“Dark horse” of modern medicine, or What is worth knowing about rheumatology?

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.

Make an appointment with a doctor

It is necessary to make an appointment with a rheumatologist if you have the following manifestations of the disease:

Restricted mobility, joint pain;
Swelling of the skin and temperature above them;
Skin rashes;
Pain in the spine;
Muscle and joint pain;
Changes in the relief and redness of the skin.

To see a doctor at a time convenient for you, make an appointment with a rheumatologist online. Call center consultants will help you choose a time and tell you in detail how to get to the Yusupov Hospital.

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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.

How does the consultation work?

A consultation with a rheumatologist in Moscow begins with clarification of complaints, anamnesis of the disease and life, an objective examination, during which the affected area is examined, and the degree of motor disorders is established by conducting functional tests.

Considering the similar symptoms of most pathologies of the musculoskeletal system, in order to make a more accurate diagnosis, a rheumatologist uses a comprehensive examination in his practice. To eliminate errors, doctors at the Yusupov Hospital use laboratory and instrumental diagnostic methods. A blood test is prescribed to determine the level of C-reactive protein, rheumatoid factor, uric acid, etc. Of the instrumental methods, doctors use radiography, ultrasound, magnetic resonance imaging and computed tomography. Rheumatologists at the Yusupov Hospital individually select the optimal treatment regimen, using a variety of approaches to treating the disease depending on the general condition of the patient.

Specialists in the treatment of rheumatological diseases use antibacterial, non-steroidal anti-inflammatory drugs, analgesics, cytostatics, and conduct hormonal injection therapy. This integrated approach can significantly reduce the activity of the inflammatory process, slow down the progression of the disease and prevent the occurrence of possible complications.

Treatment of rheumatic conditions

A rheumatologist can suggest and provide treatment for many rheumatic diseases. Procedures that a rheumatologist may recommend:

Joint injections

A rheumatologist can treat joint inflammation and pain by injecting an anti-inflammatory drug, such as a corticosteroid, directly into the affected joint or by aspirating the joint. When a doctor aspirates a joint, they use a needle attached to a syringe to remove excess fluid from the joint. Aspiration is used to reduce swelling and pain in patients' joints and to analyze joint fluid.

Use of drugs

A rheumatologist may prescribe anti-rheumatic drugs that reduce the activity of the immune system or slow the progression of rheumatic conditions. Nonsteroidal anti-inflammatory drugs—such as ibuprofen, naproxen, meloxicam, and aspirin—can also reduce inflammation and joint pain.

What does a rheumatologist treat?

The main diseases that are included in the profile of the best rheumatologists in Moscow are:

Arthritis (from the shoulder joint to the toe joints);
Rheumatism (may be a complication of a previous flu or cold);
Osteoporosis;
Gout.

But this is only a small list of diseases that specialists at the Yusupov Hospital treat; in fact, the list of pathological conditions is much wider.
Rheumatology includes inflammatory and degenerative-dystrophic lesions of the musculoskeletal system, systemic and local tissue damage, which lead to the appearance of such an unpleasant symptom as joint pain. In total, the competence of a rheumatologist includes about a hundred ailments, which are characterized by damage to almost all human organs and systems: the spine, bones, joints, muscles, internal organs and blood vessels. Advanced rheumatic diseases, the development of which is inevitably accompanied by complications, pose a serious danger to patients. When all supporting connective tissues (cartilage, bones, ligaments) are involved in the pathological process, the patient is faced with such global problems as limited body mobility in the affected areas or disability.

If a patient sees a rheumatologist with a complicated form of the disease, the specialist will not always be able to cure him. Rheumatologists at the Yusupov Hospital provide therapy aimed at reducing the severity of symptoms of the disease and preventing complications, lengthening the period between exacerbations of the disease. Enhanced therapy can improve the performance of the compounds and return the patient to the ability to independently move around the house and street without resorting to outside help.

Rheumatological diseases affect a person’s state of mind, as they affect family relationships, the ability to socially realize and mental activity. Therefore, the Yusupov Hospital has a whole team of specialists who help patients cope with such a complex pathology in all areas.

