What is ankylosing spondylitis? Ankylosing spondylitis is a form of arthritis that causes spine inflammation (spondylitis). Over time, the bones in the spine may fuse and become rigid. The sacroiliac joints located between the base of the spine and pelvis also undergoes inflammation (sacroiliitis). It is an autoimmune disease, wherein the body’s own immune system attacks the joints. Who are at risk for ankylosing spondylitis? Men more than women between 17-45 years old. Individuals with a family history of ankylosing spondylitis or other autoimmune diseases. Individuals who have a variation of the human leukocyte antigen-B gene (HLA-B). What are the symptoms of ankylosing spondylitis? Lower back pain and stiffness Hip pain Neck pain (other joints may also be swollen or painful) Fatigue Weight loss Skin rash Vision problems How is ankylosing spondylitis diagnosed? The rheumatologist will review your symptoms, and family history, as well as do a thorough physical exam. Blood tests such as HLA-B27 and imaging scans such as magnetic resonance imaging (MRI) of the sacroiliac joints or x-ray of the spine may help in the diagnosis. What are the complications of ankylosing spondylitis? Fused vertebrae (ankylosis or bamboo spine) Osteoporosis Spinal fracture Painful eye inflammation (iritis or uveitis) Heart disease Chest pain which may affect breathing How is ankylosing spondylitis managed? Your rheumatologist will provide any or a combination of these treatment options to ease pain, reduce joint damage and prevent long-term complications: Nonsteroidal anti-inflammatory drugs (NSAIDs) Disease-modifying anti-rheumatic drugs Biologics Physical therapy Surgery If you're experiencing signs and symptoms of ankylosing spondylitis, seek consultation with a rheumatologist near you. Click here to find a rheumatologist.

Gout affects 1.6 million Filipinos. (Philippine Rheumatology Association) What is gout? Gout is a form of arthritis brought about by increased uric acid levels. Uric acid crystals deposit on joints leading to inflammation and pain. Who can have gout? Males and post-menopausal females, especially with a strong family history may develop gout. Additional risk factors include metabolic syndrome (obesity, hypertension, high cholesterol, diabetes mellitus) and chronic kidney disease. What are the symptoms of gout? Patients with gout experience on and off joint pain and swelling, particularly on the big toe, foot, ankle or knee, which lasts for less than 2 weeks. This is usually accompanied by fever and warmth or redness of the joint. Other joints may be involved in the later stages. The joint is so painful that it leads to difficulty in ambulation. Even the slightest touch of the affected joint elicits pain. If left untreated, uric acid crystals continue to deposit in the joints leading to the development of tophi or stone-like deposits, which are damaging to the joints. Uric acid crystals may also deposit in the kidneys leading to development of nephrolithiasis or kidney stones, which can also damage the kidneys. What are the medications for gout? Your rheumatologist may prescribe non-steroidal anti-inflammatory drugs (NSAIDs}, colchicine and analgesics during a gout attack. Some cases of gout would require aspiration of excess synovial fluid from the joints. You may be maintained on febuxostat or allopurinol – medications that lower uric acid levels, to prevent further gout attacks. What are the diet choices in gout? Avoid foods that may further increase uric acid levels and trigger a gout attack. These include alcoholic beverages (beer/hard liquor), high-fructose containing drinks (soda, sweetened juice drinks), organ meats and shellfish. Do eat lots of vegetables and dairy products. A healthy lifestyle such as weight loss, exercise, and smoking cessation would also improve outcomes in gout. What should I do during a gout attack? Apply cold compress on the affected joint, hydrate, and take a rest. Seek consultation with a rheumatologist who will provide you with the best treatment plan in controlling gouty arthritis and its complications. If you're experiencing signs and symptoms of gout, seek consultation with a rheumatologist near you. Click here to find a rheumatologist.

