Search This Site!!

Search this site powered by FreeFind

Rheumatology

Rheumatology is a specialty of Internal Medicine dealing with disorders affecting the musculoskeletal system and therefore are commonly referred to as Arthritis Doctors.  Most Rheumatologists have completed a 3-year Internal Medicine Residency program after medical school, followed by 2 years of Fellowship training in Rheumatology. A Rheumatologist is not a surgeon.

Some of the more common conditions treated by a Rheumatologist are:

Osteoarthritis. This is caused by wear and tear and is also called degenerative arthritis. It tends to affect older individuals or previously damaged joints. There is not much inflammation and frequently treated with over-the-counter analgesics and prescription strength anti-inflammatory medicines, along with local measures such as bracing, heat or cold packs, topical agents like Ben Gay, Aspercreme etc. Injections of cortisone and anesthetic into affected joints can frequently help. Some joints are so affected that they ultimately need to be replaced. To learn more go to www.nlm.nih.gov/medlineplus/osteoarthritis.html

Rheumatoid Arthritis. This is the most devastating kind of arthritis. It can affect children, young adults and older people. Its hallmark is inflammation of the joint lining causing it to grow out of control and ultimately destroy and deform the joint. The  earlier one can diagnose and start treating RA the better the long term results. Today there are some very powerful medicines called TNF antagonists that can dramatically reverse the inflammation. The standard method of treating RA is to use anti-inflammatory medicines along with small doses of cortisone and stronger agents like anti-cancer medicines, if needed. For more information go to www.nlm.nih.gov/medlineplus/rheumatoidarthritis.html

Lupus. The real name is Systemic Lupus Erythematosus. This condition predominantly affects women between 25 and 50. Children and males are also affected. Lupus most commonly causes inflammation of the skin, joints, kidneys, brain, lining of the heart, lungs. It can at times be very severe and life threatening and can lead to kidney failure and Dialysis. Treatment usually is Cortisone and anticancer medications. Sometimes some medicines can cause a lupus-like illness. 

For more information go to www.nlm.nih.gov/medlineplus/lupus.html or www.lupus.org/

Gout. Gout is caused by the accumulation of uric acid crystals in the joint lining and bone and causes significant discomfort. It is most  often seen in patients who have kidney failure or are taking diuretics for heart failure or hypertension. Some of these patients also have kidney stones. Treatment usually consists of anti inflammatories and colchicines or allopurinol. In some instances dietary changes may be needed. A condition that can look like gout is called pseudogout.  For more information go  to  www.nlm.nih.gov/medlineplus/goutandpseudogout.html

Scleroderma. Also called Systemic Sclerosis this condition is marked by tightening of the skin in the arms, legs, face and less often the abdomen. Patients typically have spasm of the blood vessels called Raynaud’s  Phenomenon and can go on to develop kidney, heart and lung failure. Fortunately many patients have a fairly benign course, but some can have a catastrophic course. Treatment is usually with blood pressure medicines, cortisone and anticancer medicines. For more information go to www.nlm.nih.gov/medlineplus/scleroderma.html or www.scleroderma.org

Osteoporosis. Osteoporosis is a condition that causes brittle bones and fractures. Most affected are women in their menopause and men and women taking cortisone for other conditions. Early diagnosis by bone densitometry and proper treatment is the best course. Treatment consists of adequate intake of Calcium and Vitamin D, proper diet and exercise and agents such as Estrogens, Bisphosphonates, Calcitonin and Parathormone like peptide. For more information go to  http://www.nof.org or   www.nlm.nih.gov/medlineplus/osteoporosis.html

Connective Tissue Diseases. This is the name given to conditions that initially cannot be classified as Lupus, Rheumatoid or Scleroderma. It is most likely that they represent a very early form of the condition and have not yet shown all the features required to make a definite diagnosis. Sometimes they are also  referred to as Undifferentiated Connective Tissue Disease or Collagen Vascular Disease.

Vasculitis. This is the name given to conditions characterized by inflammation of the blood vessels. They can cause fairly catastrophic illnesses with stroke, heart attack, blindness, kidney failure, pneumonia and can be fatal. Treatment is usually high doses of cortisone and anticancer medicines. Some of the common forms of vasculitis are Wegener’s Granulomatosus, Temporal Arteritis, Polyarteritis. For more information go to www.nlm.nih.gov/medlineplus/vasculitis.html

Fibromyalgia and Chronic Fatigue Syndrome.  These two are poorly understood conditions causing a lot of difficulty to those affected. The main symptoms are generalised muscle aches, pain and severe fatigue. Treatment involves first making sure there is no other significant underlying illness causing it, then using analgesics, exercise, muscle toning, ensuring proper sleep and in selective individuals, antidepressants, mild stimulants like dextromethorphan and guiafenesin. For more information go to www.nlm.nih.gov/medlineplus/fibromyalgia.html

Bursitis and Tendinitis. These are exceedingly common and are usually around joints that are suddenly put to unaccustomed exertion or subjected to repeated exertion. They most commonly occur around the shoulder, elbow, hip and knee. Treatment usually consists of local measures such as heat or cold packs, anti-inflammatories and frequently local injection of cortisone with or without an anesthetic.

