The field of Rheumatology is a subspecialty of Internal Medicine and Pediatrics that focuses on the diagnosis and therapy of complex rheumatic problems involving the joints, soft tissues, connective tissue disorders, and autoimmune conditions. There are more than 200 types of these diseases, and as a Rheumatologist, I see and treat many of these conditions. But as in every field, there are always specific disease processes I see more than others. For me, the three most common conditions I see and treat are Rheumatoid Arthritis (RA), Osteoarthritis (OA), and Fibromyalgia. Let’s delve into each one to provide some clarity.
1.Rheumatoid Arthritis (RA) is a chronic inflammatory condition that causes joint pain, stiffness, swelling, and limited mobility and function of many joints in approximately 1% of the population. The stiffness seen in RA is described as difficulty moving the joints after prolonged inactivity, therefore it is often worst in the morning when getting out of bed and tends to improve with activity. RA commonly begins between 40-60 years of age, however, signs and symptoms can start at any time. Diagnosis is based on laboratory data, physical exam, and imaging studies. If left uncontrolled, RA can lead to destruction of the joints resulting in erosion of the cartilage, among other deformities. While Rheumatoid Arthritis was once considered the most disabling arthritis, many new treatment advances have now enabled those with RA to lead very active and functional lives.
2.Osteoarthritis (OA), on the other hand, is a chronic non-inflammatory arthritis, typically affecting middle-age and elderly people. This type of arthritis is often referred to as the “wear and tear” of the joints. This description is inaccurate, however, as OA affects the entire joint, involving the bone, cartilage, ligaments, and joint lining. The joints most commonly affected are weight-bearing joints, such as the hips and knees, but it can also affect the hands, feet, shoulders, and spine. Risk factors include previous trauma, overuse of joints, obesity, having family members with OA, and being older in age. In contrast to those who have RA, patients with OA will say their pain is worst at the end of the day and improves with rest. There is no cure for OA, so treatment is directed at improving functionality and minimizing pain by focusing on exercise, patient education, and weight loss, as well use of various medications and surgical interventions. The ultimate goal is to improve functionality and minimize disability.
3.Fibromyalgia is a chronic pain processing disorder that is often characterized by widespread pain involving the muscles, ligaments, and tendons at specific points on the body, eventually progressing to generalized body pain. It is often associated with fatigue and difficulty sleeping, and some patients may have a constellation of other symptoms such as depression, anxiety, headaches, irritable bowel syndrome, and TMJ pain. Patients with fibromyalgia will often say “I hurt all over” or “I feel like have the flu all the time.” Fibromyalgia has no identifiable cause and affects approximately 2% of the population, most commonly women. It is important to note that fibromyalgia is not physically damaging to the body, meaning that it can be extremely difficult to live with but is not a fatal condition. There is no cure for fibromyalgia, but with mechanisms such as a light graded exercise, aquatic therapy, medications, and coping skills, people with fibromyalgia can lead happy and fulfilling lives.
Whether you have Rheumatoid Arthritis, Osteoarthritis, or Fibromyalgia, the goal is to improve quality of life and minimize pain. The most important thing to remember is that by being educated and informed about your condition and treatment options, you have the power to be engaged with your Rheumatologist in your treatment plan.