What Causes Rheumatic Fever
Rheumatic fever is an overreaction of your bodys immune system that causes it to fight healthy tissues. An untreated strep throat or scarlet fever infection can trigger this overreaction. It happens when group A streptococcus infections are not adequately treated with antibiotics.
When your bodys defenses begin to fight back, the reaction can damage healthy tissues and organs instead of the bacteria.
In Canada The Average Wait Time To Access Specialty Care Like Rheumatology Is 78 Days During This Time Your Rheumatoid Arthritis May Be Progressing At Its Own Speed And Stopping You From Living Your Life Heres What To Do During The Wait Time To Manage Your Pain
When you have pain and swelling in your joints and your family doctor suspects rheumatoid arthritis , they will likely suggest you see a rheumatologist as quickly as possible. Rheumatologists are specialists who focus on diagnosing and treating musculoskeletal disease and systemic autoimmune conditions also known as rheumatic diseases. This includes rheumatoid arthritis, ankylosing spondylitis, lupus, and others.
Seeing this type of specialist is critical not only because you want answers to why you feel so awful, but also because research shows that there is an ideal window of diagnosing and treating RA that makes a person more likely to achieve remission with less damage to the body from inflammation. The Canadian Rheumatology Association states that the maximum benchmark for the time between referral and first appointment with a rheumatologist should be no more than four weeks. Unfortunately, the reality is very different. There are usually long wait times to see specialists in Canada, and rheumatology has one of the longest. In fact, a 2020 study published in the journal Canadian Family Physician found that the average wait time to access specialty care in Canada is 78 days . This can vary considerably depending on your province or area in which you live its possible to wait months or even up to a year. And while you wait, your rheumatoid arthritis may be progressing at its own speed and stopping you from living your life.
Do You Need To See An Orthopedic Physician Or A Rheumatologist
Patients should use the guidelines below to help determine if they should choose an orthopedic physician or rheumatologist for their arthritis and joint pain.
Patients might need an orthopedic physician if they have:
- Joint or musculoskeletal pain that began after an injury
- Gradually progressive hip or knee pain that is worse with weight bearing
- Joint pain that is severe and interfering with function
- Moderate or advanced arthritis of the knee or hip
- Previous unsuccessful treatment for joint pain
- Been told by their doctor they might need a joint replacement
Patients might need a rheumatologist if they have:
- Pain involving many joints
- New joint pain not associated with any injury
- Joint or musculoskeletal pain associated with morning stiffness, fever, fatigue, rash or chest pain
- Joint pain that followed a tick bite
- Joint pain associated with back pain
- Joint pain and psoriasis
- Muscular pain with or without any other symptoms
- New headaches or muscle aches and are over the age of 50
- Back pain with or without pain in the legs
- Unexplained, ongoing symptoms such as fever, sweats or weight loss
A patients medical needs are important and unique, that is why UMass Memorial Medical Center offers specialty trained physicians that have devoted their education and career to treating specific medical conditions to serve you.
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Role Of The Primary Care Doctor
Your primary care doctor will able to make an initial assessment following a physical examination. They can order X-rays, blood tests, or any other diagnostic tests needed to support his initial assessment. Your primary care doctor can also prescribe medications to relieve pain and other arthritis symptoms.
After test results come back and enough time has passed to evaluate how you are doing on the prescribed medications, your doctor may decide that they can handle your case. If not, they may decide to refer you to a specialist in arthritis diseases known as a rheumatologist.
These Doctors May Be Your Doctor For Life
Some specialists consult on your diagnosis and treatment plan, then send you back to your primary care doctor for most follow-up care. Not true for rheumatologists.
After making sure we have the right diagnosis, we obtain the appropriate lab work to make sure youre safe starting medication, and then see you every two to three months. Some people require less frequent follow-up, but we typically see patients more than their primary care doctors. In fact, we might become their primary care doctors, says rheumatologist Liana Fraenkel, MD, MPH, adjunct professor of medicine at the Yale University School of Medicine.
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How Is Arthritis Treated
The main goal of treatment is to reduce the amount of pain youre experiencing and prevent additional damage to the joints. Youll learn what works best for you in terms of controlling pain. Some people find heating pads and ice packs to be soothing. Others use mobility assistance devices, like canes or walkers, to help take pressure off sore joints.
Improving your joint function is also important. Your doctor may prescribe you a combination of treatment methods to achieve the best results.
What Questions Will My Rheumatologist Ask
One of the first questions the doctor will ask is, “What brings you here?” This is your chance to tell them how RA is affecting your life.
Then, get ready to answer a lot of other questions, like:
- What are your symptoms?
- How often do you have symptoms?
- What makes you feel better?
- What makes you feel worse?
- What activities cause pain?
- Where on your body is the pain?
- How bad is the pain?
- Which words best describe your pain?
- How does the pain make you feel?
