Rheumatology

Rheumatic conditions can affect any part of your body, but they most frequently affect joints, muscles, bones, tendons, ligaments and other connective tissues. There are more than 100 different rheumatologic conditions, some of which are characterized by pain, inflammation, swelling, stiffness, and loss of function. In some cases, internal organs may also be affected. Women are two to four times more likely to suffer from rheumatologic conditions, a difference that doctors attribute in part to the influence of female hormones. Among the conditions that most common rheumatologists treat are osteoarthritis, rheumatoid arthritis, lupus and scleroderma.

Rheumatological Diseases

Osteoarthritis

Osteoarthritis, the most common form of arthritis, is a chronic condition that occurs when the cartilage in your joints breaks down. Cartilage is the spongy tissue that cushions your bones and allows your joints to move easily. When the cartilage is worn away — either because of age, overuse or injury — your bones rub against each other and cause pain, stiffness, swelling and loss of movement. Osteoarthritis usually develops gradually, with mild soreness or stiffness. But over time, it can lead to permanent damage to your joints. Although any joint in your body can become arthritic, it most commonly occurs in the hands, spine, knees and hips, and big toes. An estimated 27 million Americans — equal numbers of men and women — are living with osteoarthritis today, and experts say more than 70 percent of people over the age of 70 show x-ray evidence of osteoarthritis.

Risk Factors

Advancing age is one of the biggest risk factors for osteoarthritis. The condition is often called a “wear and tear” disease because the older you are, the more wear and tear you’ve put on your joints. Being overweight is another major risk factor, especially for arthritis of the knees and hips. The more weight you carry, the more pressure you’re putting on your body’s joints. Prior injury to a bone or jobs that involve repetitive motions such as operating machinery, can also increase your risk for developing osteoarthritis.

Signs and Symptoms

Some of the most common warning signs of osteoarthritis are stiffness in a joint after getting out of bed or sitting for long periods of time, swelling or tenderness in one or more joints later in the day, and a crunching feeling when you bend or move a limb. To make the diagnosis, doctors conduct a thorough medical history and physical and also order x-rays of the affected joints. In some cases, they may also aspirate the fluid in the lining of your joints, to check for signs of inflammation.

Treatment Options

The goals of treatment for osteoarthritis are controlling pain and other symptoms, and improving your ability to participate in day-to-day activities. In addition to various medications, other effective treatments include physical and occupational therapy and surgery, if necessary. Lifestyle changes are also important, such as losing excess weight and doing regular physical activity.

Rheumatoid Arthritis

Like many other rheumatologic conditions, rheumatoid arthritis (RA) is an autoimmune diseases, which means the body’s own immune system — which normally protects you from viruses, bacteria and other health threats — attacks your own body instead. With RA, the immune system attacks the synovium, which is the membrane that lines your joints. The result is pain, inflammation and often permanent damage to your joints. Inflammation can occur throughout the body, as well, which can cause damage to your internal organs. Like most autoimmune diseases, RA is much more common in women. An estimated 1.3 million people in the U.S. have RA, and nearly three times as many women as men have the disease. The disease is chronic and can’t be cured, but early diagnosis and treatment can help put the disease in remission and avoid permanent joint damage and other serious complications.

Risk Factors

Being female is the greatest risk factor for developing rheumatoid arthritis. It most often strikes women between the ages of 30 and 60. Age is another risk factor and when the disease does occur in men, it usually happens later in their lives. A family history of rheumatoid arthritis increases your risk, and recent research has identified certain genetic markers that can dramatically up the chances of developing the disease. Other recent studies suggest that being a heavy smoker or being obese may also increase your risk of developing RA.

Signs and Symptoms

If you have rheumatoid arthritis, your joints will often feel warm to the touch. Other signs include pain and swelling around the affected joints, as well as a decreased range of motion. Another specific identifying characteristic of rheumatoid arthritis is that the symptoms are symmetrical, meaning, for instance, that if one knee is affected, the other knee is likely to be involved too. Other non-joint-related symptoms include fatigue, loss of energy and appetite, and a constant low-grade fever. Doctors make the diagnosis by doing a thorough medical history and physical and ordering x-rays and certain blood tests to look for antibodies and other markers of the disease.

Treatment Options

Treatments for rheumatoid arthritis include medications to relieve pain, inflammation and other symptoms of the disease (such as steroid drugs) as well as drugs called disease-modifying antirheumatic drugs, which can actually modify the course of the disease and even put it into remission. The earlier you get diagnosed and begin treatment with disease-modifying drugs, the better your chances of avoiding permanent joint damage and other serious complications. In addition to medications, regular physical activity is important for strengthening your muscles and increasing your flexibility.

