Rheumatology is a branch of medicine that deals with multi-system auto-immune diseases like systemic lupus erythematosus (SLE), systemic sclerosis (scleroderma), inflammatory myositis, Sjogren’s syndrome, vasculitis, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, etc. gout. In autoimmune diseases, the body’s immune system gets dysregulated & attacks the healthy cells/tissues of the body. Most autoimmune diseases have genetic risk factors and are triggered by environmental factors like viral infections, smoking, pollution, exposure to ultraviolet light, etc. Osteoporosis, a condition in which bones become weak & brittle, osteoarthritis a predominantly degenerative joint disease, gout (crystal deposition disease) and chronic (long-standing) musculoskeletal pain disorders like fibromyalgia, back pain, complex regional pain syndrome (CRPS), etc. are also dealt by a rheumatologist.

A person suffering from joint pain/stiffness/swelling or pain over the back or neck, especially when accompanied with early morning stiffness should consult a rheumatologist. Also, if a patient has symptoms like prolonged or recurrent fever, rash, photosensitivity (discoloration of skin or rash over face/body after exposure to sunlight), oral sores (ulcers), discoloration of fingers/hands especially in winters (Raynaud’s phenomenon), excessive dryness of eyes or mouth, non-healing skin ulcers, etc., he/she should see a rheumatologist. Accurate diagnosis is very important in patients with rheumatic diseases so as to prevent permanent joint/organ damage. Dr. Punit Pruthi (M.D), Director- Rheumatology & Internal Medicine at Asian Hospital has vast experience and expertise in this field and is routinely handling all kinds of arthritis and rheumatic/autoimmune diseases. With his proficiency in Internal medicine, he can also manage medical comorbidities like hypertension, diabetes, anemia, etc. Intra-articular (joint) injections are also administered routinely in the department, and the latest therapeutic regimes including administration of biological therapy (like Infliximab, Rituximab, etc.) are being followed. Dr. Punit Pruthi, the best rheumatologist in Faridabad is having more than 22 years of clinical experience and has an outstanding academic record.

Brief description of some common diseases dealt with by a rheumatologist

The information given here is brief and for general education only. Please consult your rheumatologist for an accurate diagnosis & appropriate treatment of your medical condition.

Rheumatoid arthritis (RA)

Rheumatoid arthritis is an autoimmune disease in which the body’s own immune cells attack the lining of the joints called synovium leading to joint pain, stiffness & swelling. It affects females more commonly and is also associated with smoking.

Symptoms of RA –

The patient complains of pain & stiffness in joints which is aggravated during the night/early morning hours, or after a period of rest. Rheumatoid arthritis disease is not limited to the joints only; In many patients, other manifestations develop depending on the organ involved, like long-standing cough or breathlessness when the lungs are affected (interstitial lung disease – ILD), or dryness of the mouth or eyes when salivary or lacrimal glands are involved, etc.

Importance of early treatment –

Untreated RA may lead to joint deformities causing severe disability and also may reduce the lifespan of the patient by increasing the cardiovascular risk. Accurate diagnosis & early treatment initiation prevents permanent joint damage/deformities and other organ-related complications of RA. Treatment of RA is usually life-long, and regular follow-up with a rheumatologist is required so that the disease activity is controlled.

Role of exercises & lifestyle modification –

Patients must do regular exercises under the guidance of a rheumatologist or a physiotherapist so as to maintain the range of motion of joints. Cessation of smoking helps in slowing the progression of RA.

Ankylosing Spondylitis (AS)

Ankylosing spondylitis is a type of inflammatory arthritis that mainly affects the spine & sacroiliac joints, but in many patients, other joints may also be involved. It belongs to the spondyloarthropathy group of diseases.

Cause of AS –

AS is caused by immune dysregulation in a genetically predisposed person. Persons who are positive for the HLA B27 gene are more prone to develop AS. Smoking is also considered to be a risk factor for the progression of AS.

Symptoms of AS –

The main symptom of AS is back pain and early morning stiffness. The back pain of ankylosing spondylitis is usually severe at rest and gets better with activity or exercise. In severe cases especially if untreated the vertebral joints may fuse & back may become rigid. The disease may also involve the other joints of the body, and sometimes other body organs like eyes (uveitis), intestine (inflammatory bowel disease – IBD), or skin (psoriasis).

Importance of early treatment –

Early diagnosis & treatment not only gives relief in pain & stiffness thereby improving the quality of life but also may prevent other organ-related complications of AS.

Role of exercises & lifestyle modification –

Patients must do regular exercises under the guidance of a rheumatologist or a physiotherapist so as to maintain the range of motion of joints & spine. Cessation of smoking helps in slowing the progression of AS.

Systemic Lupus Erythematosus (SLE/Lupus)

Systemic lupus erythematosus is an autoimmune disease in which the body’s immune system acts against its own cells and tissues.

Cause of SLE –

The exact cause of lupus is unknown, but multiple factors like the genetic makeup of an individual, female sex, exposure to sunlight, and viral infections may contribute to the occurrence of the disease.

Symptoms of SLE –

SLE can affect any system or organ of the body leading to a variety of possible symptoms like:

  • Low-grade fever, weight loss, tiredness.
  • Rashes over the skin, which may get worse on exposure to sunlight (photosensitivity)
  • Ulcers (or sores) inside the mouth or nose.
  • Excessive hair fall.
  • Joint pain with swelling/stiffness which is more in the morning hours
  • Kidney involvement may present as swelling over the body & around the eyes, frothy or high-colored urine, etc.
  • In some patients, neurological complications may happen like fits (convulsions), psychosis or abnormal behaviour, brain stroke leading to paralysis, etc.
  • Recurrent miscarriages, and the formation of spontaneous blood clots in veins or arteries (can be associated with the anti-phospholipid syndrome).

