Juvenile Idiopathic Arthritis (JIA) is a chronic autoimmune disease of children below (16 years) which affected the joints. JIA affects various joints of the body like; joints of the hands and feet, shoulders, elbows, wrists, hips, knees, and ankles. Usually multiple joints are involved together.

Sometimes it can start in one or few joints and may remain there, or over a period of time multiple other new joints can be affected. Most common symptoms are joint pain, with or without swelling. Severity of joint pain varies. In few patients, pain can be mild, whereas in others pain can be very severe, resulting in restriction of daily activities. Child also experiences stiffness of the joints after getting up in the morning, which can last from half an hour to few hours. Few children can also have other symptoms like fever, rashes, and painful red eye. Diagnosing the disease in the early stage, and initiation of treatment by a rheumatologist is very important. Irreversible damage of the joints can occur if the symptoms are neglected for a long time, which causes joint deformities or reduced movement at the joints.

As a result of joint deformities, child can have difficulty in doing activities like, writing with a pencil/pen, holding objects, riding a bicycle, playing outdoor games, and many other routine activities.

Various treatment options are available which can be used for a long period under the guidance and supervision of a rheumatologist. Regular follow up and continuation of treatment is important to prevent recurrence of symptoms. 

Gout is a common disease of the joints. It is usually seen in men above 40 years of age. Sometimes it also affects young men, and rarely women (after menopause). Patients usually have higher levels of a substance called “uric acid” in the blood. This uric acid gets deposited in the joints and causes arthritis. However, in few patients, blood uric acid levels will be normal. Gout arthritis occurs in episodes. Each attack lasts for around 1-2 weeks. During these episodes, common symptoms are joint pain and swelling, which is usually seen in a single joint. This arthritis starts very rapidly (over a single day). Redness and warmth is also seen over the painful joint. Pain is usually very severe, leading to walking difficulty. Pain is severe in the initial days of the attack, which then gradually decreases, and completely subsides within 7-10 days after the onset, after which patient remains pain free until the next attack begins. The duration between the pain attacks varies from few weeks to months. Most common joints affected are, the joints of the legs (great toe, ankle, feet and knee).

If not treated, uric acid also gest deposited under the skin (forming large lumps over the elbows, feet or ears), and in the kidneys (causing kidney damage). If the disease is not controlled, irreversible joint damage occurs. Variety of treatment options are available for reducing the blood uric acid levels, and preventing arthritis attacks. High proteins in the diet (large amount of pulses, and non-veg diet), and alcohol (especially beer) increases the blood uric acid levels, which leads to increased frequency of arthritis attacks. Thus, along with medications, restriction on intake of these substances is important to control the disease. The treatment has to be continued for a long time, even after normalisation of blood uric acid level.

Osteoarthritis (OA) is a very common type of arthritis, which is commonly seen in elderly people. It is usually considered as wear and tear condition of the joint. Mostly knee joints are affected, but rarely hips and finger joints are also affected. Most common symptom is pain in one or both knees. Onset of pain is gradual, and the intensity gradually increases over next few years. Pain is more on walking or climbing stairs. Other symptoms are joint swelling, and stiffness (which gets better after walking few steps) of the knees on getting up after resting for some time. In advanced stages when the joint damage is severe, patients experiences difficulty in completely folding the knee, squatting, sitting cross legs, climbing stairs and even difficulty in walking. X rays aids in knowing the severity of the damage. There is no proven treatment which can completely relieve the pain. In early and mild cases, physical exercises and use of pain medications (as required), can help. In moderate cases injection inside the knee can give relief for an extended period. In severe cases, knee replacement surgery relieves the symptoms and improves the disability. 