Lupus

Lupus is a chronic autoimmune disease that causes damage to not only the joints, but also the heart, skin, kidneys and other organs. For unknown reasons, the body’s immune system attacks itself, leading to pain, inflammation and damage throughout the body. As with other autoimmune diseases, people with lupus can alternative between times when their symptoms worsen (known as flares) and when they improve (remissions). An estimated 1.5 million Americans have lupus and the vast majority of patients (approximately 90 percent) are women. Lupus usually strikes between the ages of 15 and 44, and women of color are two to three times more likely to develop the disease than white women.

Risk Factors

As with many other autoimmune diseases, being female is the single biggest risk factor for lupus. African Americans, Hispanics/Latinos, Asian Americans, Native Americans, Native Hawaiians and Pacific Islanders are more likely than Caucasian people to develop lupus, and studies show that it usually appears at an earlier age and is more severe among these populations. People with a family history of lupus are also at an increased risk for developing the disease.

Signs and Symptoms

Doctors often call lupus “the great imitator” because so many of the symptoms can mimic other diseases. Because so many different organs can be affected, the disease can cause a wide range of symptoms. The most common symptoms of lupus include extreme fatigue, headaches, painful and swollen joints, fever, anemia, hair loss, sensitivity to light and a butterfly-shaped rash across the cheeks and nose. In some cases, lupus can cause your fingers to turn white, red or blue when cold, a condition known as Raynaud’s phenomenon. There is no single laboratory test that can confirm the diagnosis of lupus. Instead, doctors will do a series of exams and tests to look for signs of lupus.

Treatment Options

Lupus may affect any body system and a variety of treatments are available to manage the disease. In addition, the course of the disease can vary widely from one person to another, which means doctors must tailor the treatment to each individual patient. The goals of treatment are to reduce inflammation, suppress the immune system, prevent flares from occurring and control pain, fatigue and other symptoms. Many patients with lupus take a variety of medications to alleviate their symptoms or at least keep them under control, including steroids and anti-inflammatory pain relievers. Since many lupus medications are not recommended for pregnant women, women with lupus who are considering giving birth need to consult with an obstetrician who specializes in high-risk pregnancies.

Scleroderma

Scleroderma (also known as systemic sclerosis) is an autoimmune disease that most prominently affects the connective tissues of the body. The word “scleroderma” comes from the Greek words “sclera” meaning hard, and “derma” meaning skin. Hardening or tightening of the skin is one of the most common symptoms of the disease. As with other autoimmune diseases, the severity of scleroderma can vary greatly from one person to another. Some people may have only localized cases affecting mainly the skin, while for others it can be systemic, affecting multiple organs throughout the body, such as the gastrointestinal tract. An estimated 300,000 Americans have scleroderma, and women are four times more likely than men to have the disease. The localized type of scleroderma is more common in children, while the systemic form occurs more often in adults.

Risk Factors

In addition to women, people of European descent are at a higher risk of developing the localized form of the disease, and most people with this form are diagnosed before the age of 40. The systemic form of lupus is more common in African Americans and some Native American tribes, and it usually occurs between the ages of 30 and 50. There is also some evidence that people with a family history of other rheumatic diseases are at a slightly higher risk of developing scleroderma.

Signs and Symptoms

Two are the earliest symptoms of scleroderma are fingers and hands that become puffy and stiff, and fingers that become very sensitive and turn white or blue when cold. (It’s important to note that this second symptom, known as Raynaud’s phenomenon, is fairly common, and most people who develop Raynaud’s phenomenon do not have scleroderma. But if someone does have scleroderma, Raynaud’s phenomenon is often one of the first signs.) Other skin changes that can occur include loss of hair over the affected area and a change in skin color. To make the diagnosis, doctors do a thorough history and physical and also order blood tests and skin biopsies to look for certain markers.

Treatment Options

There is no cure for scleroderma, but treatment involves various medications to alleviate specific symptoms. For instance, anti-inflammatory drugs can help treat joint pain and swelling, and people with the systemic type of scleroderma often take medications to control gastrointestinal-related problems, such as heartburn. For patients with Raynaud’s phenomenon, medications can be prescribed to increase blood flow to the fingers.

How North Shore-LIJ Can Help You

The rheumatologists at the Division of Rheumatology and Allergy-Clinical Immunology at North Shore-LIJ Health System provide state-of-the-art care for patients with rheumatic diseases. Thanks to major diagnostic and therapeutic advances over the last two decades, the outlook for patients with diseases such as rheumatoid arthritis, lupus, and scleroderma has significantly improved. Because rheumatic diseases impact more women than men, we see a large number of women in our Division. We are actively involved in research studies to better understand the cause of these conditions, why it affects women and men differently and to identify more effective treatment options.

Rheumatologists are part of a team of professionals who work to assess a patient’s symptoms and their physical, psychological and social effects. Members of the team include internists, orthopedic surgeons, physiatrists, nurses, advanced practice nurses, physician assistants, occupational therapists, physical therapists, health educators, psychologists, case managers and vocational rehabilitation counselors. The Division of Rheumatology and Allergy-Clinical Immunology offers dedicated centers for the treatment of arthritis, lupus, vasculitis, myositis, gout and scleroderma.