There are several other less common conditions like Ankylosing Spondylitis, Reiter’s Syndrome, Sjogren’s Syndrome, Dermatomyositis and Polymyositis, Psoriatic Arthritis etc. Altogether there are about 100 different conditions that can cause people to seek the attention of a Rheumatologist.

Endocrinology

Endocrinology, is a specialty of Internal Medicine which deals with diseases resulting from the dysfunction of one or more of the hormonal systems in the body.  Most Endocrinologists have completed a 3 year Internal Medicine Residency training after medical school, followed by a 2-year Fellowship training in Endocrinology. An Endocrinologist is not a surgeon.

What Conditions Do Endocrinologists Treat?

The commonest conditions that come to the attention of an endocrinologist are Diabetes, obesity, thyroid and parathyroid dysfunction, disorders of growth, excessive growth of facial and body hair, and disorders of sexual and reproductive function. However, there are many other rarer conditions that are diagnosed and treated by an endocrinologist when he investigates symptoms such as excessive fatigue, unusual weight loss or weight gain, excessive thirst or appetite, depression, fibromyalgia, hypoglycemia, absence of menstruation, delayed puberty and other indicators of a major change in the internal environment of the body. The work-up may lead to the diagnosis of dysfunction of the pituitary gland or the adrenal gland, either of which could be life-threatening if left untreated, or to the discovery of some hormone-producing tumor.

Diabetes Mellitus.  

Type 2 diabetes has become an increasingly common condition in the U.S., presenting not only in more and more people, but at younger and younger ages. People who are overweight are especially at risk for developing diabetes. The alarming rise of obesity in children has raised concerns about an “epidemic” of diabetes in the younger generation coming of age. What the public needs to know is that high blood sugar levels are only a symptom of this disease, which actually damages the lining of blood vessels throughout the body, resulting in heart attacks, strokes, kidney failure, loss of vision and seriously compromised blood circulation in the legs. Early diagnosis, strict control of disease parameters and close surveillance for the signs of developing problems, are the best measures to minimize the effects of this systemic disease. In fact, the best of all would be to diagnose the condition in the pre-diabetes stage, when steps could be taken to reverse or at least  postpone,  progression to diabetes.

Type 1 diabetes is much less common and affects mostly children and young adults. There is a complete inability to secrete insulin in this form of diabetes, so that those affected need insulin for survival. The disease otherwise affects the body in the same way as in type 2 diabetes, and entails the same degree of clinical surveillance.

For more information, go to www.diabetes.org

THYROID DISORDERS.

  The thyroid gland is a small butterfly shaped gland in front of the neck  which secretes thyroid hormone, which regulates the body’s metabolic rate. A deficiency of the hormone results in a slowing down of metabolism, causing symptoms such as weight gain, depression, excessive sleep, cold intolerance, slowing of mental functions, and, in severe cases, fluid around the heart and a dangerous slowing of heart rate. An excess of the hormone produces the opposite result of a hypermetabolic state, causing weight loss, nervous excitability, insomnia, palpitations, heat intolerance, and in some cases, cardiac arrhythmias with possibly, heart failure. Some people with hyperthyroidism also develop protrusion and swelling of the eyes. Thyroid dysfunction in pregnant women has especially serious implications for the health of the mother and the child.

Thyroid nodules are very commonly discovered and offer a diagnostic challenge:  while most are benign, some may harbor cancer. A methodical work-up could prevent unnecessary surgery on the many patients with benign nodules. This is the special domain  of endocrinologists. Most forms of thyroid cancer are amenable to treatment, and are, in fact, treated by endocrinologists rather than cancer specialists, as chemotherapy is not a part of their treatment.

To learn more, go to www.thyroid.org      and   http://www.aace.com

HYPERPARATHYROIDISM.

 The parathyroid glands are attached to the thyroid gland. Parathormone regulates calcium metabolism and maintains blood levels of calcium in an optimal range.

Over- production of this hormone is very commonly found, resulting in high calcium levels, which could cause kidney stones, and systemic problems. Severe hypercalemia can be life-threatening. Most cases of routinely discovered hyperparathyroidism have a benign course, therefore surgery is not always required. Whether to perform surgery to relieve hypercalcemia, and the work-up to investigate other more serious causes of hypercalcemia, are part of the decision making process in these cases.

To learn more, go to www.aace.com

PITUITARY DISORDERS.

The pituitary is a pea-sized gland which hangs from the base of the brain on a thin stalk. It is held in a small cup of bone to protect it, and has important blood vessels and nerves very close to it. It produces several hormones  which control the thyroid gland, the adrenal glands, the ovaries or testes, water metabolism and body growth. It is easy to understand why any dysfunction of this gland can cause some major problems, some even life-threatening. Pituitary tumors cause an added problem by crowding the gland in its tight bony compartment, resulting in some destruction of the gland and surrounding structures. The latter could lead to partial or complete blindness if the tumor is not removed in a timely manner.  Pituitary dysfunction, more often than not, requires extensive work-up including testing hormonal responses to stress, other hormones, etc.  For more information, go to   www.aace.com 

OTHER CONDITIONS   that are addressed by an endocrinologist are  obesity, high cholesterol levels,  hormonally-induced hypertension, polycystic ovary syndrome,  hirsutism (excessive hair in women), adrenal disorders and some other rare endocrine tumors which may be difficult to diagnose on routine  evaluation.