Although rheumatic disorders are widespread throughout the world, public awareness of them remains low.

This field of medicine is mostly associated with joint pain, although a seemingly simple symptom – joint pain is associated with a wide range of diseases, ranging from true arthritis to autoimmune, systemic diseases. All of them require a different approach in terms of diagnosis and treatment.

On the one hand, joint pain can be blamed on a simple overload while on the other hand it indicates arthritis or systemic disease. Misinterpretation of symptoms, delayed diagnosis and treatment are even associated with irreversible functional limitations and in some cases even life-threatening complications.

We must educate the public that arthritis is a broad term that refers to joint inflammation that presents as pain, swelling, redness, localized temperature increase, and restriction of movement. There are many types of arthritis, including rheumatoid, gouty, psoriatic, and reactive.

Furthermore, arthralgia or joint pain in the absence of other symptoms of inflammation can occur in a variety of non-rheumatic disorders, including endocrine, viral, and oncological diseases.

In light of the foregoing, it is critical to have joint pain evaluated by a rheumatologist to ensure that no significant disease is hiding beneath this seemingly innocuous symptom. Even with an accurate diagnosis and prompt treatment, the patient can retain a high quality of life.

What is osteoarthritis?

Osteoarthritis is a debilitating, degenerative, wear and tear condition of the joints that occurs more frequently as people age.

Osteoarthritis is more frequently found in weight-bearing and highly stressed joints.

Typically, cartilage covers the articular surfaces of the bones, which shields them from friction and allows for painless movement. As cartilage ages, it is subjected to wear and tear, which increases friction and creates mechanical irritation, which results in inflammation. At this point, the patient may experience joint pain, restricted movement, and potentially even fullness (see Figure 1).

What can I do to feel better?

To alleviate the symptoms, follow these tips:

• Do not overload yourself – when you feel that the pain has increased during movement / activity, take a break for a few minutes;
• Maintain a healthy weight – Excess weight is a significant risk factor for osteoarthritis. When greater weight is placed to the joint, the wear process becomes more active, increasing the risk of mechanical irritation;
• Sustain physical activity – A toned muscular system benefits the joints, but inappropriate exercise can do more harm than good. Do not start exercising in the acute phase, and agree on the type of exercise with your rheumatologist;
• Choose comfortable shoes – soft sole, with adequate cushioning, and an inclination of up to 3-5 cm;
• Use auxiliary tools if needed – these can be canes, orthoses, Scandinavian sticks, etc. This will aid in weight distribution and balance, but their use and selection should be done in cooperation with your physician.
• Use warm or cold compresses – For some people, heat or cold might assist alleviate discomfort.

Can I take herbal remedies, dietary supplements, cartilage-nourishing medications, and vitamins?

There is no medication, including glucosamine and chondroitin, that will improve joint structure. Additionally, it is not advised to take any herbal remedy without consulting a doctor.

Are there any nutritional suggestions for joint health, and how much calcium and vitamin D are required?

There are no such things as “good” or “bad” foods. It is advised that you eat a balanced, healthy diet. Calcium supplementation may strengthen bones but may have little effect on joint structure or function. Vitamin D insufficiency, on the other hand, may result in general joint pain, although it has no direct effect on osteoarthritis or cartilage wear.

Are there any medications I can take?

Typically, medicines are used for osteoarthritis only during exacerbations. Nonsteroidal anti-inflammatory medicines, steroid injections into the articular cartilage, or physiotherapy may be employed. The method of treatment should be determined by the rheumatologist, taking into account the patient’s needs, health status, and potential side effects; however, a healthy lifestyle, which includes weight loss, exercise, and ankle correction with properly selected shoes, is more important than medication.

Is osteoarthritis surgically treatable?

When pharmacological therapy fails and the patient’s quality of life is significantly diminished due to persistent pain and limited movement, surgical treatment, preferably joint endoprosthesis, is advised. The most often performed procedure is endoprosthesis of the pelvis-thigh and knee joints.

The following figure contrasts joints that are normal and those that have osteoarthritis. Osteoarthritis results in the thinning of the cartilage, the narrowing of the articular fissure, and the formation of bone growths termed osteophytes.

What is rheumatoid arthritis?

Rheumatoid arthritis is one of the most often occurring chronic inflammatory joint conditions.