- Does it stop you from doing things you enjoy?
- Are there symptoms other than joint, muscle, or bone pain that seem to be linked?
- Does anyone in your family have RA?
Some of the questions may not seem to be about rheumatoid arthritis, but your doctor has a good reason for asking them. Tell them if you want to know why or if you feel uncomfortable.
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How Can Working With A Rheumatologist Help You
Rheumatologists understand the biology of rheumatic diseases and are well-equipped with information to target and treat them, notes Ginsberg. A family practitioner may not have the depth of knowledge about some of these syndromes.
The best case scenario is having a primary care practitioner as well as a rheumatologist who both regularly coordinate arthritis care, he says.
As I was growing up, my pediatric rheumatologist used to send a report to my pediatrician after every visit. That made my file, back when they were kept in folders, very thick for both doctors. But it was important to have as much documented as possible, he says.
Can Rheumatoid Arthritis Be Cured
Although there is no guaranteed cure for rheumatoid arthritis, there are many early treatment options that can reduce permanent joint damage and the overall impact of the condition. These treatments are called disease-modifying agents and Biologics. Biologics can be given by subcutaneous injections or through intravenous infusions.
Other arthritis treatment options include arthritis IV infusion therapy, medication and changes in lifestyle or diet. Incorporating diet changes and exercise into your daily routine is a great way to prevent joint pain and damage in the future.
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What Areas Of The Body Are Affected
Symptoms of joint inflammation caused by rheumatoid arthritis can occur throughout several areas of the body. The nature of autoimmune disease in RA leads to inflammation in multiple joints gradually wearing the bone and cartilage away.
The main areas affected by joint inflammation are:
RA symptoms can occur in either one or multiple locations. When symptoms occur in more than four different joints in the body, the condition is referred to as polyarthritis.
What Else Can I Do To Protect Against Rheumatic Fever
Practicing good hygiene can reduce your chances of getting a bacterial infection. It can also stop you from spreading an infection to someone else. You should always:
- Wash your hands often with soap and water.
- Cough or sneeze into a tissue, your elbow or upper shoulder .
- Use a tissue once for a sneeze or to blow your nose, then throw it away and wash your hands.
If you have been diagnosed with rheumatic fever, your physician may prescribe a long term antibiotic to prevent future bouts of strep throat and to prevent recurrences of rheumatic fever.
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What Are Bone Spurs
Bone spurs are of two basic types. One is the kind that arises near a joint with osteoarthritis or degenerative joint disease. In this situation, the cartilage has been worn through and the bone responds by growing extra bone at the margins of the joint surface. These spurs carry the formal name osteophytes. They are common features of the osteoarthritic shoulder, elbow, hip, knee and ankle. Removing these osteophytes is an important part of joint replacement surgery but removing them without addressing the underlying arthritis is usually not effective in relieving symptoms.
The second type of bone spur is the kind that occurs when the attachment of ligaments or tendons to bone become calcified. This can occur on the bottom of the foot around the Achilles Tendon and in the coroacoacromial ligament of the shoulder. These spurs often look impressive on X-rays, but because they are in the substance of the ligaments rarely cause sufficient problems to merit excision.
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Delays In Getting Diagnosed With Psoriatic Arthritis Are All Too Common Knowing What To Expect May Help Speed Up The Process
If your shoes are feeling tighter than usual or youre having difficulty or pain opening jars, a type of autoimmune disorder called psoriatic arthritis could be to blame. PsA is an inflammatory arthritis linked to psoriasis . It is characterized by pain, stiffness, and swelling in the joints although these general arthritis symptoms can take on specific characteristics when they are caused by psoriatic arthritis
As with many conditions, early diagnosis and prompt treatment are important. If you put off seeing the doctor, there are two major concerns with a delayed psoriatic arthritis diagnosis, says Bharat Kumar, MD, Associate Rheumatology Fellowship Program Director at University of Iowa Health Care and member of the American College of Rheumatology.
First, he explains, disease activity may worsen and cause lasting joint damage. Second, PsA is linked to a higher rate of heart disease, so the sooner youre diagnosed the quicker you can address cardiovascular factors like high cholesterol and hypertension. Rheumatologists are eager to see anyone with psoriasis who is also experiencing joint pain, Dr. Kumar says.
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Early Onset Arthritis Age Range
In regards to rheumatoid arthritis, for example, the average arthritis age of diagnosis in adults is between 30 and 50.7 Therefore, the early onset arthritis age is anything less than 30 because people of any age can actually develop this form of arthritis.
It is a common misconception that one is too young to have arthritis. But in fact, about half of arthritis patients are under the age of 65. While osteoarthritis is more closely associated with elderly adults and most people over 60 have at least some degree of osteoarthritis,8 the early onset arthritis age for this this condition is between 20 and 40.9
Primary Health Care Providers Should Consider Referring Patients To A Rheumatologist If:
- You diagnose or suspect an inflammatory type of arthritis , or to confirm a diagnosis.
