Rheumatology

Rheumatology is the study and treatment of rheumatic disorders, a wide range of conditions affecting the joints and connective tissue and typically causing chronic pain to sufferers. There are hundreds of diverse and sometimes unrelated rheumatic disorders, many are accompanied by inflammatory symptoms and most cause undue pain in the bones and joints.

Though rheumatic conditions can vary greatly, the goals of treatment are largely the same: To reduce pain and inflammation, to slow or stop joint damage, and to help people feel better so they can stay active.

Preventive care includes immunizations, lead screening, developmental screening and vision screening. Wellness checks and routine physical are an essential part of preventive care. Treatment options for rheumatic disorders, like the conditions themselves, vary widely in style and scope. Therapies may include long-term lifestyle changes, exercise and diet regimens, drug therapies, surgical options, and of course education.

Many rheumatic disorders are difficult to identify in the earliest stages. Rheumatologists at Central Maine Healthcare have been specially trained to examine areas of pain and swelling and to discover the root cause. As some disorders respond better to treatment in their primary stages, it’s important to get a correct diagnosis as early as possible.

Conditions We Treat

Central Maine Healthcare offers comprehensive, high quality rheumatology care with board-certified Internal Medicine physicians who are also board certified in Rheumatology. We are committed to providing our patients with advanced medical knowledge that will enable them to enjoy the best possible quality of life.

Conditions treated include:

• Arthritis
• Bursitis
• Gout
• Lupus
• Osteoporosis
• Psoriatic arthritis
• Rheumatoid arthritis
• Tendonitis

Arthritis

Arthritis, characterized by inflammation of the joints, is a disease that causes pain, stiffness, swelling and limited range of motion in any joint of the body. Anyone — including children — can be affected by arthritis, but the condition usually affects older people. According to the Centers for Disease Control and Prevention, about 30% of people between the ages of 45 and 64, and almost half of those ages 65 and older, have arthritis.

There are more than 100 types of arthritis, but the most common, by far, is osteoarthritis. Also known as degenerative joint disease, osteoarthritis is diagnosed when the cartilage — the cushiony cells that line the joints and protect the bones — breaks down. As a result, the bones can rub together, leading to damage that can reduce function and cause disability. The hips, knees and hands are most commonly affected by osteoarthritis.

Other types of arthritis include:

• Rheumatoid arthritis — a progressive and debilitating autoimmune disorder that can impact multiple joints at one time
• Psoriatic arthritis — a type of arthritis that affects people with psoriasis
• Gout inflammatory arthritis that develops because of too much uric acid
• Lupus — an autoimmune disease that causes pain and inflammation in the joints, internal organs and skin

Risk Factors for Arthritis

Your risk for osteoarthritis increases as you age, and women are at a higher risk than men for the condition. Repetitive joint stress from work or sports, along with obesity, also increase the risk for osteoarthritis.

Some bacterial and viral infections can cause joints to develop arthritis, and cigarette smoking can contribute to rheumatoid arthritis. Genetics also play a role in some forms of arthritis.

Symptoms of Arthritis

The No. 1 symptom of arthritis is joint pain, but arthritis can include other symptoms such as:

• Limited range of motion
• Stiffness
• Swelling
• Tenderness

Diagnosis of Arthritis

Arthritis can often be diagnosed based on a symptoms review, but your physician may want you to get an imaging study — such as a CT, MRI, ultrasound or X-ray — to see the extent of the damage to your joints and track its progression. Blood work can also help determine the presence of inflammation.

Treatment for Arthritis

The frontline treatment for arthritis is medication. Over-the-counter pain relievers and non-steroidal anti-inflammatory medications, along with pain-reliever creams, may help. Your healthcare provider may also recommend prescription medications to relieve inflammation. Patients with autoimmune-related arthritis may need prescription immunosuppressants. When joint pain is severe, physical therapy and/or joint replacement surgery may be recommended.

You can also do the following to manage arthritis:

• Talk to your doctor about what types of exercises can help.
• Lose weight
• Quit smoking
• You may want to install grab bars in the bathroom to help you get in and out of the tub, and you might need to wear a brace or splint to support the infected joint. A cane or walker can help ease pain in your joints, too.

Bursitis

Bursitis is inflammation of the bursae, which are small pouches of fluid in the joints that keep bones, muscles and other structures from rubbing during movement. The bursae helps prevent wear and tear.

Often resulting from overuse, bursitis can be painful, but a variety of conservative treatments, including rest and exercises to stretch and strengthen nearby muscles, can provide relief.

Risk Factors for Bursitis

Anyone can get bursitis, but the bursae often become inflamed because of too much friction — as with repetitive use — or due to an injury. People who spend a lot of time at a computer, or those who perform manual labor on construction sites, for example, are at a higher risk for bursitis.