Rheumatologists treat diseases of various tissues and organs. Joint diseases include:

Infectious arthritis;
Rheumatoid arthritis;
Osteoarthritis;
Reiter's syndrome or reactive arthritis;
Idiopathic juvenile arthritis;
Ankylosing spondylitis or ankylosing spondylitis;
Background arthritis of intestinal inflammation;
Other types of arthritis;
Still's disease;
Gout and pseudogout.
Rheumatologists also treat diffuse connective tissue diseases:
Sjögren's disease;
Lupus erythematosus;
Dermatomyositis;
Systemic scleroderma.

Rheumatological diseases include not only connective tissue lesions, but also lesions of muscle fibers, blood vessels and internal organs:

Polymyalgia rheumatica;
Acute form of rheumatic fever;
Relapsing polychondritis;
Behçet's disease;
Fibromyalgia;
Osteoporosis.

A separate group of rheumatological pathologies includes systemic vasculitis, vasculopathies and some other diseases:

Hypereosinophilic angiitis;
Microscopic vasculitis;
Henoch-Schönlein Purpura;
Aortoarteritis;
Horton's arteritis;
Polyarteritis nodosa;
Kawasaki disease;
Cryoglobulinemic vasculitis;
Antiphospholipid syndrome;
Nonspecific vasculitis.

Leading specialists in the field of rheumatology at the Yusupov Hospital devote a lot of time and attention to each patient. The autoimmune mechanism of disease development is spoken of when the connective tissue of all systems is involved in the pathological process. Therefore, it is necessary to undergo a thorough diagnosis by a qualified specialist.

Does your back hurt in the morning?

Another important symptom of rheumatological disease is inflammatory back pain. And this is not the kind of pain that occurs after heavy physical activity and goes away after rest: in this case, the back hurts in the morning, when the person just woke up.

According to statistics, a young patient with similar complaints can spend up to 10 years migrating between various specialists - neurologists, orthopedists, therapists - with diagnoses such as “osteochondrosis”, “intervertebral hernia”, etc., until he finally gets to a rheumatologist (Dubinina, Erdes, 2010). And during this time, he will develop irreversible changes that could have been avoided with timely diagnosis.

Severe chronic inflammatory diseases of the gastrointestinal tract include Crohn's disease, which is presumably caused by a pathological reaction of the immune system to the intestinal flora and substances entering the intestines. One of the extraintestinal manifestations of the disease is joint damage. On the picture:

X-ray of a hip joint with a completely destroyed head in a 36-year-old patient with Crohn's disease

Inflammatory back pain accompanies a whole group of diseases called spondyloarthropathy, which affects the joints of the spine.

A typical representative of this group is ankylosing spondylitis, or ankylosing spondylitis, or ankylosing spondylitis - a chronic inflammatory disease of the spine and sacroiliac joints, which also occurs with damage to peripheral joints and areas of attachment of the ligamentous-tendon component of the joint to the bone, damage to the eyes (uveitis) and the aortic bulb (aortitis). (Rheumatology: national guidelines, 2008).

Previously, it was believed that ankylosing spondylitis affects only men, but not so long ago it began to be actively detected in women. In addition, in women, the clinical picture has its own characteristics: the cervical spine is more often affected, the onset of the disease is characterized by peripheral arthritis, and a more benign course of the disease in general. A generally accepted predisposing factor is the carriage of one of the genes of the major histocompatibility complex HLA B 27. But there is no need to panic right away: although 90% of patients have this gene, among its carriers the disease develops only in 1–2% of cases. However, in addition to HLA B 27, more than six dozen potentially “risky” gene loci have been identified (Ranganathan, 2017).

The progression of ankylosing spondylitis (ankylosing spondylitis), in contrast to rheumatoid arthritis, is associated with the proliferation of bone tissue, which is manifested, in particular, by the process of ankylosing of the spine (fusion of the articular ends of articulating vertebrae). As a result, the spine shortens, becomes deformed and loses mobility. If left untreated, the disease can lead to complete immobility of the spine, the patient acquires a “suppliant pose” (arms bent at the elbows, a hunched back, a bowed head, legs slightly bent at the knees).

Rest is contraindicated for such patients: they must exercise for at least half an hour 4 times a day to maintain spinal mobility. In the absence of regular, proper physical activity, irreversible changes quickly occur, which leads to disability.