Osteoporosis is a condition where the bones becomes weak and fragile. It is seen in women after menopause and in elderly men. These patients have high risk of bone fractures when compared to healthy young people. Even a minor injury/trauma, or a low intensity fall can cause bone fracture. Fractures commonly occurs at hips, writs or spine bones. Sometimes spine bones fractures even without any injury, which causes chronic back pain, decrease in height of the patient, and a forward bending posture. Smoking, excess alcohol intake, suffering with rheumatoid arthritis, and very long term use of few medications, are few risk factors for developing osteoporosis. Bone strength (bone density) is measured by DEXA scan. Various treatment options are available which prevents further weakening of bones and/or increases the bone strength. Duration of treatment varies depending on the medication selected. In addition to medications, patients should also take care to avoid falls and sustain injuries. At hip joint, fracture healing is very slow and sometimes difficult, due to which few elderly patients becomes bed ridden, which in turn leads to various other complications.

Systemic lupus erythematosus (SLE) or Lupus, is a chronic autoimmune condition where our body mistakenly produces various proteins (antibodies) which attack our own body organs. SLE is mostly seen in female of age group 20-40 years. In children it is called “Juvenile SLE”. Most common symptoms of SLE are; fatigue, fever, decreased appetite, weight loss, increased hair fall, oral ulcers, rashes, and joint pains. In SLE, many major organs can be affected, and the symptoms varies depending on the organ involved, like; kidneys (protein loss), heart (chest pain/breathlessness), brain (headache/stroke), lungs (cough/breathlessness), muscles (pain/weakness), and many more. Haemoglobin, white blood counts and platelet counts commonly decreases in SLE. Various blood and urine tests are required for the diagnosis. Early recognition of the symptoms is important. These problems can become life-threatening, if remains undetected and untreated.

Most common long term complication is kidney failure which may later require dialysis or renal transplant. Variety of treatment options are available which can control the symptoms, improve the quality of life, and also prevents progression of disease in the affected organs. Patients usually require treatment for a long time. Regular follow up with a rheumatologist is extremely important to monitor disease course, and for treatment modification. 

Antiphospholipid antibody syndrome (APS or APLA syndrome) is an autoimmune disease which results in recurrent blood clots and/or recurrent pregnancy losses. Women are usually affected, but men can also have recurrent blood clots as a manifestation of the disease. Pregnancy losses occurs as; recurrent (three or more) and consecutive first trimester miscarriages; or, one or more miscarriages after 10 weeks of pregnancy. Blood clots can occur in any part of the body, resulting in; deep vein thrombosis [DVT] (clots in the legs), brain stroke, heart attack, kidney failure, and skin ulcers or rashes. Few antibody tests are used for diagnosing APS. Various treatment options are available, which should be taken under the supervision of a good rheumatologist. Patients having blood colts are given treatment for life time (which prevents new clots). Patients having recurrent miscarriages, are prescribed medications for sustaining the pregnancies.

Systemic Sclerosis (SSc) is also known as Scleroderma. This is a chronic autoimmune disease which involves the skin and many other organs. It is commonly seen in women between 30 to 50 years of age. First symptom of SSc is usually Raynaud’s phenomenon, where finger tips and/or toes turns pale, which later becomes blue, and then normalises after few minutes. This happens during cold weather and/or when fingers are exposed to cold water. Multiple episodes can occur within day. Few patients can have these symptoms only during the winters. Few patients develops painful fingertip ulcers, which are difficult to heal. In severe cases fingers turns black (gangrene), associated with severe pain. All the patients of SSc experiences hardening, thickening and tightening of the skin, over the limbs and face, or all over the body. Tightness of the skin usually increases slowly over few years. 

Other organs can also be affected, such as joints (arthritis), kidneys, heart, lungs and digestive tract. These problems can be life-threatening, if remains undetected and untreated. Various treatments are available which controls the symptoms, improves the quality of life, and also prevents disease progression. Regular follow up with a best rheumatologist is necessary to keep the disease under control.

