• Acute or chronic arthritis

 

Athritis is the symptom of a swollen joint. It is associated with different diseases and can happen is only one joint (monoarthritis) or many joints (polyarthritis). The symptoms can last for a few days to many months depending on the cause of the arthritis. It can be caused by some infections, cristlas in the joints (like gout) or certain auto-immune diseases (like rheumatoid arthritis). To be able to make the diagnostic, we have to do a complete questionnaire and physical exam and we often need blood tests and radiographs to confirm the type of disease. It is sometimes necessary to perform a joint aspiration  (taking some fluid out of a joint with a needle) to eliminate an infection or to do a therapeutic drainage with a cortisone injection. The treatment depends on the cause of the arthritis and the severity of the symptoms.

 

• Lupus

 

Lupus is an auto-immune disease that can affect many different organs. The evolution is variable and some patients will only have a few symptoms while others might have a very severe disease that can be hard to treat. Most of the patients will have at least one skin manifestation associated with lupus (skin rash), but there is a lot of different skin manifestations possible and you will need to consult a rheumatologist or a dermatologist to confirm if there is an underlying lupus. The anti-nuclear antibody (ANA) is a blood marker that is very often positive in patients with lupus, but it's presence does not necessarily mean that you have lupus. Up to 30% of the normal population (who do not have lupus) can have a positive ANA. The higher the title of the ANA, the more it is associated with an auto-immune diseases, but it is associated with many different auto-immune diseases. You will need to see a rheumatologist to determine if there is an auto-immune disease that can explain your symptoms. The treatment depends on the disease and it's severity.

 

• Scleroderma

 

Scleroderma is an auto-immune disease that can affect multiple organs, but for which the primary manifestation is a progressive thickening and hardening of the skin. It is frequently associated with the Raynaud's phenomenon. This disease can be in a limited form (the skin symptoms affects only the legs, arms and face) or can be diffuse (affects arms, legs, face and trunk). Cardiac and pulmonary manifestations can be more frequent with this disease and it is important to do a regular follow-up for the heart (echocardiogram) and the lungs (pulmonary function tests and thoracix scan if needed). The treatment depend on the severity of the disease.

 

• Sjögren's Syndrome

 

Sjögren's syndrome is an auto-immune disease that can affect multiple organs, but in which the most important manifestation is a dryness of the eyes and mouth (sicca). Fatigue is also very present in this syndrome and can be hard to treat. There is frequently pain in the joints and even arthritis in this disease. Making the diagnosis can mean having to see an eye specialist (ophtalmologist) or an ENT (eye, nose and throat specialist) to make certain additionnal tests. Treatment depends on the severity of the symptoms. 

 

• Raynaud's Phenomenon

 

Raynaud's syndrome is caracterised by a three-phased discoloration (white-blue-red) of the extremities when exposed to the cold. It mostlr affects the fingers and toes, but can also affect he ears and nose.  The is a benign form of this syndrome (primary Raynaud's), but it is important to have an evaluation done by a rheumatologist to make sure that there is no other auto-immune associated (secondary Raynaud's) because the symptoms can be more severe and can affect other organs (joints, lungs, heart, kidneys...). The workup usually includes blood tests and sometimes an exam in capillaroscopy (microscopic exam of the base of the nails). 

 

• Myopathies (muscular diseases)

 

Myopathies are a family of muscular disorders that can be inflammatory in origin (polymyositis, dermatomyositis and inclusion bodies myositis) or non-inflammatory (secondary to certain medications, infections, diseases or cancer). The principal manifestations are muscle weakness and muscle pain (myalgia). To determine the cause, we need to do a complete exam and usually some blood tests. It is often necessary to to an EMG (electromyogram) or a muscular biopsy to confirm the type of myopathy. Treatment depends on the cause and the severity of the symptoms.

 

• Vasculitis

 

The vasculitis family is a group of diseases that causes inflammation in the blood vessels. They can be caused by auto-immune diseases (temporal arteritis, Takayasu, periarteritis nodosa, ANCA vasculitis...) which all have classical manifestations depending on the disease and the place of iflammation in the vessels. Other diseases can cause symptoms that may look similar, like infections, certain drugs, medications, cancers or connective tissue diseases (Marfan, Ehler-Danlos...). It is important to have a complete evaluation by a rheumatologist to try to find the explanation for the symptoms and to exclude other diseases. Some of these vasculitis can have very severe symptoms and it is important to make an early diagnosis to prevent complications. Treatment depends on the cause and the severity of the symptoms, but often necessitate a long term treatment with medications.

 

• Spondyloarthropathies

 

The spondyloarthropathies include many forms of arthritis that have more axial symptoms (the spine) but also other joint manifestations. Most of the time, the patients are men who are below 45 years old, but women can also be affected. We need a complete exam and some radiographs to make the diagnosis. A familial history can be present and a genetic marker associated with these diseases can be positive (HLA B27), but it can also be positive in about 6% of the healthy population. Treatment often starts with anti-inflammatory medications (NSAID), exept when the is an intolerance or a contraindication. If the symptoms are resistant to the NSAID, if it is impossible to give NSAID or if the disease is very severe, there are other treatments that your rheumatologist can consider. 