Other risk factors include:

• Aging
• Gout
• Infection of the bursae
• Injury to a joint, especially if it alters movement patterns
• Overuse of a joint, such as performing repetitive motions during work or recreation

Symptoms of Bursitis

When the bursae are irritated, fluid collects at the site and causes swelling, redness and/or warmth. The area hurts consistently, but pain can increase when the affected joint moves or someone puts pressure on it.

Diagnosis of Bursitis

Your physician will start the process of diagnosing bursitis by asking about your medical history, including any chronic conditions or allergies you may have, the medications you take, and the nature of your symptoms and what you’ve done to treat them. The physician will conduct a physical exam, taking care to scrutinize your joints for swelling and other signs of bursitis. Other useful diagnostic tests include:

• Blood tests. Rarely, a bacterial infection can cause bursitis. Blood tests can determine whether an infection is present.
• Fluid samples. A sample of fluid from a swollen joint can reveal infection.
• Imaging studies. X-rays can rule out or reveal bone problems that could be causing your symptoms. An MRI or ultrasound can show inflammation of the bursae.

Treatment for Bursitis

Your physician may recommend rest, ice, compression and elevation (RICE) as an initial treatment for bursitis, and you may receive an antibiotic if an infection is the cause. If the RICE method doesn’t provide pain relief, other treatment options include:

• Bracing
• Corticosteroid injections
• Draining fluid from affected joints
• Over-the-counter anti-inflammatory and pain-reliving medications
• Physical therapy
• Splinting

If other treatments do not work, surgery may be necessary to repair damage in affected joints.

Gout

Gout is a common, highly painful form of arthritis caused by uric acid crystals in the joints, often starting in the big toe. Uric acid is formed by the breakdown of purines, which are organic compounds found in soft tissues and certain foods. When there’s too much uric acid in your blood, it can collect as crystals in the joints. Gout alternates between periods of symptom flares and remission, with weeks to years separating the two. This condition has no cure, but medications can relieve symptoms and lifestyle changes may reduce the risk of flares.

Risk Factors for Gout

Men are much more likely than women to develop gout. Factors that can increase your risk include:

• A diet that includes a lot of red meat, liver, tuna, mackerel, herring, sardines, scallops, mussels and other purine-rich foods
• A family history of gout
• Alcohol consumption
• Congestive heart failure
• Diabetes
• High blood pressure
• Insulin resistance
• Obesity
• Organ transplantation
• Reduced kidney function
• Use of aspirin and other drugs with salicylate
• Use of diuretics
• Use of the drugs levodopa and cyclosporine
• Use of the vitamin niacin

Symptoms of Gout

Gout can affect any joint, but it’s more common in the toes, ankle and knee. The condition rarely affects more than one joint at once. During flares, an affected joint may be painful, stiff and swollen, as well as red and warm to the touch.

Diagnosis of Gout

Your physician will ask about other medical conditions you may have and the medications you take. Be prepared to provide detailed information about your symptoms, including which joint is affected, what the pain feels like, when it began and how long it’s been going on.

• Physical exam. The physician will examine the affected joint signs of gout, such as swelling and heat.
• Imaging tests. An X-ray, ultrasound or MRI allows the physician to assess the condition of the joint and rule out other possible causes of your symptoms.
• Blood test. High levels of uric acid in your blood are a clue that gout may be present.
• Fluid sample. The physician may wish to draw fluid from the affected joint to look for uric acid crystals.

Treatment for Gout

Most of the treatments for gout involve lifestyle changes that can help keep patients in remission as long as possible. If you have gout, you should avoid alcohol and foods that are high in purines and fructose. Drinking plenty of water can lower uric acid levels in the blood, and low-impact physical activity contributes to weight loss and can reduce joint pain. Stress can fuel flares, so try to reduce stress levels.

Medical options to relieve pain and swelling include nonsteroidal anti-inflammatory drugs such as aspirin, oral or injectable corticosteroids, and colchicine.

Lupus

Lupus is an autoimmune disorder that causes inflammation throughout your entire body. Symptoms may cycle through periods of improvements and flare ups — but the chronic disease is not curable. However, medications, lifestyle changes and careful monitoring with the help of our providers can help you get back to feeling close to normal.

Risk Factors for Lupus

No one yet knows what causes lupus, although genetic factors are thought to be a factor. Around 90% of people with lupus are female, and most develop the disease between ages 15 to 44. People who are African American, Asian-American, Latino, Native American or Pacific Islander are slightly more likely to develop the disease, as are people who have a close family member with lupus or a different autoimmune disease.

