LIFE means activity, which in turn largely depends on mobility of a person. When a person becomes permanently immobile due to a medical condition, it leads to multiple problems including loss of means of livelihood, decrease in muscle mass of the body because of lack of exercise and quite importantly psychological changes leading to frustration and depression.

Rheumatic diseases i.e. diseases involving joints and connective tissues of body form an important cause of partial if not complete immobility of the sufferer. The field of Rheumatology is concerned with diagnosis and treatment of such disorders using drugs and other non-surgical means of treatment. This is different from Orthopaedics which has specialists trained for surgical treatment of deformities due to destruction in joints caused by these diseases. Let us try to have an overview of some common Rheumatologic disorders.
Arthritis is a disease of joints, specifically when joints are inflamed. Inflammation in joints manifests as pain, redness, swelling, heat and immobility.

There are over a hundred types of arthritis but five common types are:

1. Degenerative (e.g. Osteoarthritis of knees and cervical spondylosis)
   There is a disease of wear and tear in which the cartilage or the 'shock absorber' inside the joint deteriorates over a period of time and the bones around it thicken and grow stiff usually with little inflammation.
2. Inflammatory (e.g. Rheumatoid Arthritis)
   In this the body's defence or immune system goes wrong and body's soldier cells instead of attacking the invading bacteria attack the joints producing arthritis. Pain, swelling and stiffness of joints are usually present and can lead to permanent deformities if not treated early.
3. Body chemistry Changes
   This type of arthritis usually affects one or two joints-most commonly the joint behind the big toe. In this the body has too much uric acid in the body and these injurious crystals get deposited in joints producing intense pain.
4. Other types (e.g. septic arthritis, rheumatic fever, mixed arthritis)
   Septic arthritis occurs when bacteria penetrate the joints and set up an inflammation. Arthritis of Rheumatic fever is a reactive arthritis in which symptoms occur sometime after an infection-usually a sore throat.
5. Soft issue Rheumatism (e.g. shoulder periathritis, tennis, elbow, fibrositis etc.)
   This is where tissues around the joint are affected by injuries, sprains, strains etc. and as a result degenerate or become inflamed.

Age and Sex factors in Arthritis
It is a misconception that only elderly suffer from arthritis. The fact is that young adults and ever children can have it. Rheumatic fever is still common in India. At first these children suffer from sore throat and the develop inflammation of joints and also that of structures of the heart. Juvenile Rheumatoid Arthritis is another crippling disease that children suffer from.
Rheumatoid arthritis is thrice more common in women. Gout is more common in adult males although it can affect women as well after menopause.

Why treat Arthritis?
One question commonly asked is - Is arthritis curable? Yes, in many cases it depends on the cause and the stage of the disease. Some types of arthritis may no t be totally curable but are certainly controllable. Hence, treatment must be instituted. After all diabetes and hypertension are also incurable yet people take treatment for those diseases with a view to control them. So why neglect arthritis. In case proper treatment is not taken at the right time, almost invariably, the patient will be crippled and become dependent on other human beings even for daily activities.

Objectives and Principles of treatment: By treating arthritis we are trying to achieve:

• Relief from pain
• Greater mobility and function of joints
• Prevention of deformities and disability

The three principles of treatment in arthritis are:

1. Physical Methods
   This would include shortwave diathermy, Ultrasonic therapy, Wax bath, Transcutaneous Electrical Nerve Stimulation (TENS) etc.
2. By intelligent use of surgical operations, minor or major
3. By drug therapy which is perhaps the mainstay of arthritis management

Drug therapy includes:

• Non-steroidal anti-inflammatory drugs
  These drugs basically control inflammation i.e. reduce selling and help relieve pain. These are first line drugs but they do not change the course of arthritis.
• Steroids
  These are also anti-inflammatory drugs which can produce almost instant relief of pain. But they can lead to side effects if given in high doses or over a prolonged period. Hence, one discourages the long term use of steroids. However, they too have no effect on the course of disease.
• Disease modifying drugs
  These basically change the pathology of arthritis and induce definite remission in the disease. They are slow acting but powerful drugs and must be used under close supervision of a Rheumatologist to avoid side effects.