A characteristic sign of psoriatic arthritis (damage to the joints and spine in patients with psoriasis) is dactylitis - inflammatory processes in the fingers or toes. Moreover, in 70% of patients with psoriasis, skin lesions occur before joint damage (Korotaeva, Korsakova, 2018).

It is believed that the development of this disease is associated with the activation of cellular immunity and a shift in the balance towards inflammation. Unlike ankylosing spondylitis, in this case the peripheral joints are affected, rather than the spine. The distal interphalangeal joints are often affected, which are practically not affected by rheumatoid arthritis due to the lack of synovial membrane in them.

X-ray of the feet with psoriatic arthritis. The toes of the right foot deviated to the side due to damage to the joints. There is a “pencil in a glass” symptom characteristic of this arthritis - destruction of the bone near the joint with “creeping” onto the underlying bone

Another disease from the group of spondyloarthritis - reactive arthritis - occurs as a result of strictly defined intestinal or sexually transmitted infections. Most cases are associated with chlamydia infection. But, since the isolation of the microorganisms themselves from the joint was not successful, the theory of immune-mediated inflammation as a result of the action of antigen-antibody complexes was put forward. The onset of the disease occurs between the ages of 20 and 40, and in this case, men get sick much more often than women.

Spondyloarthritis associated with inflammatory bowel disease shares many symptoms with other spondyloarthritis. What is the primary lesion - an inflammatory process in the intestines or a lesion of the musculoskeletal system - is still a matter of debate.

In the case where all the signs of spondyloarthropathy are present, but the picture does not fit into any of the criteria for a particular disease, a diagnosis of undifferentiated spondyloarthritis is made. This at least allows treatment to begin at an early stage of the pathological process.

Gout is treated with colchicine, which is a cell poison.
How it works? Cells of the immune system are constantly and actively dividing. Colchicine (a plant alkaloid) and its synthetic analogues stop mitotic cell division, which inhibits the development of inflammation. But the patient takes these pills for a very short time, only to stop the exacerbation.

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.

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Is rheumatism a death sentence?

If the initial diagnosis is confirmed and you are diagnosed with one of the rheumatological problems, this means only one thing: from now on, a rheumatologist specialist should become your faithful companion, whom you will see even in case of colds, various infections and injuries. The fact is that patients of a rheumatologist require a special approach when treating any disease.

It is important to remember two rules. First: it is easier to prevent any disease than to cure it. Therefore, do not forget about reasonable physical activity, proper nutrition and, of course, preventive examinations by a rheumatologist.

The second rule is no less simple: every disease is easier to defeat at the initial stage. Yes, rheumatological diseases usually require long-term treatment, but in the end you will maintain mobility, good health and will not feel that your quality of life is deteriorating.

SMC Best Clinic specialists make every effort to ensure that patients forget about their diseases forever. If you are at risk or notice that something is wrong with your joints, make an appointment without delay - this way you can avoid adverse consequences and defeat the disease.

Who is a rheumatologist-cardiologist, why should you contact him?

Having studied the above classification of diseases, you can understand that many rheumatological diseases have a direct effect on the heart and blood vessels.

A cardiologist-rheumatologist, in fact, is a related doctor, and can make the most accurate diagnosis in case of manifestations:

endocarditis;
myocardial damage;
vascular obstruction;
development of arrhythmias.

All these symptoms can be caused directly by rheumatism, the treatment of which is mainly the activity of a cardiologist-rheumatologist. Systemic lupus erythematosus, vasculitis and scleroderma are also reasons to consult a specialist in these related fields.

Useful tips from rheumatologists

Every person should know that the most effective treatment for any disease is to minimize the risk of its occurrence. To prevent diseases, you should follow the useful recommendations given by rheumatologists:

Maintain physical activity, periodically exercise and lead a healthy lifestyle. You can choose swimming, running, and athletics as sports areas. It is better to avoid weightlifting;
do not forget to keep your back straight;
spend more time in the fresh air;
at work, avoid staying in one position for a long time, if possible, take breaks and do gymnastics;
during the cool and cold seasons, take vitamin complexes (your doctor will help you determine the appropriate dietary supplements);
Healthy food;
avoid hypothermia.

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;

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.