Speciality consultation in both out-patient & in-patient settings regarding various rheumatological diseases including rheumatoid arthritis, osteoarthritis, lupus, gout, chronic back or neck pains, ankylosing spondylitis, fibromyalgia, tennis elbow, frozen shoulder and others, using an evidence-based comprehensive updated approach. Detailed explanation of the disease process, including diagrams, if necessary.
General medical consultation regarding common illnesses including hypertension, diabetes, infections, asthma, tuberculosis, malaria, viral illnesses including dengue, chikungunya, COVID-19, cardiac diseases, migraine, allergic conditions, thyroid disorders, electrolyte imbalances etc, in both out-patient & in-hospital settings, including critically ill conditions.
Speciality consultation including diagnosis, treatment & monitoring of patient in ICUs (Intensive Care Units) in in-hospital setting with life-threatening or critical illnesses including – sepsis, ARDS, MODS (multi-organ dysfunction syndrome), cerebral malaria, dengue hemorrhagic fever/dengue shock syndrome, COPD, pneumonia, myocardial infarction, cardiomyopathy, heart failure, stroke, meningitis, liver failure, hepatitis, kidney failure (including dialysis), seizure/epilepsy, electrolyte imbalances etc
Interventional rheumatology is a field in which rheumatologists are responsible for performing minimally invasive procedures for diagnostic and therapeutic purposes in patients with mechanical and/or inflammatory musculoskeletal diseases accompanied by acute or chronic pain that is refractory to standard treatment. It includes – Intra-articular injection of corticosteroids, hyaluronic acid, platelet rich plasma (PRP) or allogenic stem cell therapy; USG guided soft-tissue injections in cases of bursitis, tenosynovitis, enthesitis, fasciitis; minor salivary gland biopsy, muscle biopsy, skin biopsy, nerve biopsy etc.
During the past decade biologic therapies such as monoclonal antibodies and fusion proteins have revolutionized the management of rheumatic diseases. Presently biologics are expensive, but mainstay therapies in the treatment of many rheumatic conditions. Their use has indeed allowed for a better prognosis in several rheumatic diseases (such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, systemic lupus erythematosus) and to obtain a clinical remission. Biologics approved in India at present are –
• Intravenous: Infliximab, Rituximab, Tocilizumab, Abatacept
• Sub-cutaneous: Adalimumab, Etanercept, Golimumab, Tocilizumab, Secukinumab
• Oral: Tofacitinib, Baricitinib
Viscosupplementation is a medical procedure during which a small amount of lubricating fluid, containing hyaluronic acid is directly injected into a joint. By adding hyaluronic acid to the existing joint fluid, the goal is to – facilitate better joint movement, reduce pain & perhaps slow osteoarthritis progression. Typical candidates for viscosupplementation are people with knee osteoarthritis who have failed to improve with other non-surgical treatments and want to avoid or postpone knee replacement surgeries. This procedure is intended mostly for knee joints, but can also be used for shoulder or ankle joint diseases. Almost 6 months to one year of pain free period can be achieved.
Joint injections or aspirations (taking fluid out of a joint) are performed in an OPD or hospital setting. Either joint fluid is obtained (aspirated) and used for appropriate laboratory testing or medications are injected into the joint space. Drainage of a large joint effusion can provide pain relief and improved mobility. For injections, corticosteroids (such as methylprednisolone and triamcinolone) frequently are used. They are given to treat inflammatory joint conditions, such as rheumatoid arthritis, psoriatic arthritis, gout, tendonitis, bursitis and osteoarthritis. Commonly injected joints include the knee, shoulder, ankle, elbow, wrist, base of the thumb, and small joints of the hands and feet.
Chronic pain is long standing pain that lasts for over three months. It persists beyond the usual recovery period after any injury or occurs along with a chronic health condition, such as arthritis, spondylitis etc. The pain can be there all the time, or it may come and go. It can happen anywhere in your body. Chronic pain can interfere with your daily activities, such as working, having a social life and taking care of yourself or others. It can lead to depression, anxiety and trouble sleeping, which can make your pain worse. This response creates a cycle that’s difficult to break. Chronic pain is a major medical condition that can and should be treated. A multidisciplinary approach to pain management is often required to provide the needed interventions including medications, local injections, exercise, physiotherapy, rehabilitation, even surgery to help manage the pain.