What is Lupus? Lupus is a chronic (long-term) disease that causes inflammation — pain and swelling. It can affect the skin, joints, kidneys, lungs, nervous system and other organs of the body. Most patients feel fatigue and have rashes, arthritis, and fever. Lupus flares vary from mild to serious. Most patients have times when the disease is active, followed by times when the disease is mostly quiet — referred to as a remission. What causes Lupus? The immune system is the body’s defense system. When healthy, it protects the body by making antibodies (blood proteins) that attack foreign germs and cancers. With lupus, the immune system misfires. Instead of producing protective antibodies, an autoimmune disease begins and makes “autoantibodies,” which attack the patient’s own tissues. These antibodies then end up in cells in organs, where they cause inflammation and if left untreated, lead to damage to organ tissues. This inflammatory response most likely results from genetic tendencies and environmental factors, such as sunlight, infection or certain medications. The American College of Rheumatology has a list of symptoms and other measures that doctors can use as a guide to decide if a patient with symptoms has lupus. If your doctor finds that you have at least four of these problems, and finds no other reason for them, you may have lupus: Rashes: butterfly-shaped rash over the cheeks — referred to as malar rash rash on skin exposed to the sun Mouth sores: sores in the mouth or nose lasting from a few days to more than a month Arthritis: tenderness and swelling lasting for a few weeks in two or more joints Lung or heart inflammation: swelling of the tissue lining the lungs (referred to as pleurisy or pleuritis) or the heart (pericarditis) Kidney problem: blood or protein in the urine, or tests that suggest poor kidney function Neurologic problem: seizures, strokes or psychosis Abnormal blood tests: low blood cell counts: anemia, low white blood cells or low platelets positive antinuclear antibody: referred to as ANA and present in nearly all patients with lupus certain antibodies that show an immune system problem: anti-double-strand DNA (called anti-dsDNA), anti-Smith (referred to as anti-Sm) or antiphospholipid antibodies How is Lupus treated? There is no cure for lupus, and treatment can be a challenge. However, treatment has improved throughout the years. Treatment depends on the type of symptoms you have and how serious they are. Medications for lupus include any or a combination of the following: systemic steroids, anti-malarials, immunosuppressants, and biologics. Discuss with your rheumatologist regarding the best treatment options for you. Living with Lupus The best way to control lupus is to follow these tips: Form a support system. A good doctor-patient relationship and support from family and friends can help you cope with this chronic and often unpredictable illness. Get involved in your care. Take all medications as your doctor prescribed, and visit your doctor often. Learn as much as you can about lupus and your medications, and what kind of progress to expect. Stay active. Exercise helps keep joints flexible and may prevent heart disease and strokes. This does not mean overdoing it. Switch off doing light to moderate exercise with times of rest. Avoid excess sun exposure. Sunlight can cause a lupus rash to flare and may even trigger a serious flare of the disease itself. When outdoors on a sunny day, wear protective clothing (long sleeves, a big-brimmed hat) and use lots of sunscreen. Most people with lupus can live normal lives.To prevent serious problems, you should see your rheumatologist often.This lets your doctor keep track of your disease and change your treatment as needed. If you're experiencing signs and symptoms of lupus, seek consultation with a rheumatologist near you. Click here to find a rheumatologist.

What is osteoarthritis? Osteoarthritis is a degenerative type of arthritis or often called wear and tear of certain components of the joints. Destructive changes in cartilage and bones develop slowly and may progress over time, leading to reduced function and disability. The hands, hips and knees are most commonly affected by osteoarthritis. What are the signs and symptoms of osteoarthritis? Pain on the affected joint on activity and relieved by rest Stiffness of the joint Swelling or bony enlargement of the joint Crepitations or cracking sound upon flexion of the joint Decreased range of motion Who are at risk to develop osteoarthritis? Individuals with a family history of osteoarthritis Elderly population Women more than men Individuals with history of overuse or repeated trauma to the joints Obese individuals (extra weight contributes more stress to the joints) How is osteoarthritis diagnosed? A rheumatologist examines your joints, asks about your symptoms, and may request imaging such as radiographs and other laboratory tests. How is osteoarthritis managed? There is no cure for osteoarthritis. It is irreversible. Your rheumatologist will discuss with you these available pharmacologic and non-pharmacologic management that would alleviate your joint pain and improve your quality of life: Pain relievers Physical therapy which includes muscle strengthening exercises Supportive devices such as canes or walkers Weight loss program Surgery (if other treatment options have failed; with prior counselling and assessment) If you're experiencing signs and symptoms of osteoarthritis, seek consultation with a rheumatologist near you. Click here to find a rheumatologist.

