Misconceptions: A Rheumatologist Clears the Air

“The Joys of Rheumatology”

Rheumatology wasn’t a field that I envisioned myself entering during medical school. It received minimal exposure in the undergraduate years, and most of the patient complaints involved pain, making it seem quite depressing. However, this complex and evolving field captured my interest, and much like a medical “Fifty Shades of Grey,” with nothing straightforward about it.
In general practice, rheumatologists often tackle the most mysterious cases. We’re called in to solve medical enigmas and interpret challenging test results, which piqued my curiosity. Another rewarding aspect is the opportunity to build long-terms relationships with patients and witness their gradual recovery.

Myths or Facts? Clearing the Air

Understandably, there is considerable confusion and misconceptions about rheumatologically conditions, medications, and tests. Let’s debunk some common myths which I’ve encountered.

Rheumatologists Only Treat the Elderly

A common misconception is that arthritis only affects the elderly. Rheumatic diseases can strike at any age, and it’s not unusual for me to see patients from a wide age range, often during the prime of their lives.

Rheumatologists Only Use Steroids for Treatment

This was true over a decade ago, but today, a wide array of medications has transformed treatment in rheumatology. It is now unacceptable for a patient with autoimmune condition to rely solely on steroids due to their long-term side effects.

Rheumatologists Disease is Just Another Name for Arthritis

Not true. For instance, gastroenterologists handle ulcerative colitis and Crohn’s disease, while neurologists manage multiple sclerosis. However, it’s common for patients with one autoimmune condition to have another concurrently.

Rheumatic Disease is Just Another Name for Arthritis

While rheumatic diseases fall under the umbrella term of arthritis, they are primarily autoimmune and inflammatory, affecting joints, muscles, bones, and organs.

Rheumatologists and Orthopedic Doctors Are the Same

Orthopedic surgeons treat mainly degenerative diseases and perform surgeries, while rheumatologists handle immune-related arthritic and do not perform surgeries.

Rheumatic Diseases Only Affect Women

Both men and women can be affected, though women are disproportionately impacted. Men often experience gouty arthritis, while women more frequently suffer from lupus, osteoarthritis, and rheumatoid arthritis.

Rheumatic Diseases Will Go Away With Time

Unfortunately, rheumatic diseases are typically chronic. Early and ongoing treatment can improve functionality and reduce the risk of disability and surgery.

Certain Conditions or Foods Cause Joint Pain

Cold weather, air-conditioned rooms, and green vegetables do not cause joint pain. Some rheumatism sufferers might feel more pain in the cold due to atmospheric pressure changes, but these factors do not directly cause arthritis.

Joint Pain is Always Due to Increased Uric Acid

Gout is one type of rheumatic disease caused by increased uric acid, but not all joint pain is due to this. Patients with joint pain and high uric acid levels might not necessarily have gout.

Eating Green Vegetables and Nuts Causes Arthritis

Green vegetables and nuts do not cause joint pain. Gout can be triggered by certain foods like alcohol, shellfish, and large amounts of red meat.

Rheumatic Diseases Are Hereditary

While genetic factors can influence the tendency to develop certain rheumatic diseases, they are not directly inherited from parents to children.

Rheumatic Diseases Only Affect Joints and Bones

Rheumatism can affect surrounding tissues like muscles and tendons, and some patients experience symptoms like fever, fatigue, weakness, and weight loss.

Warm Compresses Are Always Better for Rheumatic Ailments

Cold compresses help reduce pain and swelling in acutely inflamed joints, while warm compresses can relieve tension in osteoarthritis and muscle tension.

Joint Injections Are Harmful

When done correctly, joint injections are beneficial for treating inflammation. Steroid injections should be limited to three times a year to prevent joint damage.

Rheumatic Diseases Are Incurable and Require Lifelong Medication

Some joint diseases caused by viruses can heal after the infection resolves. Long-term therapy for chronic diseases can control symptoms, prevent disability, and allow patients to lead active lives.

Joint Pain Isn’t Serious Since It Can’t Kill You

Rheumatic diseases can cause significant disability and some can be life-threatening if not properly managed.

Joints Must be Moved Despite Pain to Prevent Stiffness

Severe pain requires joint rest. Once the pain subsides, gentle exercises should resume to maintain mobility.

Negative Blood Tests Rule Out Rheumatoid Arthritis (RA)

About 20% of RA patients have negative blood tests. A rheumatologist can diagnose RA based on symptoms and physical exams alone.

A Positive ANA Test Always Indicates Lupus

Positive ANA tests are common, even in healthy individuals, and do not necessarily mean lupus. Symptoms and physical exams are more critical for diagnosis.

Methotrexate Causes Instant Liver Failure

Methotrexate can cause abnormal liver tests, but regular monitoring ensuring it remains safe. Elevated liver tests lead to adjusting or stopping the medication until levels normalise.

Hydroxychloroquine (Plaquenil) Causes Blindness

Hydroxychloroquine rarely affects the retina, with risks increasing after 10 years of use. Regular eye exams help prevent vision damage.

ESR and CRP Are Essential for Monitoring Arthritis

ESR and CRP are nonspecific inflammation markers and not always reliable for arthritis monitoring. Symptoms and physical exams are better tools for assessment.

There’s a “Best” Medication for Arthritis

Arthritis treatment is individualised, and the best medication is the one that works for you. Finding the right treatment can take time.

Exercise is Bad for Arthritis

Exercise is beneficial for arthritis, improving muscle strength and flexibility. Despite the pain, staying active helps manage symptoms and prevents worsening over time.

 

I hope this has debunked some myths and clarified what rheumatologists do. Rheumatology is deeply interconnected with immunology and mental health, with physical, mental, and emotional stress often triggering flare-ups.

Recognising these patterns can help better understand and manage their conditions.