Other Rheumatic Conditions
SLE or systemic lupus erythematosus is another autoimmune disease, where antibodies produced by your immune system attacks your body’s own tissues causing inflammation. The cause of SLE is unknown. Lupus signs and symptoms include:
- Joint pain
- Joint stiffness
- Rashes, including the “butterfly rash” across the cheeks
- Hair loss
- Kidney involvement
- Blood disorders, such as anemia, blood clots, miscarriages
- Chest pain from inflammation of the lining of the heart or lungs
- Seizures or strokes
- Raynaud’s – cold fingers
Lupus is diagnosed from a history, clinical examination and specialised tests including urine tests, ESR, CRP, FBC, ANA, dsDNA.. Almost all patients with lupus have a positive ANA blood test. Regular monitoring is essential in picking up early complications of the condition.
Osteoporosis is a condition that affects the bones, causing them to become weak and fragile and more likely to break (fracture). These fractures most commonly occur in the spine, wrist and hips but can affect other bones.
Bone density is at its highest in the late 20s and early 30s. By 40, bone density begins to fall. Certain athletes are at high risk of osteoporosis (ballet dancers, gymnasts etc). There are often no warning signs for osteoporosis until someone experiences a low impact fracture, often after a minor fall.
If your doctor suspects you have osteoporosis, or are at high risk of developing the condition, you may be referred for a bone density scan (DEXA scan). This is a short and painless procedure which helps to assess your risk of a fracture.
Treatment for osteoporosis is based on treating and preventing fractures and using medication to strengthen your bones. However, the decision about what treatment, if any, you have will depend on your fracture risk. This will be based on a number of factors including the results of your DEXA scan, your age, weight, family history, smoking status etc.
Polymyalgia Rheumatica (PMR)
PMR is one of the commonest rheumatic conditions, affecting those over the age of 55. Patients typically complain of significant pain and stiffness in the muscles around the shoulders, neck, buttocks and hips because of inflammation. Symptoms are worst at night and in the morning.
Diagnosis is largely based on clinical history. Blood tests can help and support the diagnosis (ESR & CRP). The prognosis for patients with PMR is very good and the symptoms usually improve quickly if treated with steroid tablets (oral corticosteroids).Most people with PMR will need to take a long-term course of corticosteroids (one to two years) to prevent their symptoms returning. It is important to consider osteoporosis prophylaxis in this group of patients as they are at risk of osteoporosis.
Ankylosing spondylitis (AS) is a chronic (long-term) arthritis that affects parts of the spine, including bones, muscles and ligaments. It is more common in young men. In AS, the spinal joints, ligaments and the sacroiliac joints (the joints at the base of the spine) become inflamed. This inflammation causes pain and stiffness in the neck and back, worse in the morning. This inflammation can cause fusion (ankylosis) of the spine.
Diagnosis is made based on patient’s history, clinical examination, MRI and specialised blood tests including HLA B27. However, having a positive HLA B27 test does not on its own mean you have AS.
The aim of treatment is to alleviate the pain and stiffness by using various medications, and to keep the spine flexible with physiotherapy. This should then prevent the spine from fusing. Early diagnosis and treatment can significantly reduce long term disability. Treatment includes:
- Physiotherapy – is extremely important part of the management plan. A series of exercises that increase muscle strength and maintain mobility and flexibility of the spine and other joints is imperative to maintain function. Hydrotherapy can also be offered.
- Medication – helps relieve pain and inflammation and control symptoms. This can include anti inflammatories, steroids, injections and DMARD’s (disease modifying drugs).
- Lifestyle changes – to minimise the risk of other health conditions and improve symptoms
Anti-TNFα therapy are new treatments for AS which are very effective in patients with severe disease.
Myopathy (Disorders of Muscles)
Myopathies are disorders of muscles, which usually come to our attention because we develop weakness or rapid fatigue in the muscles during activities when we use our limbs. There may be delay in recovery after sport or just reduced performance compared with former days.
When you acquire a myopathy late in life there is often an underlying reason for it such as thyroid disease, diabetes or a problem developing in the adrenal glands.
Certain drugs may produce toxic myopathy, as can alcohol, steroids and statins and street drugs.
It is very important to discover exactly why you have developed these symptoms because there may be a cure; this all depends on an accurate diagnosis. Early diagnosis can prevent unnecessary pain, disability and long term damage.
Fibromyalgia, is a chronic condition with symptoms of all over body pain. Women are more commonly affected. It does not cause joint damage as it is not an inflammatory or degenerative condition. It can still have a significant affect on quality of life. Diagnosis is largely based on clinical history and examination (looking for tender points). It is also important to exclude other conditions before diagnosing Fibromyalgia, as there is no specific diagnostic test. Symptoms can vary on a daily basis and include:
- Difficulty sleeping
- Widespread pain
- Poor concentration
- Irritable bowel syndrome (IBS)
- Muscle stiffness
A multi-disciplinary team including physiotherapists, occupational therapists, and pain specialists may be involved in your care. Early diagnosis and management can significantly help in reducing the severity of symptoms. There are a number of treatments that may ease the symptoms and make the condition easier to live with. Treatment can include a combination of:
- Medicines – such as antidepressants and painkillers (anti inflammtories)
- Lifestyle changes – such as better sleeping habits, weight loss, relaxation
- A graduated exercise programme
Vasculitis is a rare disease characterised by inflammation of the blood vessels. This can cause them to burst, or can cause reduced blood flow. Symptoms vary depending on the size of vessels affected, and the organs that they supply. Management thus varies depending on the severity of the disease. Patients can become very ill. It is a condition that can occur on its own, or secondary to other conditions such as rheumatoid arthritis or lupus.
Areas affected include muscles (pain), fingers (cold), kidneys (passing blood), lungs (shortness of breath), nerves (numbness), eyes (blurred vision), skin (rash),
This condition refers to inflammation and or degeneration of tendons caused by overuse, injury, or a rheumatic condition. Tendonitis can produce pain and restrict movement in all major joints. It most commonly affects the Achilles tendon, finger tendons, elbow, shoulder and hip.
In many cases, a painful tendon will get better after a few days. However you should stop doing the exercise or activity that caused your symptoms. Self-help techniques, such as rest, painkillers and ice packs, can often help relieve tendonitis. More persistent cases of tendonitis may need to be treated with physiotherapy, podiatry, corticosteroid injections or shock wave therapy. Biomechanics may need correcting.
Dr Bawa and his team can promptly diagnose and design a personalised management plan catering for individuals needs.
There are over 100 medical conditions that are covered under the umbrella of rheumatic disease. If you have an acute or chronic pain, specifically in your joints or muscles, you should get in contact with your GP. Your GP may recommend a referral onto Dr Bawa’s support team at the Nuffield Hospital for a consultation.