Rheumatology

Paras Institute of Rheumatology is a one of its kind setup dedicated to the diagnosis and treatment of rheumatoid and autoimmune disorders, which include arthritis and connective tissue disorders. A specialist team at the institute works in conjunction with other departments like Internal Medicine, Orthopedics and Neurology to provide comprehensive treatment to patients that facilitate their recovery from these debilitating diseases. Low awareness about rheumatoid diseases inhibits people from seeking medical help, and Paras Institute of Rheumatology is dedicated to educating the public to respond to early signs and symptoms. The Institute also has a well developed clinical protocol for the  diagnosis and the treatment of Lupus :

  • Rheumatoid Arthritis
  • Reactive Arthritis
  • Systemic Lupus Erythematosus (SLE)
  • Auto Immune Disorders
  • Paras Institute of Rheumatology at Paras Hospitals, Gurgaon is one of the few centers in the country that specialize in the treatment of Rheumatic and autoimmune disorders.
  • Paras Institute of Rheumatology at Paras Hospitals, Gurgaon is one of the few centers in the country that have a well formulated treatment and management plan for Lupus, Arthritis and Gout.
  • Paras Institute of Rheumatology has taken up many social initiatives to promote and create awareness in the public about various Rheumatic and autoimmune disorders.

Inflammatory Arthritis: In this disease inflammation occurs in and around the joints, thereby damaging the tissues, causing pain, stiffness and swelling. Inflammatory type of arthritis affects several joints. The different manifestations of this type of arthritis are:

  • Rheumatoid Arthritis
  • Psoriatic Arthritis
  • Ankylosing Spondylitis
  • Osteo arthritis

Connective Tissue Disease: This disease includes tendons, ligaments and cartilage that supports, binds and separates the body tissues and organs. Inflammation in these tissues can make one feel a range of other symptoms. The different manifestations of this type of CTD are:

  • Systemic Lupus Erythematosus (SLE)
  • Scleroderma
  • Dermatomyositis & Polymyositis

Vasculitis: This is a condition that involves inflammation in the blood vessels. The condition occurs if your immune system attacks your blood vessels by mistake. The result is that this causes thickening, weakening, narrowing and scarring of the blood vessels. This may happen as the result of an infection, a medicine, or another disease or condition. The different manifestations of vasculitis are:

  • Polymyalgia Rheumatica
  • Giant Cell Arterisis
  • Wegeners Garnulomatosis
  • Churg – Strauss

Metabolic Bone Disorders: This refers to an umbrella term that is used to describe allthe abnormalities in the bones. It could be due to hormonal imbalance or due to the deficiency of an essential minerals, such as – phosphorus, magnesium or vitamin D leading to dramatic clinical disorders that are commonly reversible once the underlying defect has been treated. The teams of experts carefully understand the underlying issues to distinguish the same from any genetic or hereditary disorders. The different manifestations of Metabolic Bone Disorders are:

  • Osteoporosis
  • Paget’s Disease
  • Gout and Psuedogout

Soft Tissue Conditions: Soft tissue disorders are medical conditions affecting the soft tissues.

Often soft tissue injuries are some of the most chronically painful and difficult to treat because it is very difficult to see what is going on under the skin with the soft connective tissues, fascia, joints, muscles and tendons. The different manifestations of soft tissue conditions are:

  • Tennis Elbow
  • Carpel Tunnel & Tarsal Tunnel Syndrome
  • Fibromyalgiar

Paras Institute of Rheumatology has a well defined management and treatment protocol for Systemic Lupus Erythematosus (SLE). The institute is well supported by a team of pathologists, radiologists, physiotherapists and other multi disciplinary team that help in providing the precise diagnosis and treatment for this autoimmune disorder. It should also be noted that SLE is more likely to affect women than men- Age groups – 15-24 yrs. The ratio of susceptibility between men and women is 11:1.

What is Lupus?

Lupus is a chronic disease that can affect the joints, skin, kidneys, lungs, heart, brain, and other organs and tissues. Lupus happens when something goes wrong with the immune system of the body. Normally, antibodies in the immune system defend the body from attack by germs and viruses, and keep a person healthy. In lupus, the antibodies of the immune system become too active and go out of control. Instead of protecting the body, the antibodies attack healthy parts of the body, such as the kidneys, heart, and skin. This attack can cause problems such as kidney failure, heart attack, and stroke, and symptoms such as joint pain, skin rash, and fever.

