Defining Rheumatology:
Rheumatology is a specialty practice of internal medicine focused upon the non-surgical evaluation and treatment of rheumatic diseases.  In general, rheumatalogic diseases are characterized by abnormalities of the immune system. A common manifestation of these diseases is arthritis. 

Rheumatologists have special interests in unexplained rash, fever, arthritis, anemia, weakness, weight loss, fatigue, joint or muscle pain, autoimmune disease, and anorexia.  Some diseases are rare and often more challenging to diagnose by primary care providers.  Rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, systemic lupus erythematosus, antiphospholipid antibody syndrome, Adult Still’s disease, dermatomyositis, polymyositis, polymyalgia rheumatica, Sjogren's syndrome, vasculitis, scleroderma, mixed connective tissue disease, sarcoidosis, Lyme diease, osteoarthritis, back pain, gout, pseudogout, relapsing polychondritis, Henoch-Schonlein purpura, reactive arthritis, fibromyalgia, Raynaud's disease, iritis, osteoporosis, and reflex sympathetic dystrophy are some of the major diseases which are managed by rheumatologists. 

They also treat common outpatient medical orthopedic ailments such as tendonitis, trigger finger, and bursitis.  Some diseases may require joint aspirations or therapeutic joint, tendon, bursal, or muscle injections in addition to medical treatments.  The availability of more highly specialized medications known as biological agents has altered the course of many chronic inflammatory diseases.  As a direct result, the quality of life for many of these patients has improved and many are able to live more meaningful lives. 

Common Diseases and Conditions Treated: 
1.  Osteoarthritis—Osteoarthritis, characterized by the gradual wear and tear of the cartilage in joints over time, is the most common form of arthritis.  Joints that are most commonly affected include hand joints, knees, hips, neck and low back.  Unfortunately, there is no cure but oral, topical, and intraarticular injectable medications are available to help you function and live an active lifestyle.  Despite these measures, surgery is sometimes needed.

2.  Gout—Gout is a common form of arthritis due to the formation of uric acid crystals within a joint.  It is marked by acute attacks of severe pain, tenderness, redness, and swelling of a joint.  The joint at the base of the big toe is most often affected.  Gout is more common in men than women; although, women are at an increased risk after menopause.  It is quite common in Filipinos and Pacific Islanders.  Certain foods may trigger an attack.  It may be a challenging disorder to treat, but with the right treatment, the frequency of attacks can be significantly decreased.

3.  Back pain—Back pain is a very common condition and is high on the list of reasons for missed work.  There are many causes for back pain; the more common causes including degenerative disc disease, strains of muscles and ligaments, sciatica or pinched nerve, osteoporotic fracture, herniated disc, and skeletal abnormalities.  Treatment is highly individualized depending on the condition, degree of severity, patient’s needs and comfort level.

4.  Rheumatoid arthritis—Rheumatoid arthritis is an autoimmune disorder in which your own immune system attacks the affected joints.  This condition is marked by chronic inflammation primarily of the small joints of your hands and feet.  Ultimately, if left untreated, it can cause joint erosion and deformities.  Unlike osteoarthritis, rheumatoid arthritis affects the synovium, or the lining of the joint. There are multiple medications available to treat this condition.  

5.  Lupus—Lupus is a chronic inflammatory disease in which your immune system abnormally attacks your own tissues and organs.  This disease most commonly affects young females.  There are different forms of lupus and the most common and most serious is systemic lupus erythematosus.  It is a multi-system disease which can often affect the skin, joints, kidneys, brain, heart, lungs, and blood cells.  The presentation of lupus is quite variable; fortunately, there are multiple medications that can effectively treat this condiiton.  

6.  Psoriatic arthritis—Psoriatic arthritis is marked by psoriasis and joint inflammation.  Most patients typically develop psoriasis before developing the arthritis, although the reverse can also occur.  Just about any joint can be affected, including the spine and sacroiliac joints. Inflammation of the eye, known as iritis or anterior uveitis, can be associated with psoriatic arthritis.  Highly specialized medications are available to treat the skin and musculoskeletal manifestations.     

7.  Ankylosing spondylitis—Ankylosing spondylitis, like psoriatic arthritis, is a part of a group of diseases known as seronegative spondyloarthropathies.  It is a chronic inflammatory condition that not only affects joints in the spine, sacrum, and lower extremities, but also the eye, heart, kidneys, and lungs.  Treatment is most effective if started before any irreversible damage has been done. 

8.  Osteoporosis—Osteoporosis is marked by weak, thin, and brittle bones.  It is common in postmenopausal women although men can also be affected.  If osteoporosis goes untreated, simple falls and other nontraumatic activities such as bending or pulling can lead to fractures.  Although it can be primary, there are secondary causes of this condition which are also treatable. 

9.  Outpatient medical orthopedic conditions
Tendonitis—Tendonitis is inflammation or irritation of a tendon which is the thick fibrous tissue that connect muscles to bones.  This condition may be associated with inflammatory conditions, sports-related injuries, or overuse.  Common tendons involved include those around the elbow, wrist, shoulder, and heel.  Treatment may include rest, pain management, physical therapy, corticosteroid injection, and massage.  

Bursitis—Bursitis is inflammation or irritation of a bursa which is the soft-tissue padding amongst bones, tendons, and muscles around your joints.  Bursitis is often due to repetitive motion and overuse of the associated joint.   Common areas affected are bursae around the shoulders, elbows, hips, and knees.  Although the pain can be quite severe, this condition is treatable.  Treatment often includes rest, pain management, physical therapy and in severe or recurrent cases, corticosteroid injections.  

Trigger finger—Trigger finger is a condition that causes any one of your fingers or thumbs to catch and become flexed when you bend them.  In severe cases, the digit involved may not straighten and may become locked.  Individuals with diabetes or those whose work or hobbies require a lot of gripping are at increased risk.  Medical treatment can be effective although in severe cases with recurrence, surgery may be required. 

Frozen shoulder—Frozen shoulder, also known as adhesive capsulitis, is quite common, especially amongst diabetics.  It causes pain and stiffness of the shoulder with decreased active and passive range of motion.  Whenever there is decreased activity of the shoulder joint as in a stroke patient or one who has his arm in a sling due to injury, the risk of frozen shoulder is increased.  Medical intervention coupled with physical therapy can be effective; however, in some cases, surgery to loosen up the fibrosis of the joint capsule, may be required so the shoulder joint can move more freely.