Sjogren’s syndrome (SjS), is a chronic autoimmune disorder, which causes inflammation of the few glands, leading to decreased tear and saliva production. Common symptoms are dryness of the mouth and/or eyes. These patients can experience burning or gritty sensation in the eyes, and/or difficulty in swallowing or chewing food (requiring frequent sips of water while eating), sticky tongue, and/or swellings in front of ears. Other symptoms are fatigue, arthritis, fever, or rashes over the legs. When kidneys are affected, body potassium is lost into the urine causing hypokalemia (low blood potassium). Due to low potassium levels, patients have repeated episodes of muscle pains with muscle weakness. Blood potassium levels rapidly improves with potassium supplementation. Bones also becomes weak, and fractures very easily with a minor trauma. Few blood tests and lip biopsy helps in diagnosis. Various treatments are available which controls the symptoms, and improves the quality of life. Regular follow up with a qualified rheumatologist is necessary to keep the disease under control.

Myositis is an autoimmune condition which affects various muscles of the body. There are various types of myositis, of which the most common are; Dermatomyositis, Polymyositis and Inclusion body myositis. There conditions are more common in women. Dermatomyositis is seen in people with any age group (ranging from children to elderly). Whereas inclusion body myositis is seen in elderly women.

Most common symptoms are muscle pain and muscle weakness. These patients can have difficulty in doing various activities like; getting up from the ground/bed/chair, climbing stairs, and difficulty in raising arm above shoulders. In severe cases patients cannot even stand on their feet, have difficulty in walking without support, and/or difficulty in swallowing water/food. Few other symptoms are joint pains, rashes, fever, decreased appetite, weight loss, cough and breathlessness. Various blood tests, MRI scan and/or muscle biopsy helps in making diagnosis and treatment. If appropriate treatment is not taken on time then patient can develop breathing difficulty which can be fatal. Various treatment options are available which can be used for a long time under the guidance and supervision of a rheumatologist. Regular follow-up and compliance with medications is important to prevent recurrence of symptoms. 

Vasculitis is an autoimmune condition which causes inflammation in the blood vessels. There are various types of vasculitis, which are; Takayasu arteritis, Giant cell arteritis, ANCA vasculitis [Granulomatosis with polyangitis (GPA)/ Wegener’s disease, Eosinophilic granulomatosis with polyangitis (EGPA)/ Churg-Strauss syndrome, and Microscopic polyangitis (MPA)], Cryoglobulinemic vasculitis, IgA vasculitis [Henoch schonlein purpura (HSP)], Kawasaki disease (seen in children), Polyarteritis nodosa (PAN), Behcet’s disease, and Cogan’s syndrome. Age of the patients varies according to the type of vasculitis. Common symptoms are fatigue, fever, weight loss, arthritis, red eyes, rashes, and various other symptoms. When the vessels of major organs affected, it causes, brain stroke, heart attack, kidney failure, and lung inflammation. Few blood investigations and biopsy from the affected organs helps in diagnosis. These conditions can be life threatening if appropriate treatment is not initiated on time. Various options are available for treating vasculitis, which should be used under the supervision of a qualified rheumatologist. Regular follow up is necessary to keep the disease under control

Takayasu arteritis (TAK) is an autoimmune disease of the blood vessels. It causes inflammation in the arteries (called vasculitis). This condition is also known as pulseless disease. This is more common in women between 20 to 40 years age. Patients can remain asymptomatic for many years. Most common symptoms are; pain in one or more limbs. Pain usually occurs only after activities like; cleaning, washing, cutting vegetables, walking and jogging. Other symptoms are fever, fatigue, giddiness/blackouts, and arthritis. Patients can have high blood pressures when kidney blood vessels are involved. Doctor can notice absent pulses and blood pressures. Blood pressure recordings can vary between both the arms. Blood tests and scanning (MRI / CT) helps in assessing the extent and severity of disease. Diagnosing and treating in the early stage by a best rheumatology doctor is crucial. Irreversible damage can occur if disease is neglected for a long time. Various treatments are used for a long time to control the disease. Few patients may also require placement of stents in the involved blood vessels.  

• Sarcoidosis
• Amyloidosis

• Still’s disease
• Fibromyalgia

• IgG4 related disease
• Autoinflammatory diseases
• Primary Immunodeficiency Diseases (PID)