Osteoporosis causes weak bones. What is osteoporosis? Osteoporosis is defined by low bone density which reduces bone strength and increases fracture risk. It usually has no symptoms. However, there may be loss of height, stooped posture, known as Dowager’s hump, if there is a fracture in the spine. Pain may be experienced in the presence of a fracture. If your bones are osteoporotic, there in an increased risk for fractures, especially in the forearm, spine and hip. What factors increase the risk for osteoporosis? Lifestyle factors: low calcium intake, Vitamin D insufficiency, consumption of 3 or more alcoholic drinks per day, high caffeine intake, smoking, inadequate physical activity or immobilization, low body weight, and increased episodes of falling. Rheumatic and autoimmune diseases: ankylosing spondylitis, rheumatoid arthritis, systemic lupus erythematosus Medications: steroids, proton pump inhibitors, chemotherapeutic drugs, anti-epileptic drugs How is osteoporosis diagnosed? X-ray of the bones cannot detect early osteoporosis, but may show the presence of fractures. The gold standard or the most accurate test for the diagnosis of osteoporosis is Bone Mineral Densitometry. A T-score between -1.0 and -2.5 among post-menopausal women and men 70 years old and above, indicates the presence of osteoporosis. What medications are given for osteoporosis? Medications for osteoporosis help prevent the occurrence of future fractures. Your rheumatologist will discuss with you the appropriate treatment options which consists of any or a combination of the following: Calcium Vitamin D Hormonal therapy Bisphosphonates Bone-forming agents What are the sources of calcium and vitamin D that can strengthen the bone? Green leafy vegetables Dairy products Eggs Fish Mushroom Sunlight exposure anytime from 10 AM – 2 PM will provide Vitamin D! What exercises are good for osteoporosis? Weight bearing exercises Flexibility exercises Resistance exercises Discuss with your rheumatologist for the appropriate exercises for you. If you think you have osteoporosis, seek consultation with a rheumatologist near you. Click here to find a rheumatologist.

What is psoriatic arthritis? Psoriatic arthritis is a type of arthritis which causes joint swelling and damage if left untreated. It occurs in some patients with psoriasis, which is a skin disease in which scaly red and white patches develop on the skin. Both psoriatic arthritis and psoriasis are autoimmune diseases, wherein the body is attacked by its own immune system. Any joints may be involved in psoriatic arthritis and sometimes it manifests even before the appearance of psoriasis. What are the symptoms of psoriatic arthritis? Swollen fingers and toes (so-called sausage digits) Foot and ankle pain and swelling Low back pain Nail pits Raised, red, scaly patches on the scalp and skin What are the risk factors for psoriatic arthritis? Occurrence of psoriasis Family history of psoriasis or psoriatic arthritis How is psoriatic arthritis diagnosed? The rheumatologist will review your symptoms and family history as well as perform a thorough physical examination of your skin and joints. Imaging tests such as x-rays or MRI of the affected joints may aid in the diagnosis. There is no specific test that can confirm the diagnosis of psoriatic arthritis, but the rheumatologist will gather all clinical evidence to support the diagnosis. What is the management of psoriatic arthritis? Psoriatic arthritis is a chronic (lifelong) disease which requires regular follow-up with your rheumatologist to monitor disease activity and prevent complications and joint damage. Any or a combination of the following medications may be prescribed: NSAIDs Disease-modifying antirheumatic drugs (DMARDs) Biologic Agents What lifestyle modifications can help me in my psoriatic arthritis? Maintaining a healthy weight Regular exercise Smoking cessation Limiting alcohol use If you're experiencing signs and symptoms of psoriatic arthritis, seek consultation with a rheumatologist near you. Click here to find a rheumatologist.