Symptoms of Lupus

There are many different symptoms of lupus, and they vary from person to person. Symptoms can also change as the disease evolves or worsens. Some of the most common symptoms are:

• Arthritis or joint pain
• Chest pain
• Fatigue
• Fever
• Hair loss
• Low blood cell counts
• Mouth sores
• Muscle pain
• Rashes, often butterfly-shaped on the face
• Sensitivity to the sun
• Swollen glands

Diagnosis of Lupus

After our providers evaluate your medical history and symptoms, they will order blood and urine tests, as poor kidney function can be another sign of lupus. The blood will be screened for specific antibodies. If you test positive for the antinuclear antibody — a test that helps identify autoimmune disorders — you will undergo additional bloodwork that can help diagnose lupus. Your doctor may also order a tissue biopsy of your skin or your kidney.

Treatment for Lupus

There is no cure for lupus, and your treatment plan will likely change throughout the course of your life, as symptoms flare and subside. Our rheumatologists will help you decide what medications might be needed, and what other medical care you might need. Common medications used in lupus treatment include corticosteroids and the antimalarial drug hydroxychloroquine. You may also need medications to treat heart or kidney problems that lupus can cause.

Osteoporosis

Osteoporosis literally means “porous bone.” This disease weakens bone density and mass, leading to fragile bones that can easily be broken in a fall. Over 53 million people in the U.S. have osteoporosis or are at high risk for developing it, but the disease can be prevented and treated in most cases.

Risk Factors for Osteoporosis

Women are far more likely to get osteoporosis than men, especially white and Asian women, and women who have smaller frames. Older people are significantly more likely to develop the disease. Other risk factors include a family history of osteoporosis, smoking, excessive alcohol consumption, low activity levels, a diet low in calcium and Vitamin D, and longtime use of some medications, including glucocorticoids. Some chronic diseases can also lead to bone loss.

Symptoms of Osteoporosis

Osteoporosis often has no external symptoms and is not discovered until a person has a sudden fracture. Some patients with osteoporosis in their vertebrae have back pain or develop a hunched back.

Diagnosis of Osteoporosis

A bone mineral density test is the first step toward an osteoporosis diagnosis, after a general physical exam. A dual energy X-ray absorptiometry (DXA or DEXA) test, which works much like a normal X-ray, can measure bone mineral density at various points across your body, like your thigh, your hip and your spine. If the DXA shows possible osteoporosis, your provider may order more bloodwork or other scans.

Treatment for Osteoporosis

Prevention of osteoporosis is the best treatment. A healthy diet with good amounts of calcium and Vitamin D, along with regular exercise and strength-training, can go a long way toward helping prevent osteoporosis for many people. Post-menopausal women at risk may also want to consider taking estrogen supplements.

For patients where osteoporosis has already developed, nutrition and exercise will be a part of treatment. Certain medications like bisphosphonates, calcitonin, estrogen and other hormones may be prescribed. Fall prevention will also be important, especially for older patients, and orthopedic shoes, canes or shower stools could be recommended to help maintain safe mobility.

Tendonitis

Tendonitis is a common condition that puts wear and tear on the tendons — tissues in the body that connect muscles to bones. Any type of repetitive motion, including playing sports like tennis or bowling, playing an instrument, or working in a factory, can cause tendonitis.

Tennis elbow is one of the most common types of tendonitis. Golfers often experience a similar repetitive injury called “golfer’s elbow.” Achilles tendonitis, another form of tendonitis, is common among runners, and basketball players are familiar with jumper’s knee. Other types of tendonitis include biceps tendonitis and rotator cuff tendonitis.

Risk Factors for Tendonitis

From athletes to office workers, anyone who engages in any type of repetitive movement on a regular basis can get tendonitis. If you have diabetes, arthritis, gout, overactive or underactive thyroid, you also have an increased risk of tendonitis.

Symptoms of Tendonitis

The first signs of tendonitis are usually pain and tenderness where the tendon attaches to the bone. The pain, often a dull ache, is usually present when the joint is moved. Tendonitis can also cause mild swelling around the sore joint.

Diagnosis of Tendonitis

If you think you have tendonitis, talk to your doctor. Your doctor will review your medical history and conduct a physical exam, where you can describe your symptoms and he or she will evaluate the area. Tendonitis can usually be diagnosed just based on the physician’s exam. However, these additional tests may be performed:

• An MRI to see if the tendon is inflamed
• Injecting an anesthetic into the area to see if the pain diminishes.
• Testing to see if there’s an infection. This is done by taking fluid from the area.
• X-rays to see if there are other injuries or problems in the area

Treatment for Tendonitis

The frontline method for treating tendonitis is usually the RICE technique: rest, ice, compression and elevation. Medications, such as aspirin, naproxen or ibuprofen can help reduce pain and inflammation.

If you have tendonitis, you can prevent it from getting worse by strengthening the area with stretching exercises and wearing a brace, band or splint on the injured area.

Patients who experience more severe tendonitis may need an injection that contains a steroid called cortisone and a numbing medication. Physical therapy and surgery may be recommended for more severe cases.