What is a rheumatologist?
A rheumatologist is an internist or pediatrician who is qualified by additional training and experience in the diagnosis and treatment of arthritis and other diseases of the joints, muscles and bones. Many rheumatologists conduct research to determine the cause of and better treatments for these disabling and sometimes fatal diseases.

What do rheumatologists treat?
Rheumatologists treat all forms of arthritis, autoimmune diseases, musculoskeletal pain disorders and osteoporosis. There are more than 100 types of these diseases, including rheumatoid arthritis, osteoarthritis, gout, lupus, back pain, osteoporosis, fibromyalgia and tendonitis. Some of these are very serious diseases that can be difficult to diagnose and treat.

When should you see a rheumatologist?
If musculoskeletal pains are not severe or disabling and last just a few days, it makes sense to give the problem a reasonable chance to be resolved. But sometimes, pain in the joints, muscles or bones is severe or persists for more than a few days. At that point, you should see your physician.

Many types of rheumatic diseases are not easily identified in the early stages. Rheumatologists are specially trained to do the detective work necessary to discover the cause of swelling and pain. It is important to determine a correct diagnosis early so that appropriate treatment can begin early. Some musculoskeletal disorders respond best to treatment in the early stages of the disease.

Because some rheumatic diseases are complex, one visit to a rheumatologist may not be enough to determine a diagnosis and course of treatment. These diseases often change or evolve over time. Rheumatologists work closely with patients to identify the problem and design an individualized treatment program.

How does the rheumatologist work with other health care professionals?
The role the rheumatologist plays in health care depends on several factors and needs. Typically the rheumatologist works with other physicians, sometimes acting as a consultant to advise another physician about a specific diagnosis and treatment plan. In other situations, the rheumatologist acts as a manager, relying on the help of many skilled professionals including nurses, physical and occupational therapists, psychologists and social workers. Teamwork is important, because musculoskeletal disorders are chronic. Health care professionals can help people with musculoskeletal diseases and their families cope with the changes the diseases cause in their lives.

What Is Rheumatoid Arthritis?

Rheumatoid Arthritis, often referred to as RA, is an autoimmune disease. It is a chronic disease that causes inflammation in the lining of the joints and other internal organs. This swelling can lead to pain, stiffness, swelling and loss of function in the joints. The disease can vary widely by individual in respect to severity, joints affected and the nature of other organs involved such as the eyes, lungs or skin.

What Are The Symptoms of Rheumatoid Arthritis?
- Prolonged stiffness in the joints in the morning.
- Swelling and inflammation in the joints.
- Damaged joints, as shown by X-rays.
- Blood tests showing an antibody known as rheumatoid factor.

Other signs of RA can include loss of appetite, weight loss, fatigue, fever or anemia.
For a list of the signs a physician would look for to diagnosis Rheumatoid Arthritis, see the American College of Rheumatology.

Who Gets Rheumatoid Arthritis?
Rheumatoid Arthritis affects more than 2 million Americans - about 1 percent of all Americans. RA affects three times as many women as men. Peak onset is between ages 20 and 45. < Top

What Causes Rheumatoid Arthritis?
The cause of Rheumatoid Arthritis is unknown. What is known is that RA is an autoimmune disease which means the body?s immune system is mistakenly attacking the body?s own tissues. It is the body?s immune system?s over reaction that leads to the inflammation and resulting joint damage.

There are some indications that a susceptibility to Rheumatoid Arthritis may be inherited. Many people with RA have a genetic marker called HLA-DR4. Research is ongoing looking into the genetic and environmental factors that may influence the development of Rheumatoid Arthritis.

What Are The Effects of Rheumatoid Arthritis?
The effects of RA include:
Fatigue, soreness, stiffness and aching.
Pain and swelling may occur in the same joints on both sides of the body.
Pain will usually start in the hands or feet.
RA can also can affect elbows, shoulders, neck, knees, hips and ankles.
The swelling tends to persist over prolonged periods of time.
Inflammatory cells release enzymes that may digest bone and cartilage.
The involved joint can lose its shape and alignment leading to pain and loss of movement.
The swelling can also lead to lumps, or rheumatoid nodules, which develop under the skin.

How Is Rheumatoid Arthritis Diagnosed?
Rheumatoid Arthritis can be difficult to diagnosis. There is no one blood test, X-ray or sign that determines whether you have Rheumatoid Arthritis. Also, the signs of Rheumatoid Arthritis can vary from person to person and can range in severity from time to time.

Not all of the symptoms of Rheumatoid Arthritis must be present in order for a physician to diagnosis the disease. A diagnosis of Rheumatoid Arthritis only requires four of seven signs of the disease must be present for at least six weeks. Physicians also take into consideration the overall pattern of symptoms, medical history, physical exam, X-rays and lab tests including a test for rheumatoid factor. Rheumatoid factor is an antibody found in the blood of about 80 percent of adults with RA. However, the presence or absence of rheumatoid factor does not indicate that one has RA.

How is Rheumatoid Arthritis Treated?
Treatment options for Rheumatoid Arthritis have expanded dramatically during the past several years. Typically, treatment will involve some combination of medication, exercise, rest, joint protection, and physical and occupational therapy.

