PATIENTS with rheumatology problems often complain of either localised or whole body pains.
Equally, the autoimmune diseases that are treated by rheumatologists can present with eye and/or nose inflammation, fatigue, mouth ulcers, and rashes, to name a few.
Given the high prevalence of rheumatic complaints within the population, general practitioners are experienced in the assessment of these complaints.
They are very well placed to help people with rheumatic complaints by undertaking preliminary investigations, offering advice on holistic management strategies such as physical therapy, and administering first-line medical therapies for rheumatic complaints.
Further opinion and therapies can be delivered in conjunction with a rheumatologist who can optimise pain control strategies and, where appropriate, use immune modulatory drugs, which stop inflammatory arthritis.
Broadly speaking, arthritis falls into two major categories: Osteoarthritis (often referred to as “wear and tear” arthritis) and inflammatory arthritis. Osteoarthritis usually affects people as they grow older, with 5% of people in their 30s suffering from it growing to nearly 100% of people in their 80s.
People with osteoarthritis tend to have brief “stiffness” for a few minutes upon getting up in the morning and upon standing after rest, with the pain being relatively constant.
Osteoarthritis can be helped by physical therapy under the guidance of a chartered physiotherapist, using painkillers and local joint injections prescribed by general practitioners or rheumatologists.
Advanced osteoarthritis is often best managed by an orthopaedic surgeon. Inflammatory arthritis has many subdivisions and the most common ones we see in
Ireland include gout, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and polymyalgia rheumatica.
Gout occurs either because someone produces too much uric acid or because they retain too much uric acid. It is an imminently treatable condition. Those in the throes of an initial attack can be prescribed anti-inflammatories or colchicine which was originally extracted from plants and has been used for millennia to treat the disease. If attacks are frequent then diet and uric-acid-lowering drugs will resolve the issue. It is always important for a physician to identify the cause of a patient’s gout.
Rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis affect up to 4%-5% of the population. They can present at any age, affecting both men and women, and patients complain of prolonged pain and stiffness which slightly improve with exercise. Polymyalgia rheumatica is the scourge of people once they reach their 50s and 60s, when those affected usually complain of hip and shoulder pain. It may be associated with large blood vessel inflammation when patients can have severe headaches, visual loss or pain upon chewing.
The future for rheumatology patients is, however, bright as rheumatologists now have a battery of medications with which they can deliver personalised treatment to patients, preventing the disability and damage that these conditions promoted in yesteryear.
The Mater Private Cork has established a comprehensive suite of tests, including whole body blood vessel imaging, blood testing, and blood vessel sampling where needed.
Its department of rheumatology has recently expanded with the appointment of Dr Len Harty to join Dr Brian Mulcahy in providing service for people with musculoskeletal disorders, connective tissue, and autoimmune diseases. Both are enthusiastic about providing a multidisciplinary rheumatology service for their patients in collaboration with their primary care doctors.
n Mater Private Cork,
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