RHUMATOLOGY

PATHOLOGIES

Rheumatology is a medical speciality concerned with the diagnosis and treatment of diseases of the musculoskeletal system, i.e. diseases of the bones, joints, muscles, tendons and ligaments, as well as associated neurological dysfunctions.

The rheumatologist treats and prevents pain in the neck, back and all the joints of the skeleton.

Rheumatological treatment is often multidisciplinary. Various medical and paramedical staff are involved: the general practitioner, the rheumatologist, the orthopaedic surgeon, the physiotherapist, the chiropodist, etc.

Diseases of the skeleton and its attachments :

osteoarthritis, osteoporosis, fatigue fracture, osteonecrosis, tendinopathy, sciatica, etc.

Inflammatory diseases :

rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, scleroderma, rheumatoid pseudopolyarthritis, Horton's disease, etc.

Diseases of infectious origin :

septic arthritis, spondylodiscitis, etc.

Neoplastic diseases :

benign and malignant tumours

Metabolic diseases :

gout, articular chondrocalcinosis, etc.

Other diseases of the musculoskeletal system :

algoneurodystrophy, fibromyalgia, etc.

DIAGNOSIS

STEP 1: A THOROUGH CLINICAL EXAMINATION

Examination procedure :

A "police" questioning on the characteristics of the pain: mode of onset, evolution over time, topography, intensity, schedule and type of pain (grinding, tearing, neuropathic pain, etc.).
Observation
Palpation and specific manual tests
Assessment of active and passive mobility
General signs

This examination makes it possible to distinguish between two types of pain:

Mechanical pain: increased by effort and improved by rest
Inflammatory pain: permanent during the day and night. They wake up in the second half of the night and are at their worst in the morning, with joint stiffness lasting at least 30 minutes and gradually improving with movement. Typically, the painful joint is red, hot and swollen. General signs may be associated (asthenia, anorexia, weight loss, febrile episodes, etc.).

Following this clinical examination, it may be necessary to order further tests.

STEP 2: ADDITIONAL TESTS

BIOLOGY
IMAGERY: X-ray, ultrasound, CT scan, MRI, bone densitometry, bone scintigraphy, PET-Scan, ELECTROMYOGRAMS

TREATMENTS

The therapeutic arsenal is varied. Several treatments are available: medicinal and non-medicinal.
The role of each of these treatment options varies according to the type and severity of the rheumatism. In all cases, taking into account non-medicinal measures, and in particular maintaining physical activity, is fundamental and an integral part of the treatment.

Medicinal treatments

Medicines must be adapted by the doctor to each patient, in order to effectively eliminate the symptoms.

There are three approaches:

Symptomatic treatments for pain (analgesics) and inflammation (anti-inflammatories).
In-depth treatments to treat the general disease (for certain inflammatory rheumatic conditions, osteoporosis, gout, etc).
Local treatments: evacuation punctures, intra-articular and peri-tendinous infiltrations.