Please note that many of the above-mentioned symptoms are non-specific and thus the symptoms need to be correlated with lab reports by a rheumatologist for accurate diagnosis.

Importance of early treatment –

Although lupus can affect vital organs like kidneys, brain, heart, blood, etc., and can lead to serious complications in some patients, with early recognition & correct treatment the disease can be brought under control and organ damage can be prevented in most patients. The choice of medicine used to treat SLE depends on the severity of the disease and the organ involved.

Role of lifestyle modification –

Sun exposure should be avoided and sunscreen should be used by lupus patients as the ultraviolet light can aggravate the lupus rash and may even trigger a flare of disease activity in the internal organs. Regular exercise should be a part of daily routine as it helps by improving muscle strength & joint pain, and also by reducing cardiovascular risk.

Osteoarthritis (OA)

Osteoarthritis (OA) is one of the commonest types of arthritis seen in the general population. Osteoarthritis is a joint disease in which there is wear and tear or degeneration of the cartilage which acts as a cushion inside the joint.

Cause of OA –

Osteoarthritis is commonly seen with advancing age however, sometimes OA may occur at an early age. In such cases, other risk factors contribute, like genetic predisposition, obesity, rigorous or unsupervised athletic activities, and repeated kneeling or squatting positions. Osteoarthritis commonly occurs in the knees, hips, hands, feet & joints of the spine.

Symptoms of OA –

Joint pain is the most common symptom associated with OA. In OA of the knees, the early symptom is pain while climbing up or down the stairs, or while getting up from a sitting position. Osteoarthritis patients can have stiffness in their joints which is usually aggravated when the patient takes rest, but unlike rheumatoid arthritis, the duration of stiffness is usually short lasting.

Role of exercises & lifestyle modification –

Certain precautions like avoidance of sitting on the floor and kneeling or squatting positions can help to slow down the progression of OA. Obese patients are more prone to develop knee & ankle OA, and weight loss may help to slow down its progression. Exercises help in the treatment of OA by increasing the strength of muscles surrounding the joint. One should increase the exercises gradually and preferably under the guidance of a trained physiotherapist.

Treatment of OA –

The medications used in OA are mainly for symptomatic relief to provide a better quality of life to the patients. Surgery is usually considered in patients who have advanced osteoarthritis and are not benefited from conservative management. The most common surgery done for OA is joint replacement surgery which is most commonly done for the knee & hip joints. Surgical procedures are done by orthopedic surgeons.


Osteoporosis is a common condition in which the bones become brittle and fragile. Bone is in a constant state of regeneration; The body removes old bone (called bone resorption) and replaces it with new bone (bone formation). In their middle age, most people begin to slowly lose more bone than can be replaced. As a result, bones gradually become thinner and weaker in structure. This process accelerates in women at the time of menopause.

Risk factors for osteoporosis –

The major risk factors for osteoporosis include advancing age, menopause, smoking, low body weight, parental history of hip fracture, cigarette smoking, alcohol abuse, sedentary lifestyle, certain diseases that affect bone metabolism like hyperthyroidism, and certain medicines like glucocorticoids.

Symptoms of osteoporosis –

Osteoporosis is a silent disease and is either diagnosed when a patient suffers from a fracture even after a minor injury or on routine health check-ups that include a bone density test (DEXA scan).

Common sites of osteoporotic fractures –

The most common fractures occur at the spine, wrist, and hip. Spine and hip fractures in particular may lead to long-term pain and disability, and even death.

Treatment of Osteoporosis –

The rheumatologist takes into account several factors like the severity of osteoporosis, comorbidities, pregnancy consideration, etc before tailoring the treatment of osteoporosis in an individual patient. Along with the medicine for osteoporosis calcium & vitamin D, supplementation is also prescribed by the rheumatologist as per the individual case.

Role of exercises & lifestyle modification –

Regular physical weight-bearing exercises like walking also help in the prevention and treatment of osteoporosis, and strategies need to be implemented to decrease the risk of falling.


Gout is a painful and potentially disabling form of arthritis that occurs when excess uric acid (a product of protein metabolism) collects in the body, and needle‐like urate crystals get deposited in the joints.

Cause of gout –

Gout happens because either uric acid production increases or if the kidneys cannot remove uric acid from the body well enough.

Risk factors for gout –

Gout occurs more often in men, and people with kidney disease. It is also strongly linked to obesity, high blood pressure, high cholesterol, and diabetes. Certain foods (with high purine content) may raise uric acid levels and lead to gout attacks like Shellfish, red meat, alcohol, and food high in fructose.

Symptoms of gout –

Gout presents as episodes of severe pain & swelling of joints, usually involving one or two joints of lower limbs. Acute gout attacks are typically followed by periods of no symptoms. In addition to being located in the joints, crystals can form tophi (lumps) under the skin, often located over a joint or on the outer ear. Uric acid also can deposit in the urinary tract, causing kidney stones.

Implications of uric acid levels in gout –

Uric acid levels in the blood are helpful to diagnose gout but can sometimes be misleading, especially if measured at the time of an acute attack as the levels may be normal or even low during attacks. Also, many times people who do not have gout can have increased uric acid levels.

Treatment of gout –

Treatment should be done under the guidance of a rheumatologist and self-medication should be avoided. During an attack, resting the affected joint and application of ice packs or cold compresses also help to reduce pain and swelling. Patients who have repeated gout flares, or tophi or kidney stones are prescribed medicines to lower blood uric acid levels.

Role of diet & lifestyle modification –

Lifestyle changes like avoidance of alcohol, and reduced consumption of foods high in purines along with control of the co-existent common metabolic diseases like diabetes, obesity, hypertension, etc. are part of the treatment of gout.