What causes Lupus?

Lupus is a mystery. No one knows why some people get it, and others don’t. The disease can start for no obvious reason, or in reaction to something in a person’s life. The following are few set of examples that are noted to increase the effect of Lupus:

  • Exposure to ultraviolet light, usually from sunlight, is known to trigger the disease and symptom flares.
  • Hormonal factors are linked to the autoimmune disease, though the link is poorly understood. There is some evidence that there is increased risk of lupus with higher levels of estrogen (taken for fertility treatments, birth control & hormonal replacement therapy). There is also some data to suggest that post menopausal women have a milder version of lupus.
  • Some infections are suspected triggers.
  • Some chemical and drug exposure also triggers lupus symptoms.

Who is most likely to get Lupus?

Females are at greater risk. At present the data shows that the susceptibility of women and men to lupus is in a 11:1 ratio. Lupus may occur in males or females and can happen at any age, but it is young women between the ages of 15 and 44 who are most likely to first develop symptoms of the disease.

What are the signs & symptoms of Lupus?

symptoms-of-LupusMost people with lupus have symptoms in only a few organs. If you have already been diagnosed, these signs and symptoms may indicate increased activity of the disease, known as a “flare.” You may also have periods of “remission” in which few or no symptoms are present.

  • Achy joints (arthralgias)
  • Fever over 100 degrees F – for no apparent reason
  • Swollen or painful joints
  • Prolonged fatigue
  • Skin Rashes
  • Anemia
  • Swollen ankles (kidney involvement)
  • Chest pain upon deep breathing
  • Butterfly shaped rash across the cheeks and nose
  • Sensitivity to sun (photosensitivity)
  • Unusual hair loss
  • Problems with abnormal blood clotting
  • Pale or purple fingers from cold or stress
  • Seizures, depressions and headache
  • Mouth ulcers (often painless, at the root of the mouth)

Are there different types of Lupus?

There are three types of lupus:

Systemic Lupus Erythematosus (S.L.E.) is the most serious form of lupus and is the focus of this brochure. “Systemic” means that the disease is affecting the whole body.

Discoid or “Cutaneous” Lupus Erythematosus affects the skin. It may cause a red or raised rash or other skin changes on the face, scalp, or other parts of body. Usually this kind of lupus does not lead to systemic lupus (S.L.E.).

Drug-Induced Lupus is caused by certain medicines. When the medicine that is causing the reaction is stopped, the lupus goes away.

What tests are done to diagnose & access Lupus?

The basic tests done are – complete blood count, ESR, creatinine, urine routine and chest x-ray. Anti- nuclear antibody test (ANA0, complement tests are few of the specialized tests that are required to assess the presence of Lupus.  The specialist can also request special testing based on the patient situation.

How is Lupus treated?

Till date there is no definite cure for Lupus, however just like hypertension and diabetes. Lupus can be controlled by regular monitoring, medication & diet.  The treatment depends on the severity and the organ system involvement. Hence combined consultation and treatment plans headed by rheumatologist and supported by cardiologists, gastroenterologists, nephrologists are required.

Does Lupus Run in Families?

Most relatives of people with lupus do not develop the disease.

Is Lupus Contagious?

No. A person cannot catch lupus from another person. Lupus is not a form of cancer or HIV/AIDS.

Paras Institute of Rheumatology has a well defined management and treatment protocol for Rheumatoid Arthritis. The institute is well supported by a team of pathologists, radiologists, physiotherapists and other multi disciplinary team that help in providing the precise diagnosis and treatment for this autoimmune disorder. Nearly seven million people in India suffer from a form of arthritis the rheumatoid arthritis – that initially affects the small joints. Females are more affected than males. The ratio is 3:1. And one very important observation has been that the number of females affected prior to menarche and after menopause are less and almost the same as males.

What is Rheumatoid Arthritis?

Rheumatoid arthritis is a disease that affects the joints. It causes pain, swelling, and stiffness. If one knee or hand has rheumatoid arthritis, usually the other does too. This disease often occurs in more than one joint and can affect any joint in the body. People with this disease may feel sick and tired, and they sometimes get fevers.

