelling, redness and atrophy on the fingertips and palms.
- Enanthema– red areas with hemorrhagic patches on the oral mucosa.
- Trophic skin changes– general dry skin, hair loss, deformation and brittleness of nails.
- Photosensitivity– one of the most important and frequently encountered signs, which is observed in 30–60 percent of patients with systemic lupus. Photosensitivity, along with lupus butterfly, is a diagnostic criterion. It is characterized by increased sensitivity of patients to ultraviolet rays.
- Damage to mucous membranes is also a diagnostic criterion. In this case, whitish plaques appear on the mucous membrane of the nose or mouth, which often turn into erosions and ulcers.
- Telangiectasia- dilation of small vessels without signs of inflammation, a common symptom not only with lupus, but also with most connective tissue pathologies.
Joint pain is observed in almost 100 percent of patients. Pain intensity correlates ( tied) with the degree of illness. With high activity of the inflammatory process, the pain syndrome can last more than several weeks; with low activity, pain can last from several minutes to several days. In this case, the development of inflammatory phenomena is most often recorded in the interphalangeal and metacarpophalangeal joints ( that is, like rheumatoid arthritis). The knee joints are less commonly affected.
Inflammation in the joints is usually symmetrical, morning stiffness and dysfunction of the joints are also recorded. However, all these changes quickly regress under the influence of drug therapy. The ligamentous apparatus is also involved in the pathological process, which leads to the development of tendinitis and tendovaginitis. In turn, these secondary phenomena lead to the development of contractures.
Massive destruction of cartilage tissue, such as in rheumatoid arthritis, is not typical for lupus. Thus, during an X-ray examination of joint erosions ( destruction) are found only in 3–5 percent of cases. However, at the same time, this disease is characterized by aseptic bone necrosis. Necrosis of the head of the femur and humerus is often recorded. Less commonly, multiple aseptic necrosis develops with damage to the bones of the wrist, knee joint, and foot.
Muscle damage in lupus has the character of classic dermatomyositis.
Systemic scleroderma
Systemic scleroderma is a progressive chronic disease, which is based on connective tissue damage with a predominance of fibrosis and vascular pathology. This pathology is characterized by changes in the skin, damage to the musculoskeletal system and internal organs. Systemic scleroderma is a polysyndromic disease that occurs with multiple lesions of the lungs, heart, kidneys, and digestive tract.According to the modern classification of rheumatic diseases, it is a systemic disease of connective tissue, which ranks second in prevalence after systemic lupus erythematosus. The incidence ranges from 3 to 10 new cases per 1 million population per year. Unfortunately, despite new diagnostic and treatment methods, systemic scleroderma is a progressive pathology leading to disability.
The clinical picture is distinguished by its diversity. The main components are damage to the skin and musculoskeletal system. As the disease progresses, vascular pathology occurs, which underlies damage to internal organs. With this disease, almost every organ and tissue is involved in the pathological process, thus reflecting the systemic nature of the disease.
The main signs of systemic scleroderma are ( frequency of occurrence in percent):
- weight loss – 50;
- lung damage – 80;
- heart damage – 85;
- kidney damage – 40;
- damage to the nervous system – 45;
- increase in ESR ( more than 20 millimeters per hour) – 70;
- increase in protein level more than 85 grams per liter – 60;
- presence of antinuclear factor – 75;
- presence of rheumatoid factor – 50.
Literally translated, scleroderma means hard-skinned, which indicates the essence of the disease. Skin lesions are one of the main criteria for diagnosing the disease and include three stages - dense swelling, induration ( seal) and atrophy. These stages can follow one after the other or develop separately. The severity of skin changes depends on the stage of the disease and can vary from minor changes in the form of swelling in the area of the hands ( fingers) and face until the skin is completely thickened.
