Rheumatology
Treatment
Our Rheumatology department, led by Dr. Rahul Ladda, specialises in the diagnosis and management of autoimmune and inflammatory disorders affecting the joints, muscles, bones, and connective tissues. Below are the key services and treatments we provide
1. Arthritis Management
Arthritis management involves the treatment and control of joint inflammation and pain caused by conditions like osteoarthritis, rheumatoid arthritis, and psoriatic arthritis. It includes a combination of medications, physical therapy, lifestyle modifications, and sometimes surgical intervention to improve mobility and reduce pain.
Rheumatoid Arthritis (RA) is a chronic autoimmune disease that primarily affects the joints but can also involve other organs and systems. It occurs when the immune system mistakenly attacks the body's tissues, particularly the synovium, the lining of the joints. This leads to inflammation, pain, and eventual joint damage.
Osteoarthritis (OA) is the most common form of arthritis, characterised by the progressive breakdown of joint cartilage and underlying bone. It often develops gradually, leading to pain, stiffness, and reduced joint function. OA is commonly called a "wear-and-tear" condition, though it also involves complex biological processes such as low-grade inflammation.
Spondyloarthropathy (SpA) refers to a group of inflammatory diseases that primarily affect the spine, joints, and entheses (where tendons and ligaments attach to bones). These conditions share common clinical, genetic, and radiological features but can also affect other parts of the body, including the skin, eyes, and gastrointestinal tract.
Types of Spondyloarthropathies
- Ankylosing Spondylitis (AS):
Primarily affects the spine and sacroiliac joints.
Can lead to fusion of vertebrae, causing stiffness and loss of mobility.
More common in young men. - Psoriatic Arthritis (PsA):
Associated with psoriasis (a skin condition).
Affects peripheral joints, spine, and entheses.
May cause dactylitis ("sausage digits") and nail changes. - Reactive Arthritis:
Triggered by infections (e.g., gastrointestinal or genitourinary infections).
Classic triad: arthritis, conjunctivitis, and urethritis (though not always present). - Enteropathic Arthritis:
Associated with inflammatory bowel diseases (IBD) such as Crohn's disease or ulcerative colitis.
Involves peripheral joints and/or spine. - Undifferentiated Spondyloarthropathy:
Features overlap with SpA but do not fit a specific subtype.
Juvenile Inflammatory Arthritis (JIA), also known as Juvenile Idiopathic Arthritis, is the most common type of arthritis in children and adolescents under the age of 16. It encompasses a group of autoimmune or autoinflammatory diseases characterized by persistent joint inflammation, pain, and stiffness lasting for at least six weeks.
Types of Juvenile Inflammatory Arthritis:
- Oligoarticular JIA:
Affects four or fewer joints.
Commonly involves large joints (e.g., knees, ankles, elbows).
Uveitis (eye inflammation) is a potential complication. - Polyarticular JIA:
Affects five or more joints.
Can involve small and large joints symmetrically (similar to rheumatoid arthritis in adults). - Systemic JIA:
Involves systemic symptoms such as fever, rash, and organ involvement (e.g., liver, spleen).
Joint inflammation may not be the first symptom.
Associated with macrophage activation syndrome (MAS), a severe complication. - Enthesitis-Related JIA:
Involves inflammation where tendons and ligaments attach to bones (entheses).
Often affects the lower extremities and spine.
Associated with the HLA-B27 gene. - Psoriatic JIA:
Associated with psoriasis or family history of psoriasis.
May include dactylitis ("sausage digits") and nail changes. - Undifferentiated JIA:
Symptoms do not fit into other subtypes
2. Connective Tissue Disorders (CTD)
Connective tissue disorders are a group of diseases that affect the tissues supporting and connecting organs, such as skin, blood vessels, and joints. Conditions like lupus, scleroderma, and rheumatoid arthritis are examples, and treatment focuses on managing symptoms and preventing organ damage.
Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease in which the immune system attacks healthy tissues, causing inflammation and damage to various organs and systems. It is the most common form of lupus and is characterised by a wide range of symptoms, which can vary in severity.