Some people have this disease for only a few months or a year or two. Then it goes away without causing damage. Other people have times when the symptoms get worse (flares), and times when they get better (remissions). Others have a severe form of the disease that can last for many years or a lifetime. This form of the disease can cause serious joint damage.

Who can get Rheumatoid Arthritis?

Anyone can get this disease, though it occurs more often in women. Rheumatoid arthritis often starts in middle age and is most common in older people. But children and young adults can also get it.

What are the causes of Rheumatoid Arthritis?

Doctors don’t know the exact cause of rheumatoid arthritis. They know that with this arthritis, a person’s immune system attacks his or her own body tissues.

Researchers are learning many things about why and how this happens. Things that may cause rheumatoid arthritis are:

  • Genes (passed from parent to child).
  • Hormones

What are the signs and symptoms of Rheumatoid Arthritis?

RA usually starts over a period of weeks to months, with more joints affected over time. You should see your doctor if you experience any of the following symptoms for more than two weeks:

  • You start to feel unusual pain and stiffness in your joints.
  • Swelling of the wrists, knuckles or small joints of the fingers or toes, including the ball of the foot.
  • Pain and stiffness in the morning, typically lasting more than 30-60 minutes before you “loosen up” and start feeling better.
  • Unexplained tiredness.
  • Weight Loss
  • Unexplained fever
  • Loss of appetite
  • Dry eyes and mouth from a related health problem, Sjogren’s syndrome
  • Firm lumps, called rheumatoid nodules, which grow beneath the skin in places such as the elbow and hands

How is rheumatoid arthritis diagnosed?

People can go to a family doctor or rheumatologist to be diagnosed. A rheumatologist is a doctor who helps people with problems in the joints, bones,  and muscles. Rheumatoid arthritis can be hard to diagnose because:

  • There is no single test for the disease.
  • The symptoms can be the same as other kinds of joint disease.
  • The full symptoms can take time to develop.

To diagnose rheumatoid arthritis, doctors use medical history, physical exam,  x rays, and lab tests.

Why is early diagnosis and treatment of Rheumatoid Arthritis essential?

RA causes inflammation (swelling, pain and warmth) in the affected joints. You can think of this inflammation like a “fire” burning in the joints. If the fire of inflammation is left “burning,” it can permanently damage the joint. To emphasize, RA can cause permanent joint damage quickly when it is not treated and controlled. This damage can occur even when the pain is not severe.

Once damage occurs, it is not reversible and can cause significant pain and disability. Fortunately, we know that much research has confirmed that treating RA early and aggressively often improves the long-term outcome and significantly reduces damage.

How can I manage Rheumatoid Arthritis?

Once your diagnosis is confirmed, there are many treatments that can help decrease your pain and increase your movement.

Physical activity: Physical activity protects joints by strengthening the muscles around them. Strong muscles and tissues support those joints that have been weakened and damaged by arthritis. A properly designed program by the physiotherapists helps in reducing pain and fatigue, improving mobility and overall fitness.

Heat & Cold: Heat: Taking a warm shower and using warm packs are great ways to help reduce pain and stiffness. Always use a protective barrier, such as a towel, between the warm pack and the skin. Heat is ideal for:

  • Relieving pain.
  • Relieving muscle spasms and tightness.
  • Enhancing range of motion.

To avoid making symptoms worse, heat should not be applied to an already inflamed joint.

Cold: Using a commercial cold pack or a homemade one (from crushed ice, ice cubes or a bag of frozen vegetables) can be helpful. Always use a protective barrier, such as a towel, between the cold pack and the skin. Cold is ideal for:

  • Decreasing swelling.
  • Decreasing pain.
  • Constricting blood flow to an inflamed joint

Relaxation & Coping Skills: Developing good relaxation and coping skills can help you maintain balance in your life, giving you a greater feeling of control over your arthritis and a more positive outlook. Relaxing the muscles around a sore joint reduces pain.

Healthy Eating:  The most important link between your diet and arthritis is your weight. Being overweight puts an extra burden on your weight-bearing joints (back, hips, knees, ankles and feet). Maintaining an appropriate weight will help you more than any food supplements. If you are overweight and have arthritis, consider a balanced diet as a way to help you achieve and maintain a healthy weight.

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