When the history of patients who have reached a certain age is taken, there are very few patients who have not had rheumatism in the past or present. Indeed, as in the famous movie of the master actor Kemal Sunal, many patients can tell that it is raining because their joints hurt. According to many patients, if any of their joints hurt once, they definitely have rheumatism. The window seen through the eyes of rheumatologists is completely different. Rheumatologists roughly divide rheumatic disorders into two. The first and the disease that mainly concerns us is inflammatory rheumatic diseases. The second and more common one is non-inflammatory (non-inflammatory) rheumatic diseases. In this article, important tips will be given to distinguish between inflammatory and non-inflammatory rheumatoid disorders. Then, the presenting complaints that patients should know for each rheumatic disease will be discussed.
The first and most important initial complaint of rheumatic diseases is joint pain (arthralgia). This pain may be on the joints or around the joints and may be reflected in different parts of the body (for example, lower back pain may be felt in the hip). Although joint pain is an important complaint on its own, some additional findings are required for rheumatologists to call it inflammatory rheumatism. These include swelling of the joint, redness on the joint, warmth in the joint, and inability to perform full joint movements (loss of function). Joint swelling is more easily seen in the finger joints, above the wrist, elbow, knee, ankle and metatarsal bones. Again, the increase in temperature on the joint can be understood by the increased temperature when we touch the joints listed above with our hands, compared to another joint surface without swelling. Redness on the joint is a very important finding and suggests microbial joint inflammation (septic arthritis), which is a rheumatological emergency until proven otherwise. Failure to perform the functions of the joints may cause damage to large joints such as knees and hips, which may lead to the use of prostheses in the future. As a result an addition If there is swelling along with pain, it can be concluded that this joint is inflamed and these patients should definitely consult a rheumatologist. This inflammation can be short-term (acute) or can persist for weeks, months or even years (chronic). For this reason, the duration of the joint complaint is a question that must be learned by the rheumatologist.
Ankylosing Spondylitis: This disease, which can also be called inflammatory spinal rheumatism, is seen with a frequency of approximately 0.5-1% in the society. It is especially important because it affects young individuals. Having a family history of waist and neck strain due to spinal rheumatism is an important finding. Even in developed countries, diagnosis can take 6-8 years. Therefore, early recognition of complaints is especially important. The patient's most important complaint is low back pain. In individuals younger than 45 years of age, especially those aged 25-30, any patient with low back pain that lasts for more than 3 months, has an insidious onset, wakes up at night due to low back pain, creates a feeling of stiffness and stiffness in the waist and hips in the morning, and decreases over time with movement. It should be seen by a rheumatologist at least once.
Rheumatoid Arthritis: The inflammatory joint rheumatism described above applies especially to rheumatoid arthritis. This disease is seen with a frequency of 0.5-1% in the society. It is more common in women than in men. Although it can occur at any age, it generally starts at the age of 40-50. The main complaints are pain, swelling and increased temperature in the hand joints, wrist, elbow, shoulder, hip, knee, ankle and metatarsal bones, starting from the second knuckle of the fingers. Joint swelling in rheumatoid arthritis is long-lasting, often continuing for months or years if left untreated, causing permanent damage. If any of these joints swell, a rheumatologist should be consulted. Rheumatoid factor, which is called rheumatology tests and can be performed in many centers including health centers, is a marker of rheumatoid arthritis. However, the following information about rheumatoid factor should be known. Rheumatoid factor is positive (i.e. h It will not be positive in every rheumatoid arthritis patient) and rheumatoid factor may be positive in some diseases other than rheumatoid arthritis and even in older patients without an underlying disease. Therefore, a decision cannot be made in a patient just by looking at the rheumatoid factor. The most important reason for admission is joint swelling.
Psoriatic arthritis (Psoriatic arthritis):Psoriatic arthritis or psoriasis arthritis is the presence of joint pain and swelling similar to rheumatoid arthritis along with psoriasis rashes on the skin. Unlike rheumatoid arthritis, the first knuckle at the end of the hand may also be affected and inflammatory lumbar rheumatism similar to ankylosing spondylitis may occur. Psoriasis rashes may be found on the trunk or scalp, especially around the knees and elbows. Most of the time, psoriasis rashes appear years before joint complaints. Sometimes these rashes occur in hidden places such as the genital area. Changes such as yellowing and breaking of nails may also develop due to psoriasis.