Sjögren's Syndrome is a chronic autoimmune disorder in which the immune system primarily attacks the glands that produce moisture, such as salivary and tear glands. This leads to symptoms of dryness, especially in the eyes and mouth. It can occur alone (primary Sjögren's) or in association with other autoimmune diseases like rheumatoid arthritis or lupus (secondary Sjögren's).
Systemic sclerosis (SSc), also known as scleroderma, is a chronic autoimmune connective tissue disease characterized by excessive collagen deposition, leading to skin thickening and fibrosis of internal organs. It primarily affects the skin but can also involve the lungs, kidneys, heart, gastrointestinal tract, and vascular system. The disease has a variable course, with presentations ranging from mild forms, such as limited skin involvement, to life-threatening complications involving internal organs.
Types:
- Limited Cutaneous SSc (lcSSc): Characterized by skin thickening limited to the hands, face, and lower arms/legs, often associated with CREST syndrome and slow progression.
C: Calcinosis (calcium deposits in the skin)
R: Raynaud's phenomenon
E: Esophageal dysmotility
S: Sclerodactyly (thickening and tightening of the skin on the fingers)
T: Telangiectasias (dilated blood vessels)
2. Diffuse Cutaneous SSc (dcSSc): Involves widespread skin thickening on the trunk and proximal limbs, with rapid progression and early internal organ involvement, often marked by the presence of anti-topoisomerase I (Scl-70) antibody.
Mixed Connective Tissue Disease (MCTD) is a rare autoimmune disorder characterised by overlapping features of several connective tissue diseases, including systemic lupus erythematosus (SLE), scleroderma, polymyositis, and sometimes rheumatoid arthritis. It is considered an "overlap syndrome" and is primarily associated with the presence of a specific antibody called anti-U1 RNP (ribonucleoprotein).
Myositis refers to a group of rare inflammatory diseases that cause muscle inflammation, weakness, and, in some cases, systemic involvement. It can affect people of all ages and may involve autoimmune processes, infections, or drug-induced reactions.
Types of Myositis:
- Polymyositis (PM):
Affects multiple muscles, usually proximal muscles (e.g., thighs, shoulders).
Progressive muscle weakness without rash.
Common in adults. - Dermatomyositis (DM):
Includes muscle weakness and distinctive skin rashes.
Rash may appear as a heliotrope rash (purple discoloration around the eyes) or Gottron’s papules (red, scaly patches on knuckles, elbows, or knees).
Can occur in children or adults. - Inclusion Body Myositis (IBM):
Affects both proximal and distal muscles.
Gradual onset and progression.
More common in older adults.
Often involves difficulty with grip strength or walking. - Necrotizing Autoimmune Myopathy (NAM):
Severe muscle weakness with muscle cell necrosis.
Often associated with specific autoantibodies or drug use (e.g., statins). - Infectious Myositis:
Caused by bacterial, viral, or parasitic infections (e.g., HIV, influenza, or toxoplasmosis). - Overlap Myositis:
Features of myositis combined with symptoms of other connective tissue diseases (e.g., lupus, scleroderma).
Undifferentiated Connective Tissue Disease (UCTD) is a term used when a person exhibits symptoms of a connective tissue disease but does not meet the full criteria for a specific condition, such as lupus, rheumatoid arthritis, or scleroderma. It often represents an early or mild stage of an autoimmune disease, and in some cases, it remains stable without progressing to a defined disease.
3. Vasculitis Treatment
Vasculitis refers to inflammation of blood vessels, which can cause narrowing or blockage of vessels, leading to organ damage. Treatment involves controlling inflammation through medications like corticosteroids, immunosuppressants, and biologics, depending on the type and severity of vasculitis.
Specialized care for inflammation of large arteries like the aorta and its branches.
- Takayasu's arteritis (TAK): Expert management of this rare chronic disease causing inflammation and narrowing of major arteries.
- Giant cell arteritis (GCA): Tailored treatment to prevent complications like vision loss from this temporal artery inflammation.