In addition to the stages described above ( swelling, induration, atrophy) skin lesions may manifest as hyperpigmentation or depigmentation. In the first case, dark spots appear on the skin, which is due to the accumulation of melatonin pigment in this area. In the case of depigmentation, light areas devoid of pigment form on the skin. Skin changes may also manifest as erythema ( redness), ulcerations or telangiectasia ( local vascular dilations). Hyperkeratosis, hair loss up to baldness, and increased brittleness of nails are almost always observed.
Initially, the changes affect the fingers. In this case, a dense, painless swelling is formed, which gives the fingers a “sausage-shaped” appearance. The development of edema depends on the type of scleroderma. In the chronic course, the swelling persists for a long time, and in the subacute form it quickly turns into induration. Next, the pathological process affects the skin of the face and neck. Patients with scleroderma are characterized by a mask-like face with pronounced skin tension, thinning of the lip line, and sharp facial features. Due to trophic changes, the skin becomes thin and tense, resulting in the formation of purse-shaped wrinkles around the mouth, limiting mouth opening.
Lung damage
Damage to the lungs in scleroderma is the cause of the development of pulmonary failure and one of the causes of mortality ( deaths) for this disease. The lesion is based on the process of pneumofibrosis and sclerosis, when the lung tissue is replaced by connective tissue. As a result, the main function of gas exchange is lost, and chronic hypoxia develops ( oxygen starvation).
Symptoms of damage to the pulmonary system are shortness of breath and dry cough, which is caused by chronic bronchitis. Pain syndrome is not typical, and if observed, it is associated with the development of pleurisy.
Heart damage
Heart damage is the main cause of death in scleroderma. The incidence of damage to the cardiovascular system reaches 90 percent, which creates certain difficulties in the treatment of such patients. In this case, all layers of the heart can be affected - the myocardium, endocardium or pericardium. Heart damage is based on two pathological processes - the process of sclerosis ( replacement of muscle tissue with connective tissue) and impaired blood circulation. All this leads to loss of cardiac contractility, decreased cardiac output and the development of edema.
Manifestations of cardiac pathology in scleroderma are rhythm and conduction disturbances in the form of blockades and arrhythmias. Patients complain of frequent heartbeats, pain in the heart area, and shortness of breath. The electrocardiogram reveals characteristic ischemic phenomena ( ST segment depression), absence of sinus rhythm, changes in voltage.
Pain and other symptoms of rheumatic diseases
Pain syndrome is the main one in the clinical picture of rheumatic diseases. Intensity of pain, its nature, irradiation ( spreading) and other characteristics depend on the type of pathological process. When a patient describes pain, it is very important to find out its exact location.The characteristics of pain syndrome in rheumatology are:
- pain along the joint space – indicates severe arthropathy ( secondary joint changes);
- pain along the periphery of the capsule, which is limited to the limits of the joint, means damage to the capsule;
- the presence of periarticular tender points outside the capsule indicates bursitis.
When joints are damaged, muscles are almost always involved in the pathological process. This is explained by the fact that the muscles are attached with their tendon part to the surface of the joint. When inflammation develops inside the joint, it spreads to the muscles, as a result of which myositis initially develops, and then atrophy of muscle tissue.
Atrophy - loss of previous muscle function is a common symptom. However, it can develop quickly ( for several days for infectious arthritis) or gradually. Also, atrophy may be widespread ( generalized) or local. The degree of atrophy correlates ( tied) with the degree of lost muscle strength - the lower the muscle strength, the more pronounced the atrophy.
Crepitus
Crepitation is a grinding sound that is felt by a rheumatologist when palpating the joint. It can also be heard with a stethoscope placed on the joint. Crepitus is present when the synovium or tendons become inflamed. Rough crepitus, which develops when the bone itself is affected, can be heard at a distance.
In addition to crepitus, other sounds such as tendon clicks may be heard in rheumatic diseases. Such sounds are a consequence of the formation of gas bubbles inside the joint.
Local hyperthermia
Local hyperthermia is a local increase in temperature in the area of the affected joint. Hyperthermia is caused by the development of inflammation inside the joint. A rheumatologist assesses hyperthermia by applying the back of the hand to the inflamed joint and then to the healthy one.