- A patient needs a management plan for a type of inflammatory arthritis.
- A patient has unexpected complications such as unexplained fever, abnormal laboratory findings, or onset of unexplained symptoms .
Find rheumatologists near your patient in ACRs Find a Rheumatologist databaseExternalexternal icon.
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What Does An Orthopedist Do
Orthopedists handle the disorders, injuries, prevention, treatment, and repair of the skeletal system and its related joints, ligaments, and muscles.
Orthopedists and orthopedic surgeons are specially trained in the diagnosis and treatment of bone and joint disease. They use an array of testing modalities to aid in diagnosis and treatment.
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Dupuytrens Disease And Contracture
Dupuytrens contracture is a thickening of the fibrous tissue layer underneath the skin of the palm and fingers. Although painless, the thickening and tightening of this fibrous tissue can cause the fingers to curl .
Dupuytrens contracture is more common in men than in women.
Dupuytrens contracture symptoms usually occur very gradually and starts with nodules and pitting of the palmar skin.
Nodules. One or more small, tender lumps form in the palm. Over time, the tenderness usually goes away without treatment.
Bands of tissue/Cords: Tough bands of scar tissue can form a linear looking and feeling tissue along each finger.
Contracture: One or more fingers bend toward the palm as the cords contract. The ring and little fingers are most commonly affected, but any or all fingers can be involved. Grasping large objects and putting your hand in a pocket becomes difficult.
The cause of Dupuytrens contracture is not known. It is not caused by an injury or heavy hand use.
There are factors that put people at greater risk for developing Dupuytrens contracture.
- It is most common in people of Northern European or Scandinavian ancestry.
- It often runs in families .
- It may be associated with drinking alcohol.
- It is associated with certain medical conditions, such as diabetes and seizure disorders.
- It increases in frequency with age.
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Come Prepared With Your Health History
You are more than just your joint pain. Any and all medical conditions that have affected you in the past might be relevant to your current condition. Keep a list with the names and dates of any illnesses and surgeries youve had. Bring a list of what medications you take prescription, over-the-counter, vitamins, alternative/herbal remedies and their doses. Write down anything you can think of that might be relevant in your familys medical history, too. Did anyone in your family have a rheumatic disease or autoimmune condition ? Ask your primary care doctor for a copy of your medical record, as well any relevant images or lab results.
How Do You Test For Rheumatoid Arthritis
The best way to make a diagnosis is by detailed history and a thorough physical examination by an experienced rheumatologist. Blood tests and imaging tests are also helpful in supporting the diagnosis. Imaging tests like X-rays and MRIs can help rheumatologists with diagnosis because they examine soft tissue, cartilage, and bones that may be exhibiting RA signs.
Blood tests look for markers for inflammation and specific antibodies. Around 30 percent of patients have normal blood test results yet still can have a form of rheumatoid arthritis called Seronegative Rheumatoid arthritis. That can only be diagnosed by an experienced rheumatologist during a thorough physical examination.
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Reaching A Ra Diagnosis
Once all of these steps have been conducted, doctors will look at all of the test results and reach a conclusion based on the overall picture. Some doctors take a more symptom based approach to diagnosing RA while others rely on blood tests and medical history to confirm a RA diagnosis.
This is why its possible to be diagnosed with RA but not test positive for antibodies or have a medical history of RA in your family. If the symptoms themselves are consistent with RA, then it can still be diagnosed.
That being said, the main criteria for diagnosing RA do not change. The patient must exhibit symptoms for greater than six weeks, symmetrical symptoms, as well as multiple joints being affected including fingers and hands.
Reasons To See A Rheumatologist
Muscle and joint pain are common, but see a primary care physician if you have pain that lasts for more than a few days.
A doctor can evaluate whether youre experiencing temporary pain from an injury or other inflammatory causes. They can also refer you to a rheumatologist if needed.
If your pain worsens over a short time, you should see a rheumatologist.
Also, if your symptoms decrease with initial treatment, such as with pain medication, but return once the treatment stops, you might need a specialist.
You may want to see a rheumatologist if you:
- experience pain in multiple joints
- have new joint pain not related to a known injury
- have joint or muscle pain accompanied by fever, fatigue, rashes, morning stiffness, or chest pain
- have muscle pain with or without other symptoms
- are over 50 years old and have recurring headaches or muscle aches
- have a chronic illness without a unifying diagnosis
Many rheumatic conditions are hereditary, so let your doctor and rheumatologist know if you have any family history of:
- autoimmune disease
- rheumatic disease
Dont delay seeking treatment if you have persistent joint, bone, or muscle pain. A doctor should evaluate joint stiffness that lasts more than 30 minutes, especially if its worse in the morning after long periods of inactivity or any joint swelling.
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