Successful treatment depends on early diagnosis and early, aggressive treatment before function is impaired and joints are damaged. However, there is no cure for Rheumatoid Arthritis.

Initially, treatment may focus on pain relief and swelling reduction. Pain medications may include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or one of the new pain medications known as COX-2 inhibitors.

NSAIDs and aspirin, analgesics, and glucocorticoids may be used to help reduce joint pain, stiffness and swelling. The newer pain medications, COX-2 inhibitors, have been shown to cause less stomach upset than traditional nonsteroidal anti-inflammatories. (NSAIDs).

Disease-modifying anti-rheumatic drugs (DMARD) may also be used to treat RA. People with persistent swelling in the joints are candidates for treatment with disease-modifying drugs, according to the American College of Rheumatology website. These drugs include methotrexate, hydroxychloroquine, sulfasalzine, corticosteroids, intramuscular and oral gold, d-penicillamine, minocycline, azathioprine and cyclosporine. A newly released disease-modifying drug is leflunomide, (Arava), which is thought to work by affecting the function of immune cells.

Biologic agents, or biologic response modifiers (BRMs), are newly introduced medications that target specific components of the immune system. The drugs inhibit tumor necrosis factor (TNF), a protein believed to foster inflammation in the joints. Biologics include infliximab (Remicade) and etanercept (Enbrel).

The key to all treatment is comprehensive coordinated care, patient education and the expertise of a number of providers. These providers include rheumatologists, primary care physicians, nurses, occupational and physical therapists, physiatrists and orthopedic surgeons.

Joint replacement is another options. The American College of Rheumatology notes the tremendous success of total joint replacement surgery (especially for the hip and knee), which allows many patients with advanced disease to be active and mobile.

What is Pediatric Rheumatology?
Rheumatology is the medical specialty that cares for pediatric patients with a wide spectrum of disorders, both inflammatory and non-inflammatory of muscle, connective tissue, blood vessels and skin. Many of them are felt to be caused by an aberrant activation of the immune system in that the affected tissues are injured by an inappropriate immune attack. Because the immune system is damaging itself, they are often called "autoimmune diseases.

What is the most common cause of arthritis in children?
The most common cause of arthritis in children is termed "post-viral arthritis." Typically, a child may have a mild upper respiratory infection or common cold and a week or two later develop one or more painful, swollen joints. The arthritis may last for a few days or even several weeks but passes without any permanent damage. Any virus can lead to an arthritis, but the most common causes are Parvovirus, the agent of Fifth's Disease, and Epstein Barr Virus, the agent of infectious mononucleosis. Drugs such as ibuprofen or naproxen help diminish the inflammation which causes the pain and swelling.

Why did the doctors want to take fluid out of my child's joint when it was swollen?
The doctor was concerned your child might have a joint infection. Bacterial infection within the joint, know as septic arthritis, is a relatively uncommon cause of arthritis. However, this type of arthritis requires urgent care because bacterial infections can rapidly and permanently damage joint tissue. If a child has a fever or severe pain and arthritis in a single joint, determining whether the joint is septic is critical. The physicians must take a sample of fluid from inside the joint and examine it for the presence of bacteria. Bacterial, or septic, arthritis can be cured by antibiotic treatment.

What is "JRA"?
"JRA" stands for Juvenile Rheumatoid Arthritis, a term slowly going out of use. A more recent term is Juvenile Idiopathic Arthritis or JIA. Juvenile Idiopathic Arthritis is an "umbrella" term for several different patterns of arthritis in children. They all appear to be caused by an autoimmune reaction - that is, the body fighting its own tissue as if it were a foreign substance. Most frustrating to the parents (and the physician as well) is that there is no lab test that diagnoses JIA. Rather, it is diagnosed by putting together many facts such as the age of the child, the presence of associated arthritis or other disorders in the family, which joints and for how long the joints have been tender and swollen, and which (if any) laboratory tests are abnormal. To make a diagnosis of JIA, the arthritis must be present for at least six weeks without any other cause of arthritis being found. Once sufficient time has passed and the physician evaluates various laboratory tests and x-rays, the arthritis can be classified among at least seven different types of JIA, each having a somewhat different course.

What is a positive ANA test?
ANA stands for antinuclear antibody and it indicates the presence of an antibody in the blood made against one or more components of the nucleus of the cells of the body. It is found in the blood of patients who have many types of autoimmune diseases, including JIA and lupus. However, it is also found in the blood of at least 5% of healthy children and in up to 25% of the healthy elderly. Although knowing whether an ANA is positive is helpful in diagnosing many autoimmune diseases, having a positive ANA without any other abnormalities is not in itself a cause to worry.

Is Juvenile Arthritis curable?
Unfortunately, Juvenile Arthritis is not curable at the present time. However, this is not a cause for despair. Rheumatologists have learned that aggressive, early treatment with standard drugs, such as methotrexate and injections of corticosteroids into the joints, can usually prevent significant damage to joints. This, in addition to the increased use of methotrexate coupled with newly discovered biologic agents, such as Etanercept and possibly Infliximab, gives a more optimistic outlook. We encourage people to look at juvenile arthritis as a controllable disease.