Rheumatologic Diseases

Major Rheumatologic Diseases:

Rheumatoid Arthritis (RA)

Behçet’s Disease

Ankylosing Spondylitis (AS)

Fibromyalgia (FMS)

Rheumatoid Arthritis (RA)

What is Rheumatoid Arthritis?

Rheumatoid arthritis is a chronic, inflammatory, systemic, and generally symmetrical polyarthritis of unknown cause, primarily affecting peripheral synovial joints. It can lead to joint deformities and permanent damage over time. Other organs in the body may also be affected. The clinical course varies greatly between individuals. It most commonly begins between the ages of 35 and 60 and is more frequent in women. The condition is more prevalent in cool and humid climates. Rheumatoid arthritis in children differs from that in adults and is one of the chronic diseases with the highest risk of leaving sequelae in childhood. Abdominal pain and severe anemia may accompany it.

Causes of Rheumatoid Arthritis

The exact cause is unknown, but factors such as genetics, infections, immune system disorders, and gender differences play a role.

Symptoms and Signs of Rheumatoid Arthritis

The onset of rheumatoid arthritis varies from patient to patient. About 70% of cases have an insidious onset over weeks or months. During this period, mild fever, fatigue, weight loss, and pain in one or more small joints may occur. Morning stiffness, defined as stiffness around joints after sleep or prolonged rest, is a key symptom.

Joint Symptoms:

• Morning stiffness: Early morning stiffness lasting over 1–2 hours is a hallmark symptom.
• Synovial inflammation: Painful, swollen, red, and warm joints.
• Pain: The most significant problem in RA.
• Joint deformities: Patients may position joints in ways that minimize pain, leading to stiffness.
• Cartilage and bone damage.
• Tendon, ligament, and muscle changes.
• Tendon nodules and ruptures.

Most Commonly Affected Joints:
Fingers, wrists, small joints in the feet, and shoulders. RA often causes symmetrical joint involvement, such as in the hands and wrists. Deformities like swan-neck fingers, boutonniere deformity, and carpal tunnel syndrome may develop. Other complications include hip pain, Baker’s cyst in the knee, hallux valgus, hammer toes, and subluxation in the feet.

Extra-articular Symptoms:
Fatigue, muscle pain, edema, weakness, flu-like symptoms, morning pain, rheumatoid nodules, dry eyes, loss of appetite, depression, cold hands and feet, difficulty with daily activities, and others.

Diagnosis of Rheumatoid Arthritis

RA diagnosis involves immunological tests, hematological evaluations, imaging techniques, and assessment scales.

Treatment of Rheumatoid Arthritis

The main goals are to reduce inflammation, prevent tissue destruction and functional loss, and improve the patient’s adaptation to the environment and society. Treatment options include:

• Patient and family education.
• Medication.
• Physical therapy and rehabilitation.
• Surgery.

In physical therapy and rehabilitation, the focus is on pain reduction, preventing muscle atrophy, maintaining joint mobility, ensuring rest, and preventing or minimizing deformities. Individualized rehabilitation programs are developed based on detailed physiotherapy evaluations. Treatment approaches include immobilization, splinting, hot/cold applications, electrotherapy, stretching, strengthening, joint mobility exercises, hydrotherapy, manual therapy, fine motor exercises, aerobic exercises, relaxation techniques, massage, and more.

Consult your doctor and physiotherapist for proper guidance.

Ankylosing Spondylitis (AS) – Bechterew Disease – Marie-Strümpell Disease

What is Ankylosing Spondylitis?

AS is a chronic, progressive, seronegative rheumatic disease primarily affecting the sacroiliac joints bilaterally and progressing upwards towards the cervical spine. It results in ossification, loss of elasticity in ligaments, joint fusion, and restricted mobility.

Causes of Ankylosing Spondylitis

The exact cause is unknown. However, the presence of the HLA-B27 antigen in 95% of cases highlights the role of genetic factors. AS typically begins between the ages of 16 and 35 but may manifest later. It is more common in men, occurring 3–5 times more frequently than in women.

Symptoms and Signs of Ankylosing Spondylitis

Skeletal Symptoms:

• Sacroiliitis and spondylitis.
• Arthritis of the root joints (hips, shoulders).
• Costovertebral joint involvement.
• Peripheral arthritis.
• Enthesitis.
• Osteoporosis.
• Vertebral fractures.

Extra-skeletal Symptoms:

• Acute anterior uveitis.
• Cardiovascular involvement.
• Pulmonary involvement.
• Cauda equina syndrome.
• Enteric mucosal lesions.
• Amyloidosis.

Diagnosis of Ankylosing Spondylitis

Common Criteria:

• Modified New York Criteria: Based on clinical and radiological findings.
• ASAS Criteria: For patients under 45 with chronic back pain lasting over 3 months.

Tests and Findings:

• Physical examination, postural analysis, lab tests, and radiological findings.
• HLA-B27 positivity in 90% of cases.
• Increased ESR and CRP levels.

Treatment of Ankylosing Spondylitis

The primary goal is to relieve pain and prevent disease progression. Treatment includes medication, physiotherapy, surgery, and exercise. Physiotherapy focuses on pain relief, maintaining posture, improving spinal and hip mobility, and preserving chest mobility and respiratory capacity.

Consult your doctor and physiotherapist for appropriate treatment.

Fibromyalgia – Fibromyalgia Syndrome (FMS)

What is Fibromyalgia?

Fibromyalgia is a chronic pain syndrome characterized by widespread muscle pain, sleep disturbances, and fatigue. It is more common in women.

Causes of Fibromyalgia

The exact cause is unknown. Triggers include genetic predisposition, physical trauma, emotional trauma, medications, and viral infections.

Symptoms and Signs of Fibromyalgia

• Widespread pain in various body areas.
• Sleep disturbances, fatigue, muscle tension, and cramps.
• Morning stiffness, swelling, dry eyes/mouth, depression, anxiety, and digestive problems.

Diagnosis of Fibromyalgia

Diagnosis involves examining tender points, identifying pain localization, conducting blood tests, and using imaging to differentiate it from other conditions.

Treatment of Fibromyalgia

Treatment focuses on individualized evaluations. Physiotherapy options include hot/cold applications, deep friction massage, aerobic exercises, energy management techniques, posture corrections, and specialized methods like acupuncture, yoga, GTOS therapy, and dry needling.

Seek professional medical advice from doctors and physiotherapists to ensure proper treatment.