Typical symptoms include the following:

• Pain
• Inflammation
• Deformation
• Movement restriction

What causes rheumatoid arthritis?

Although the specific etiology of rheumatoid arthritis is unknown, we do know that it is autoimmune in nature, meaning that the patient’s own immune system attacks and damages the joints.

Additionally, it is recognized that a genetic predisposition and a variety of environmental factors contribute to the manifestation of the disease. Take cigarette consumption as an example.

How can I determine whether or not I have rheumatoid arthritis or another type of arthritis?

Without conducting specific examinations, this is impossible to say. Only a rheumatologist is qualified to make an accurate diagnosis of rheumatoid arthritis.

Rheumatoid arthritis is most commonly diagnosed when the tiny joints of the wrists and ankles are involved. Typically, it is symmetrical arthritis, or damage to both sides. It is less prevalent in other kinds of rheumatoid arthritis.

What occurs when rheumatoid arthritis progresses?

While it is true that rheumatoid arthritis typically begins with damage to the tiny joints, it can affect any joint. Even in circumstances where the damage is irrevocable. Additionally, rheumatoid arthritis affects other organs such as the eye, lungs, and heart occasionally. Regrettably, it is hard to determine who would develop such a complication in advance.

Is timely treatment essential?

Do not squander time if you have been diagnosed with rheumatoid arthritis. Begin therapy immediately, as early intervention saves you from further complications such as deformities and functional limitations.

How is rheumatoid arthritis treated?

There are numerous treatments available for rheumatoid arthritis, however the most appropriate one for you should be determined by your rheumatologist based on the following factors:

• How severe the disease is
• How many joints are affected / damaged
• What is the development of the disease
• Have you ever had any side effects on your medication?
• What are the changes on hand and ankle radiographs
• Analysis/Test results

Usually, treatment options look like this:

• Disease-modifying antirheumatic drugs – methotrexate, leflunomide, sulfasalazine, hydroxychloroquine
• Steroidal anti-inflammatory drugs – methylprednisolone, deflazacort
• Biological disease-modifying antirheumatic drugs

Is there anything I can do to make myself feel better?

Yes. Take an active role. You may avoid physical activity due to pain, which is incorrect because the muscles weaken and the joints become more susceptible to harm. Exercise can aid in the maintenance of joint function. A physical therapist can assist you in selecting the most appropriate workouts for you.

Furthermore, eat a balanced diet. Patients with rheumatoid arthritis are more likely to develop cardiovascular disease; therefore, they should avoid fatty foods. Fruits and vegetables should be served.

What should I do if I’m thinking about becoming pregnant?

Do not be alarmed; there are drugs that are safe to take throughout pregnancy, and in many cases, rheumatoid arthritis goes into remission during pregnancy, becoming asymptomatic or characterized by modest symptoms and worsening only after deliveries. It is possible to create safe settings for the fetus during pregnancy and to avoid or effectively manage postpartum aggravation with the help of appropriate therapy; however, if you are considering a pregnancy, see your rheumatologist. Certain drugs are dangerous to the fetus even if they are stopped immediately upon becoming pregnant. As a result, each pregnancy should be planned in consultation with a rheumatologist.

What exactly is gout?

Gout is a type of arthritis that primarily manifests as pain and swelling in a single joint, typically, the first toe. Gout is more prevalent in men and rarely in postmenopausal women.

Gouty arthritis is a condition that occurs when a person’s blood contains an abnormally high level of uric acid. Uric acid is a substance that is produced when certain nutrients are broken down. Uric acid solidifies into needle-shaped crystals that build up in joints and cause pain. Additionally, uric acid crystals can form stones in the kidneys, causing pain and a delay in urinary excretion.

What are the symptoms of a gout attack?

Gout attacks are generally characterized by intense pain, swelling, and redness in the first toe, ankle, or knee joint. Typically, the attack is limited to a single joint and begins at night. The pain may be excruciating. The symptoms progressively improve over several days or weeks, however the mechanism by which the body “shuts down” the attack is unknown.

Is there a method to diagnose gout?

Yes. It is feasible to extract synovial fluid and do microscopy on the sore joint. The appearance of needle-shaped crystals confirms the diagnosis of gout.