Changes in the skin over the surface of the joint
The skin over the affected joint often changes. Most often, local hyperemia is observed ( redness), caused by the inflammatory process. Scratching, rashes, or other manifestations of a skin disease may also appear on the skin ( for example, psoriasis). These symptoms, in turn, may indicate the nature of the disease, for example, psoriatic arthritis.
Causes of skin changes include:
- infections and, as a result, infectious arthritis;
- accumulation of crystals in gout or calcific periarthritis;
- palindromic rheumatism;
- Reiter's syndrome;
- reactive arthritis;
- erosive osteoarthritis;
- arthropathy in erythema nodosum.
Joint swelling is a typical manifestation of rheumatic diseases. It develops due to the accumulation of fluid in soft tissues or other joint structures. Initially, intra-articular fluid collects in places of least resistance of the joint capsule. So, if we are talking about the shoulder joint, then the inflammatory fluid fills the depression between the collarbone and the deltoid muscle; when the ankle joint is inflamed, the effusion appears in the front. In case of severe edema, a fluctuation test is used. In this case, the doctor presses at one point of the joint, causing an increase in pressure and, as a result, “bulging” in another place.
Signs of synovitis are:
- loss of mobility in all planes;
- soreness in all directions;
- swelling;
- presence of effusion ( inflammatory fluid) in the joint cavity;
- pain along the joint space;
- local temperature increase;
- mild crepitus ( grinding) when pressing on the joint.
Diagnosis by a rheumatologist
Diagnosis of rheumatic diseases is based on a detailed examination by a rheumatologist, as well as additional tests and studies. Diagnosis of the disease usually takes place in two stages. Initially, a preliminary diagnosis is made, which after additional examinations is excluded or confirmed. Reception ( consultation) rheumatologist
A consultation with a rheumatologist includes a survey and examination. During the examination and questioning, the rheumatologist, first of all, must determine the exact localization of the inflammatory process and the extent of the lesion.It happens that the patient is bothered by one or two joints, but during the examination it is discovered that the pathological process covers much more. After determining the location, it is important to find out the chronological onset - when the first symptoms appeared and how they progressed. An important place in diagnosis is played by previous provoking factors, that is, all the diseases that the patient had previously suffered from. If these are colds, then it is important to ask the patient how often he was sick, whether he saw a doctor, and so on. In differential diagnosis, factors that alleviate and aggravate the condition are also taken into account. For example, the patient says that the pain is most pronounced at rest and in the morning and weakens with movement.
Also, the rheumatologist should ask whether the patient has previously sought help from a specialist, whether he has undergone treatment and, most importantly, whether there was a response to treatment or not.
Where does a rheumatologist see?
Most often, a rheumatologist sees patients in clinics or specialized institutions. The latter include rheumatology departments in general hospitals. Rheumatologists can also practice privately.What symptoms do you see a rheumatologist for?
In his practice, a rheumatologist encounters not only articular symptoms, but also general ones. The first includes pain, stiffness, deformation, the second includes weakness, increased fatigue, and fever.The main symptoms encountered by a rheumatologist are:
- pain;
- stiffness;
- swelling and deformation;
- sleep disturbance;
- deterioration of general condition.
This is the main and most important symptom for the patient. During the examination, it is important to ensure the localization of the pain syndrome, since the patient’s description ( for example, pain in the shoulder) may not be true. To do this, the rheumatologist usually asks you to indicate the location of the greatest pain and roughly outline its area.
Regardless of the type of pain syndrome ( be it joint or periarticular pain) it can radiate widely ( give away) to various areas. Such referred pain is true because it does not originate from the pathological focus itself. Its difference is its unclear outline and the fact that the patient feels it somewhat deeper.