In this group of diseases, we include the anlylosing spondylitis, the arthritis associated with the inflammatory bowel syndromes (Crohn's disease, ulcerative colitis), the arthritis associated with psoriasis (which can have many forms) and reactive arthritis (Reiter's syndrome secondary to certain infections).

 

• Polymyalgia Rheumatica

 

Polymyalgia rheumatica (PMR) is an inflammatory disease that affects more frequently women than men and that happens after the age of 50 years old. It causes stiffness and pain in the shoulders and hips (scapular and pelvic girdles) with symptoms that are worse in the morning an at night. Treatment usually include prednisone (cortisone pills), often for many months. Follow-ups included blood tests to make sure the disease in well controlled during the treatment. This disease can be associated with a form of vasculitis (inflammation of the blood vessels) that can cause headaches, changes in vision (loss of vision, double vision or bright spots) or a jaw or tongue pain when masticating. If you have a diagnosis of PMR and that you have one or more of these symptoms, you have to immediately consult with either a rheumatologist, your family doctor or go to the emergency department if youy do not have access to a doctor. There is a risk of permanently losing the vision of one or both eyes.

 

 

• Low back pain or neck pain

 

Back pain and neck pain are very frequent reasons to consult a doctor in North America. These pain can have different causes, but the most frequent ones are the mecanical causes (facet osteoarthritis, degenerative discopathy, back sprain, herniated disc...). These problems are most often associated with worn discs and joints (osteoarthritis) and can cause chronic pains that can be hatd to treat. It is often the first line doctor (general practionner) who can treat and follow these problems, but it is sometimes nesessary to consult another specialist (rheumatologist, physiatrist, orthopedic surgeon...) when the symptoms are severe, progressive or if other neurological symptoms or inflammatory symptoms are present (spondyloarthropathies). Treatment depends on the cause of the pain and its intensity. A few sessions with a physiotherapist or a kinesiotherapist can often help to treat and to prevent recurence of the pain.

 

• Osteoarthritis

 

Osteoarthritis is wear and tear of the joints, which usually happens with aging. Some persons have symtpoms at an early age (30-40 years old) but it is usually starting to be symptomatic above 40 years old. The joints the most often implicated are the spine (lower back and neck), the thumbs, knees and the big toes. Some accidents or injuries can precipitate or cause osteoarthritis in some joints that are not usually affected by this conditions (shoulders, elbows, wrists...). The general practionner is usually able to treat this disease, but it is sometimes necessary to consult with a rheumatologist when the symptoms do not respond to the general treatments or if there is a suspicion of another inflammatory disease (arthritis). Treatment usually consists of some medication (acetaminophen and sometimes anti-inflammatory medications, either topical or in pills) and cortisone injections if needed. It is often useful to have a few sessions with a physiotherapist to protect the joints and reduce the pain. 

 

• Tendinitis

 

Tendinitis (or tendinosis, tendinopathy) is an irritation of the tendons. This disease is very frequent and can appear at any age. It can affect many different areas in the body and the diagnosis can usually be made by a general practionner. It is sometimes useful to have the opinion of a specialist (rheumatologist, physiatrist, orthopedic surgeon...) for some cases that are harder to treat or to make sure there is no underlying disease. Treatment usually consists of anti-inflammatory medication (topical or pills), cortisone injections and a follow-up in physiotherapy. SOme orthotics can be useful depending on the type of tendinitis.

 

 

• Osteoporosis

 

Osteoporosis is a fragilisation of the bones because of a reduced bone mass. It usually happens to women after menopause, but other diseases or medications can cause a premature osteoporosis. Men can also be affected, but it is less often the case and there usually is a medication or a hormonal deficit that can explain it. Osteoporosis do not cause pain, except if there is a fracture associated to a weakened bone. The diagnosis is made with the bone mineral density (BMD), which is rarely indicated in patients below 65 years of age unless there is a clear factor that predisposes to osteoporosis (certain medication, prednisone, arthritis, smoking, alcoolism, hormonal diseases...). Treatments consists of calcium and vitamin D and, depending on the severity, some other medication to protect the bones from losing strenght. Except for the calcium and vitamin D, we now try not to give medication for a prolonged period of time (more than 5-10 years). It can unfortunately be associated with a rise in the risk of some type of fractures. However, some patients might need long term treatment. Treatments must be periodically reassessed and adjusted depending on the response and severity of the osteoporosis.

 

• Fibromyalgia

 

Fibromyalgia is a syndrome that has various manifestations, the most frequent one being chronic and often diffuse pain. It is more frequent in women and often associated with a chronic fatigue, a non-restful sleep and some psychological smptoms like depression. It is possibly caused by an hypersensitivity to pain and a dysfunction in the molecules that transmit the painful informations in the nerves. It is not a disease that can cause joint deformities or destruction, but the symptoms can become invalidating and hard to tolerate for a lot of patients. Treatment consists of a progressive trial of certain medications, but it is often necessary to use more than just one medication to achieve results. Good sleeping habits and physical exercice (low impact exercises like tai chi, walking, yoga, elliptical or heated pool exercices) are an extremely important part in the treatment of fibromyalgia, but the symptoms can persist for long period and can often become chronic. A follow-up in psychology or with a support group can help to better understand the diagnosis and to assist with the pain management.