Advanced care for diseases affecting medium-sized blood vessels.
- Polyarteritis nodosa (PAN): Comprehensive management for this rare condition causing blood vessel damage and organ involvement.
- Kawasaki disease (KD): Pediatric-focused care for this condition that can lead to coronary artery complications.
Precise care for inflammation of small blood vessels.
A. Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV): Targeted therapies to manage immune-mediated vessel inflammation.
- Microscopic polyangiitis (MPA): Treatment to reduce kidney, lung, and other small-vessel organ damage.
- Granulomatosis with polyangiitis (GPA): Multidisciplinary care for this rare disease affecting the respiratory tract and kidneys.
B. Immune complex SVV: Customized therapies to manage immune-mediated small-vessel disorders. - Anti-glomerular basement membrane (anti-GBM) disease: Timely intervention to prevent kidney and lung damage.
- Cryoglobulinemic vasculitis (CV): Effective treatment for this immune complex disease linked to cryoglobulin proteins.
- IgA vasculitis (Henoch-Schönlein) (IgAV): Pediatric and adult care for this condition causing skin, kidney, and joint involvement.
- Hypocomplementemic urticarial vasculitis (HUV): Management of this rare disorder causing hives and systemic symptoms.
Expert care for vasculitis affecting both small and large vessels.
- Behçet's disease (BD): Specialized care for this systemic disorder affecting multiple organ systems.
- Cogan's syndrome (CS): Treatment to manage inflammation of the eyes and ears linked to systemic vasculitis.
Precision care for vasculitis limited to a single organ.
- Cutaneous leukocytoclastic angiitis: Treatment for isolated small-vessel inflammation affecting the skin.
- Cutaneous arteritis: Care for medium-vessel vasculitis presenting as skin lesions.
- Primary central nervous system vasculitis: Advanced therapies for inflammation affecting brain blood vessels.
- Isolated aortitis: Management of aortic inflammation without systemic involvement.
Expert management for vasculitis secondary to other conditions.
- Lupus vasculitis: Comprehensive care for vasculitis linked to systemic lupus erythematosus.
- Rheumatoid vasculitis: Treatment for rare inflammation in rheumatoid arthritis patients.
- Sarcoid vasculitis: Specialized care for blood vessel inflammation associated with sarcoidosis.
Tailored care addressing the underlying cause of vasculitis.
- Hepatitis C virus-associated cryoglobulinemic vasculitis: Management targeting HCV-related immune complex vasculitis.
- Hepatitis B virus-associated vasculitis: Treatment of vasculitis linked to HBV infection.
- Syphilis-associated aortitis: Targeted therapy for aortic inflammation caused by syphilis.
- Drug-associated immune complex vasculitis: Care for vasculitis triggered by drug-induced immune responses.
- Drug-associated ANCA-associated vasculitis: Expert management for medication-related ANCA vasculitis.
- Cancer-associated vasculitis: Treatment for vasculitis linked to malignancies.
4. Metabolic Bone Disorders
Metabolic bone disorders, such as osteoporosis and Paget's disease, result from abnormalities in bone metabolism that affect bone density and strength. These conditions can lead to an increased risk of fractures, and treatment typically includes medications, calcium, vitamin D supplements, and lifestyle modifications to promote bone health.
- Characterized by low bone mass and deterioration of bone tissue.
- Leads to increased fracture risk, especially in the hip, spine, and wrist.
- Common in postmenopausal women and older adults.
- Caused by defective bone mineralization due to vitamin D deficiency or phosphate metabolism disorders.
- Osteomalacia results in bone pain and muscle weakness.
- Rickets causes skeletal deformities, delayed growth, and bowed legs in children.
- A chronic disorder causing abnormal bone remodeling (excessive breakdown and rebuilding).
- Results in enlarged, weak, and misshapen bones.
- Commonly affects the pelvis, spine, skull, and legs.
- Overactivity of the parathyroid glands leads to high calcium levels and bone loss.
- Can result in osteoporosis and increased fracture risk.
- A rare genetic disorder affecting bone and teeth mineralization.