The pain can be acute, shooting with characteristic irradiation. Such pain is characteristic of root entrapment, which is noted when the joints of the vertebrae are affected. Sometimes extremely severe and cramping pain can be experienced, which is characteristic of crystalline arthritis. The severity of pain depends on many factors, but the emotional state of the patient plays a big role in the perception of pain.
Pain that intensifies during movement indicates its mechanical nature. Pain that passes during exercise and intensifies at rest indicates a pronounced inflammatory process. The most dangerous from a prognostic point of view is night pain, which leads to insomnia and exhaustion of the patient. It is a reflection of intraosseous hypertension and is characteristic of severe arthropathy ( secondary joint damage). Constant day and night “bone pain” is typical for tumor metastases.
Stiffness
Stiffness is another common symptom that rheumatologists often encounter. This symptom is a subjective sensation of the patient, who describes it as some kind of obstacle to movement. It is most pronounced in the morning immediately after waking up. As a person begins to move, there is an increase in the outflow of fluid from the inflamed joint, as a result of which the stiffness goes away. The duration of morning stiffness is an important diagnostic criterion. Therefore, during the examination, the rheumatologist should ask the patient how long the morning stiffness lasts and after which it goes away.
Joint swelling and deformity
In the initial stages of the disease, patients may notice swelling in the joint area, sometimes redness above the joint. The severity of swelling depends on the degree of swelling inside the joint. Thus, the swelling can be so great that the contours of the joints disappear. In later stages, when the joint structures are destroyed, the joint may become completely deformed.
Sleep disturbance
Sleep disturbance is a common symptom in rheumatic diseases. There are several reasons for this. First of all, this is chronic pain, which can worsen at rest, that is, when a person sleeps. Sleep may also be affected by medications prescribed by a rheumatologist. The total duration of sleep can be influenced by the fear of destruction and deformation of the joint, as well as the duration of the disease itself. With a long-term illness, sleep disturbance must be considered in the context of depression, since this disease is very often observed in patients with severe damage to the musculoskeletal system.
General condition
Systemic inflammatory diseases are usually accompanied by a deterioration in general condition. The reason for this is constant pain and sleep disturbance. Against the background of periodic insomnia and exhaustion of the nervous system, there is a decrease in appetite, weight loss, general malaise, and irritability. Sometimes, at a doctor’s appointment, the patient may not present any specific and specific complaints, but complain about general malaise and fatigue. In old age, during the period of exacerbation of the disease, confusion and delusional symptoms may be noted.
Examination by a rheumatologist
An examination by a rheumatologist begins with an assessment of mobility. Assessing mobility in all joints, and not just where there is pain, is an integral step in the diagnosis of rheumatic diseases. The volume of active and passive movements is assessed on both sides. When the synovial capsule is involved in the inflammatory process ( that is, with the development of synovitis) there is a decrease in all types of movements. With periarticular inflammation, joint mobility is impaired in only one plane. Arthropathy ( secondary joint damage) is accompanied by a decrease in both active and passive movements.The predominance of passive movements over active ones indicates damage to muscles, nerves and tendons. The nature of the pain that occurs during movements is also of important diagnostic importance. The same intensity of pain in all movements is more typical for mechanical lesions. Pain at certain points indicates local periarticular inflammation. Pain in all or almost all directions is a sign of synovitis.
The stages of patient activity testing are:
- Examination of the patient while walking– walking forward and backward, turning.
- Examination of a standing patient– the rheumatologist asks the patient to touch the floor with his hands ( flexion in the lower back, checking the mobility of the spine), open your mouth and move your jaw ( mobility in the temporomandibular joints is checked), put your hands behind your head ( shoulder joints are examined), clench your fists ( functionality of the metacarpophalangeal joints) and so on.
- Examination of a patient lying on a couch- the range of motion in the knee and hip joint is determined ( flexion, extension, abduction), also examination of the sole and ankle joints.
