General rheumatology is the work-up, diagnosis and management of a wide array of diseases ranging from mechanical joint pain and osteoarthritis to inflammatory joint such as rheumatoid arthritis. We also manage patients with complex multi-system diseases such as connective tissue disease/lupus and vasculitis. Below is a list of some the diseases rheumatologists treat:
Inflammatory arthritis
Rheumatoid arthritis, psoriatic arthritis, reactive arthritis and arthritis related to connective tissue diseases are all managed by rheumatologists. These diseases are manifest as pain, swelling, and morning joint stiffness in the peripheral joints that improves throughout the day and with activity. Today, there are many treatment options available and patients often live a normal, fulfilling life.
Axial Spondyloarthropathy
Axial spondyloarthropathies include most commonly ankylosing spondylitis but also psoriatic arthritis. These diseases manifest as inflammatory back pain with morning stiffness, alternating buttock pain and nocturnal symptoms. Left untreated, these diseases can lead to joint fusion and loss of motion. Treatment comprises exercise, physiotherapy and initiation of medications that slow the disease process. With treatment, most patients are able to life normal fulfilling lives.
GOUT, PSEUDO-GOUT
Gout and pseudo-gout are crystal arthropathies resulting from deposition of uric acid and calcium pyrophosphate in the joints. These arthropathies present as acute monoarthritis but, left untreated, can lead to progressive destructive polyarthropathy. Both disorders are highly treatable and can be managed in the medical home. However, rheumatology consultation is often needed in cases of diagnostic uncertainty, comorbid complications, or refractory cases.
CONNECTIVE TISSUE DISEASES
Connective tissue disease (lupus, myositis, scleroderma) is an autoimmune disease that can involve the skin, joints, heart, muscles, kidneys and nervous system. Symptoms vary depending on the organ involved but can manifest as inflammatory arthritis, rashes, hair loss, muscle weakness, numbness, and feelings of general unwellness. A diagnosis of a connective tissue disease is based on a careful clinical history and physical examination suggestive of the diagnosis and is supported by serological tests. It is important to point out that a positive ANA (anti-nuclear antibody) is not diagnostic of lupus or any other connective tissue disease without objective evidence and physical examination.
VASCULITIS
Vasculitis is an autoimmune condition of the blood vessels that can involve large vessels (Giant Cell Arteritis, Takayasu Arteritis), medium vessels (Polyarteritis Nodosum), or small vessels. Depending on the size of the vessels involved or the organ involved, it can present in a variety of ways. As it is a multisystem disease that requires immunosuppression, management often requires the involvement of a rheumatologist, but it is also often managed by specialists in general internal medicine, nephrology, respirology, and neurology. In the last 20 years there have been huge advances in the diagnosis of these diseases, and it is recommended that patients be assessed at a centre with expertise in vasculitis. Victoria, BC is home to the Vancouver Island Vasculitis Clinic and Dr. Baldwin is a member of CanVasc (https://www.canvasc.ca/).