Gout:Gout disease (also called rich man's disease) is more common in men at older ages, and its prevalence in the society is higher than rheumatoid arthritis and ankylosing spondylitis. It is a disease that is more common. At the beginning of the disease, there is joint swelling, especially in the big toe, which starts suddenly, is seriously painful (like being stung by a scorpion), hurts even when it comes into contact with the bed sheet, is accompanied by a rash, and heals in 1-2 weeks. These joint swellings come in the form of attacks. After the first attack, it may take years for the second attack to occur, but the time between attacks shortens over time. Joint swelling begins to occur in other joints, such as the ankle, knee, hand joints and elbow. There is a relationship between the amount of uric acid in the blood and gout disease. High uric acid is associated with eating protein foods. For this reason, gout can be triggered by foods and beverages such as meat and meat products, caviar, and beer.
Behçet's Disease:Behçet's disease, named after the Turkish dermatologist Behçet Us, is included in the medical literature. Recurrent canker sores in the mouth (painful wounds on the inside of the tongue and lips that heal in 1-2 weeks), wounds similar to those in the mouth in the genital area (which can leave scars, last longer and are more painful), eye sores It is a disease characterized by uveitis (blurred vision, stinging, red eyes), erythema nodosum (painful, red, raised sores the size of a coin on the skin below the knees), and more pronounced joint pain and swelling in the knee and ankle. Behçet's disease affects young adults, average age 25. In Behçet's disease, aphthous ulcers in the mouth are seen in almost all patients. However, aphthous ulcers in the mouth are common in society, even without an underlying disease. Patients with canker sores and one or more of the other findings should consult a rheumatologist.
Familial Mediterranean fever (FMF):It is a genetically inherited disease that can start in childhood as well as in adulthood. It is common for first- or second-degree relatives to have this disease. The most important symptom of the disease is that it occurs in the form of attacks. The interval between attacks may last from 1-2 weeks to 1-2 years. Abdominal pain is one of the most important findings, it usually lasts 1-3 days, it is especially evident on the first day, the patient lies down in bed due to abdominal pain, there is a hardening in the abdomen, sometimes patients lie down in this way because sitting bent over with their legs towards their abdomen causes a decrease in pain. Fever accompanied by chills and shivering (like malaria) is observed, the temperature may rise up to 39 degrees when measured, and some patients may experience pain and swelling in the knee and ankle, which may be accompanied by a rash. Some patients may also experience chest pain similar to abdominal pain. Since it is a familial disease, genetic examination can be performed. It should not be forgotten that kidney failure may develop in some patients without treatment.
Vasculitides:The incidence in the society is much less than other rheumatic diseases, but it is an important disease that can cause permanent damage and even organ failure by involving internal organs. It is a collection of disorders. Vasculitis means inflammation of the vessels. Depending on the size of the involved vessel, large vessels (giant cell arteritis, Takayasu arteritis), medium vessels (polyarteritis nodosa) and small vessels (Wegener's granulomatosis, Churg-Strauss syndrome, microscopic polyangiitis, Henoch Schönlein purpura) may be affected. this huh Each of the diseases are very rare diseases and their findings are not usually associated with rheumatic diseases by patients. For this reason, the patient is referred to a rheumatologist by another doctor (such as an internal medicine doctor, dermatologist).
Connective Tissue Diseases:Systemic lupus erythematosus, scleroderma and Sjögren's syndrome are the most common connective tissue diseases. Systemic lupus erythematosus is a disease of young women. In addition to weakness and fatigue, the most common symptoms of Rayno's disease, accompanied by a red rash around the nose, discomfort in the sun, painless sores in the mouth, serious hair loss, and first whitening and then bruising on the fingers in the cold, are the most common symptoms. In this disease, internal organs, especially the kidneys, heart, lungs, eyes and brain can be affected. Scleroderma is also a disease of women, but it is seen at older ages. The skin of the hands and feet first swells and then thickens. Over time, as Rayno's disease progresses, sores may appear on the fingertips. Food getting stuck in the esophagus while eating and shortness of breath are other symptoms that may be encountered. In Sjögren's syndrome, dry mouth and eyes occur for months. While systemic lupus erythematosus and scleroderma diseases are very rare diseases, Sjögren's disease is seen with a frequency of up to 1% in middle-aged women. Dry mouth continues for months. If a patient does not have diabetes mellitus, which is an important cause of dry mouth, it is useful to investigate Sjögren's disease. Patients mention the need to constantly carry fluids to drink due to the low amount of saliva. Dry eyes also continue for months. Patients complain of a foreign body sensation in the eye, a feeling of sand escaping, and when they want to cry, tears do not come. In general, it is observed that patients with dry eyes are given tear drops and do not undergo further examination. However, patients with long-term dry eyes should be seen by a rheumatologist at least once.
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