Disability due to rheumatic diseases
Unfortunately, rheumatic diseases sooner or later lead to decreased functioning and, in turn, to impaired activity. The patient's disability is noted when inferiority is recorded in everyday, social and professional activities. However, it is worth noting that even significant inferiority of an organ does not always lead to disability and loss of activity. This depends, first of all, on the level of medical care and social rehabilitation provided.What tests does a rheumatologist prescribe?
Most laboratory parameters used in rheumatology ( and in particular in the diagnosis of rheumatoid arthritis), are not specific. This means that they cannot specifically indicate a specific disease. In general, they indicate the general picture of inflammation, namely the severity of the inflammatory process.Analysis | What is characteristic? | When does it meet? |
General blood test | Normochromic anemia is a decrease in the number of red blood cells without changing the color indicator. | Most connective tissue diseases ( rheumatoid arthritis, rheumatism). |
Thrombocytosis is an absolute or relative increase in the number of platelets per unit of blood. | Rheumatoid arthritis, rheumatism, systemic lupus erythematosus. |
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With rheumatoid arthritis and concomitant vasculitis, pericarditis, also in the presence of rheumatoid nodules |
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Increased erythrocyte sedimentation rate ( ESR). | It is the most important indicator of the activity of rheumatoid arthritis and rheumatism. This laboratory sign can appear long before the first symptoms of the disease. |
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Biochemical blood test | A decrease in serum albumin concentration and, at the same time, an increase in globulin levels. | Rheumatic diseases in the chronic phase. |
Acute phase proteins:
| Acute phase proteins indicate the onset or exacerbation of diseases such as rheumatoid arthritis, rheumatism, scleroderma. |
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Specific antibodies | Antinuclear factor. |
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Rheumatoid factor. |
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Synovial fluid examination
A more specific test is the study of synovial fluid. To do this, the joint is first punctured, after which the inflammatory fluid is removed for further examination. Externally, it is a transparent, slightly opalescent liquid, sometimes yellow in color. In some rheumatic diseases, in particular rheumatoid arthritis, its amount may be increased. However, normally its volume should not exceed 3.5 milliliters. A characteristic symptom of rheumatic pathology is an increased content of leukocytes in the synovial fluid. A specific parameter is a decrease in the sugar level in the test exudate. A more informative method is to determine rheumatoid factor in the joint fluid. It should be noted that in some patients rheumatoid factor is not detected in the blood serum, but is present in the synovial fluid.
Specific tests in rheumatology
The most important indicator from a diagnostic point of view is rheumatoid factor. It is an IgM antibody ( acute phase), which is synthesized by the human immune system. This indicator can also occur in healthy people with a frequency of 3 to 5 percent. Rheumatoid factor is a highly specific indicator. It is also present in other diseases. For example, high titers ( concentrations) rheumatoid factor are recorded in tuberculosis, bacterial endocarditis, and malignant tumors. However, in these diseases the titers are significantly lower than, for example, in rheumatoid arthritis.
The highest level of rheumatoid factor ( more than 1 in 1000) is observed in patients with Sjogren's syndrome, which is combined with rheumatoid arthritis.
Treatment by a rheumatologist
A wide range of drugs are used in the treatment of rheumatic diseases. These are mainly medications that eliminate symptoms and reduce the severity of inflammation. The main groups of drugs in rheumatology are:
- non-steroidal anti-inflammatory drugs ( NSAIDs);
- slow-acting drugs - antimalarials, gold salts, antimetabolites, cytotoxic agents.
Nonsteroidal anti-inflammatory drugs ( NSAIDs)
This is a class of drugs whose action is aimed at preventing the development of inflammation or reducing its activity. This is one of the most diverse classes, including more than 50 drugs. In turn, within each class there is a division into subclasses. It is also one of the most frequently prescribed groups of medications.Mechanism of action
Being organic acids in structure, non-steroidal anti-inflammatory drugs actively bind to proteins ( proteins) plasma and accumulate at the site of inflammation ( in this case in the joint). The main mechanism of action is to inhibit enzyme activity
