DIAGNOSES

OSTEOPOROSIS

rheumatic_6 Osteoporosis (OP) is the excessive thinning of bone with age, predisposing especially postmenopausal women to fracture easily with minimal trauma.  Anti-resorptives like Bisphosphonates and RANK-Ligand inhibitors have good efficacy in treating OP, and may also ameliorate fracture and osteoarthritic pain.  Parathyroid Hormone analogues and Sclerostin inhibitors have robust bone building capability, while Strontium salts seem to both inhibit bone resorption as well as stimulate bone formation.

OSTEOARTHRITIS

rheumatic_5 Osteoarthritis (OA) is the commonest arthritis, involving wearing down of the cartilage of the knee and hip joints, causing mobility difficulties.  Synthetic Hyaluronic Acid acts as lubricating and shock-absorbing gel, which when injected into the degenerative joint, is effective and safe for pain relief.  Ultrasound guidance for accurate gel placement into the joint space is critical to ensure efficacy and avoid post-injection swelling and pain.

GOUT

rheumatic_4 Gout attacks commonly occur in the ankle and big toe joints, usually affecting men and postmenopausal women, who may also have associated metabolic conditions like diabetes, hypertension and high cholesterol.  Diet and alcohol have direct impact on this arthritis.  Xanthine Oxidase inhibitors (which reduce uric acid production) and Uricosuric agents (which increase the excretion of uric acid) are the mainstay of Urate Lowering Therapies.  Rarely, Uricase is needed to break down urate crystals rapidly, like in impending acute kidney failure.  IL1 inhibition is effective in treating refractory inflammation.

RHEUMATOID ARTHRITIS

rheumatic_1 Rheumatoid Arthritis (RA) affects mainly middle-aged women, causing symmetrical painful joint swelling in the limbs.  Rarely, the eyes and lungs can become inflamed.  Unless diagnosed early (aided by ultrasound and MRI) and treated aggressively by a rheumatologist, chronic RA results in disability and job loss, costly and toxic treatments, and increased lymphoma and cardiac deaths.  Targeted therapies, which block various mediators of inflammation (eg TNF, IL6) or their intracellular signalling pathways (JAK), have revolutionized the treatment of RA: dramatically relieving pain, restoring function, and preventing joint damage and disability; thereby inducing disease remission.

PSORIATIC ARTHRITIS

rheumatic_3 Psoriatic Arthritis (PsA), characterized by periodic asymmetrical swelling of joints and tendons, is associated with physical strain, nail deformities and a scaly rash called psoriasis.  "Silver bullet" therapies targeting TNF and IL17 are very effective treatments for both the skin as well as joint manifestations.

ANKYLOSING SPONDYLITIS

rheumatic_2 Ankylosing Spondylitis (AS) often presents insidiously as early morning back stiffness and pain in otherwise healthy young men.  As such, the symptoms are often dismissed and the diagnosis missed, resulting in eventual irreversible spinal fusion, lifelong disability, and even eye and heart complications.  Like its cousin, Psoriatic Arthritis, anti-TNF and anti-IL17 are very effective for pain relief and disease control.  Anti-resorptives may help to reduce bone pain and treat associated osteoporosis.

SYSTEMIC LUPUS ERYTHEMATOSUS

rheumatic_7 Lupus (SLE) is a life threatening autoimmune disease affecting mainly young women, causing rashes, arthritis, blood problems and even major organ failure.  B-cell depletion therapy can induce durable remission in some patients, replacing more toxic treatments like cytotoxic drugs. Inhibition is emerging as another effective treatment, especially in earlier disease.

For more details, please refer to: RheumaKnowledgy