What is rheumatoid arthritis? Rheumatoid arthritis is an autoimmune disease affecting predominantly the joints, which, if left untreated, leads to joint deformities and damage. When you have an autoimmune disease such as rheumatoid arthritis, your immune system attacks your own cells in the body, such as the joints, causing inflammation and pain. The most commonly involved joints in rheumatoid arthritis are the small joints of the hands and feet, wrist, shoulders, elbows, knees, and ankles. Any joint in the body may be affected. What are the symptoms of rheumatoid arthritis? Joint pain in more than one joint Joint stiffness Tenderness and swelling of the joint Fatigue Fever Weight loss Who are at risk to develop rheumatoid arthritis? Women more than men Individuals who have a family history of autoimmune disease Smokers Individuals who had a previous viral infection Note that there are some patients with rheumatoid arthritis who do not possess any of these risk factors. Hence, most risk factors for rheumatoid arthritis remain unknown. How is rheumatoid arthritis diagnosed? Your rheumatologist will review your symptoms and do a thorough physical examination. Laboratory tests such as rheumatoid factor, ESR and CRP and imaging such as radiographs or musculoskeletal ultrasound may be requested for the diagnosis of rheumatoid arthritis. It is best to diagnose rheumatoid arthritis early in its course, before joint damage sets in, so that treatment to stop or slow disease progression may be initiated. What is the treatment for rheumatoid arthritis? Discuss with your rheumatologist the appropriate medications that would alleviate joint pain, improve joint function, and more importantly, prevent joint damage. Treatment usually consists of disease-modifying antirheumatic drugs (DMARDs) and biologics How do I manage my rheumatoid arthritis? Engage in appropriate physical activity that would strengthen the joints Stop smoking Maintain a healthy weight Regular follow-up with your rheumatologist to monitor disease activity and response to treatment If you're experiencing signs and symptoms of rheumatoid arthritis, seek consultation with a rheumatologist near you. Click here to find a rheumatologist.

What is systemic sclerosis? Systemic sclerosis or scleroderma is a chronic autoimmune connective tissue disease/rheumatic disease characterised by excessive production and accumulation of collagen, called fibrosis, in the skin and internal organs and blood vessel injuries or vasculopathy. The exact cause of systemic sclerosis is not known and it occurs 4x more in women than in men and most common among people ages 20-50. Systemic sclerosis can be categorized as: Limited systemic sclerosis: affects just the skin or mainly only certain parts of the skin. Sometimes called the CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) Diffuse systemic sclerosis: often causes skin damage that is widespread or generalized and affects internal organs more. This type of scleroderma progresses rapidly Systemic sclerosis without scleroderma (systemic sclerosis sine scleroderma) What are the symptoms of systemic sclerosis? Thickening and tightening of the skin/swelling of digits and skin Raynaud's phenomenon (fingers suddenly become numb and pale and sometimes become cyanotic in response to stress or cold) Difficulty of breathing Joint pains or arthritis Difficulty swallowing or reflux symptoms What are the risk factors for systemic sclerosis? Genetics/Family History of Scleroderma Environmental exposure (bleomycin, silica, vinyl chloride) How is systemic sclerosis diagnosed? The rheumatologist will review your symptoms and family history as well as perform a thorough physical examination of your skin and joints. Nail fold capillaroscopy could also help in diagnosing scleroderma Antibody testing is also helpful in diagnosing systemic sclerosis. Antinuclear antibodies (ANA) are present in >/= 90% of patients, often with anti-nucleolar pattern. Other systemic sclerosis-related autoantibodies include anticentromere, ant-Scl-70, and anti-RNA polymerase III. Other ancillary tests that is helpful in diagnosing scleroderma inlcude pulmonary function testing, 2D echocardiogram, high resolution Chest CT scan, and endoscopy. There is no specific test that can confirm the diagnosis of systemic sclerosis, but the rheumatologist will gather all clinical evidence to support the diagnosis. What is the management of systemic sclerosis? Systemic sclerosis is a chronic (lifelong) disease which requires regular follow-up with your rheumatologist to monitor disease activity and prevent complications. Treatment is directed at symptoms and dysfunctional organs but no drug significantly influences the natural course of systemic sclerosis. Any or a combination of the following medications may be prescribed: Immunosuppressants including methotrexate, azathioprine, mycophenolate mofetil, and/or cyclophosphamide Calcium-channel blockers especially for Raynaud's phenomenon Proton-pump inhibitors for reflux symptoms ACE-inhibitors for scleroderma renal crisis Phosphodiesterase inhibitors/Endothelin receptor antagonists/prostacyclin analogues What lifestyle modifications can help me in my systemic sclerosis? Regular exercise Smoking cessation No lifestyle modification can change the course of systemic sclerosis but it can relieve symptoms and complications Wearing gloves/avoiding cold If you're experiencing signs and symptoms of systemic sclerosis, seek consultation with a rheumatologist near you. Click here to find a rheumatologist.