- Leads to soft bones, fractures, and dental problems.
- A genetic disorder causing fragile bones due to defective collagen production.
- Often referred to as "brittle bone disease."
- Bone disease caused by imbalances in calcium, phosphorus, and parathyroid hormone (PTH) in chronic kidney disease.
- Leads to soft or brittle bones.
5. Gout and Pseudogout
Gout is a type of arthritis caused by the buildup of uric acid crystals in the joints, leading to intense pain and inflammation, often in the big toe. Pseudogout, similar to gout, occurs when calcium pyrophosphate crystals deposit in the joints, causing joint pain and swelling. Both conditions are managed with medications to reduce inflammation and prevent future flare-ups.
Gout is caused by the deposition of monosodium urate crystals due to elevated levels of uric acid in the blood (hyperuricemia).
Pseudogout, also known as Calcium Pyrophosphate Deposition Disease (CPPD), is caused by the deposition of calcium pyrophosphate dihydrate crystals in the joints
6. Infections
Infection is the invasion and multiplication of microorganisms such as bacteria, viruses, fungi, or parasites in the body, causing illness or damage to tissues. It can lead to inflammatory conditions like viral arthritis, post-viral arthritis, or infective arthritis, affecting joints and other systems.
Viral Arthritis is a form of joint inflammation caused by a viral infection. It can occur during or after the viral illness as the immune system reacts to the infection. Viral arthritis is usually self-limiting, meaning it resolves on its own, but in some cases, it may persist or mimic other types of inflammatory arthritis.
Common Viruses Associated with Viral Arthritis:
- Parvovirus B19
- Hepatitis Viruses: Hepatitis B and Hepatitis C
- Rubella Virus
- Chikungunya Virus
- Dengue Virus
- Alphaviruses (e.g., Ross River virus, O'nyong-nyong virus)
- HIV
- Epstein-Barr Virus (EBV)
Post-Viral Arthritis is a condition where joint pain, stiffness, or inflammation persists after a viral infection has resolved. It is a self-limiting, reactive arthritis triggered by the immune response to the viral infection rather than a direct infection of the joint.
Infective Arthritis, also known as Septic Arthritis, is a serious condition where a joint becomes infected, usually by bacteria, but sometimes by viruses, fungi, or mycobacteria. It leads to inflammation and can cause rapid joint damage if not treated promptly
7. Soft Tissue Rheumatism (STR)
Soft Tissue Rheumatism (STR) refers to a group of conditions affecting the soft tissues around joints, including tendons, ligaments, muscles, bursae, and fascia. These conditions often cause pain, tenderness, and swelling but do not involve joint inflammation directly.
Inflammation of tendons.
Common examples:
- Rotator Cuff Tendinitis: Affects the shoulder.
Achilles - Tendinitis: Affects the heel.
- Tennis Elbow (lateral epicondylitis): Affects the outer elbow.
Inflammation of the bursa (fluid-filled sacs that cushion joints).
Common examples:
- Shoulder Bursitis.
- Trochanteric Bursitis: Affects the outer hip.
- Olecranon Bursitis: Affects the elbow.
- Chronic pain caused by trigger points in the muscles or fascia.
- Common in the neck, shoulders, and back.
- Inflammation of the fascia on the bottom of the foot.
- Causes heel pain, especially in the morning.
Fibromyalgia is a condition characterized by widespread musculoskeletal pain, fatigue, and tenderness, often accompanied by sleep disturbances and cognitive difficulties. Chronic pain syndromes refer to persistent pain that lasts longer than expected, and managing fibromyalgia and chronic pain involves medications, physical therapy, lifestyle changes, and stress management techniques.
Caused by nerve compression.
Examples:
- Carpal Tunnel Syndrome: Compression of the median nerve in the wrist.
- Tarsal Tunnel Syndrome: Compression of the tibial nerve in the ankle.
Inflammation of the tendon sheath.
Examples:
- De Quervain’s Tenosynovitis: Affects tendons on the thumb side of the wrist.
Overuse injuries caused by repetitive movements, often occupational or sports-related
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