Diffuse connective tissue diseases: Rheumatoid arthritis, Juvenile inflammatory arthritis, Systemic lupus erythematosus, Scleroderma, Polymyositis, Sjogren's syndrome, Vasculitis, Overlap.

Nonarticular and regional musculoskeletal disorders - Fibromyalgia, Low back pain, disc disorders, Tendinitis, Bursitis, etc

Diagnosis of rheumatological disorders is clinical. It depends on pattern of joint involvement and associated clinical features. Xray and other imaging techniques are used to assess the extent of joint damage. Laboratory tests are carried out to further establish the diagnosis, find out involvement of other systems of body and to monitor drug toxicities.

Osteoarthritis OF Knees	Secondary Osteoarthritis (Deformed Legs)

This commonest form of arthritis is due to degeneration of cartilage. It commonly affects weight bearing joints such as knee. Cartilage, which covers bone like a tyre on wheel , gets worn out. The surface becomes rough and finally bone gets exposed with reactionary growth of osteophytes. Knee gets deformed and may swell due to accumulation of fluid inside the joint.

Hands in Rheumatoid Arthritis	Leg in Rheumatoid Arthritis

Rheumatoid Arthritis is an autoimmune disease in which immune mechanisms affect healthy parts of our own body, particularly joints. Pain and swelling of multiple joints simultaneously is peculiar of this arthritis. Prolonged morning stiffness is a typical feature. Small joints of hand and commonly involved symmetrically and progress to deformities if treatment is delayed.

This arthritis usually affects females of younger age and other organs such as lungs, heart, eyes and blood vessels can be damaged in the later stages of this disease.

MRI of Sacroiliitis	Psoriatic Arthritis

These diseases present as severe low back pain aggravated after rest. Common in young males these can be genetically determined as indicated by HLA B27 positivity. Four main subtypes are recognized in the form of Ankylosing spondylitis, Psoriatic, Enteropathic and Reactive Spondyloarthropathies. The entire spine ultimately becomes stiff (bamboo spine) and patient becomes incapacitated. Other forms of reactive arthritis such as Poncet's disease (Tuberculosis) are also considered in this category.

Acute Gout

Gout is a disease of purine metabolism which generally manifests as acute severely painful hot-red swelling of base of the great toe though other forms are also recognized. It usually affects males and recurrent attacks of pain and swelling ultimately lead to deformities. Uric acid levels in blood are elevated which can also cause kidney stones.

Treatment of arthritis aims at relief of pain, maintenance of joint function; modify disease process to induce remission and prevention/correction of deformities. Early diagnosis is, therefore, essential. A rheumatologist must be consulted and followed up at the earliest symptoms of the disease. Evidence based therapeutic protocols are now available. These appear to be effective in over 60% cases. Alternate protocols are also available. Rheumatologists start appropriate therapeutic regimen after making a proper diagnosis, monitor response to treatment, watch for side-effects and change drugs if required. The drugs can usually be withdrawn on successful achievement of therapeutic goals.