The diagnosis can be made taking into account the following factors:

• single joint pain and swelling, particularly if it is the first toe of the ankle
• After a period of time, the symptoms disappear altogether and the interval between exacerbations is asymptomatic.
• A blood test reveals an elevated uric acid level (it is important to remember that blood testing should not be performed during flare up. The optimal time to undergo the testing is to be chosen with the consultation of your rheumatologist)

How is gout treated?

Gout is a condition that is treated in a variety of ways. There are numerous classes of drugs that can be used to treat inflammation (pain, swelling). Your rheumatologist should determine the best option for you in the appropriate dose, taking into account your comorbidities and adverse effects.

Gout flares are treated with:

• Colchicine
• Nonsteroidal anti-inflammatory drugs such as ibuprofen, naproxen, etc.
• Steroidal anti-inflammatory drugs such as metiprednisolone.

Is there a way to prevent gout attacks?

Yes, there is. The majority of patients with frequent attackes require not only flare up  treatment but also uric acid-lowering therapy.

In Georgia, the following uric acid-lowering medications are available: allopurinol and febuxostat.

Because uric acid-lowering therapy may initially increase the risk of frequent attacks at the beginning, it may be used together with anti-inflammatory medications such as colchicine to lessen the chance of frequent exacerbations until the target concentration of uric acid is reached. Continuous monitoring of blood acid levels is critical.

Can I self-prevent gout?

Yes. For instance, obesity is a risk factor for developing gout. Therefore, if you are overweight, decreasing weight can help minimize your risk of developing gout.

Additionally, eliminating certain foods from the diet significantly reduces the likelihood of acquiring gout.

It is critical to avoid sugary fizzy drinks and to drink enough water throughout the day, as dehydration also plays a role in the development of gout.

The majority of people with gout also have comorbidities such as diabetes, hypertension, or obesity. Their management also serves to avoid gout episodes indirectly.

What is osteoporosis?

Osteoporosis is a condition that results in a loss of bone density, that makes them weak.  Fractures are common in people with this disease. Even during a simple home accident.

For example, a femoral fracture can be serious. Such injury may impair an individual’s capacity to move independently in the future. Many such patients require life-long care. Therefore, it is critical to avoid fractures. 

How do I know whether I have osteoporosis?

Osteoporosis is painless unless it results in a fracture. The most accurate method of diagnosis is the osteodensitometry DXA test, a type of radiography.

Experts recommend that women over the age of 65 get bone examinations, as this age group has the highest risk of disease. Patients of other ages, however, may potentially benefit from the study. Consult your treating physician on this matter.

Some patients become aware of osteoporosis following the development of a fracture following a minor trauma. A fracture induced by fragility is referred to as a pathological fracture, as healthy people in identical settings should not suffer fractures. A single fracture signifies an increased chance of getting more fractures.

What should I do to maintain healthy bones?

• Consume Foods High in Calcium – Milk, Yogurt, and Green Vegetables (Refer to Table 1);
• Consume vitamin D-rich foods such as fortified milk and ocean fish;
• If you are unable to complement your normal diet with calcium and vitamin D, take calcium and vitamin D supplements;
• Maintain an active lifestyle, exercise at least  30 minutes a day;
• Abstain from smoking;
• Limit your alcohol consumption to two glasses per day.

Try as much as possible not to fall!

Sounds simple, but very important, because avoiding falls can prevent many fractures, for this:

• Ascertain that your rugs, carpets, and shoes do not slip and are securely attached to the floor;
• Remove/hide all wires, cords, and cables;
• Avoid moving in the dark, even if you are at home;
• Avoid slipping on wet surfaces;
• Put on soft-soled comfortable shoes with rubber heels;
• Resolve any vision impairments that may exist;
• Consult with your doctor about all permissible medications and their potential for causing dizziness and/or drowsiness, which raise the risk of falling.

Is osteoporosis treatable?

Yes, anti-osteoporosis medications are available. These drugs help prevent fractures.

While bisphosphonates are frequently prescribed first, if they cannot be provided due to adverse effects and/or contraindications, or if they are insufficient for the patient, additional treatments are available.

How do I determine if the treatment is effective?

Due to the asymptomatic nature of osteoporosis, the only approach to determine the success of treatment is to repeat osteodensitometry. Additional blood and urine tests may be required on occasion.

Table 1