What diseases do rheumatologists treat?
For many years rheumatology has been a specialty practically unknown to the population, who did not know very well what diseases we rheumatologists dealt with. Today the majority of the population knows that we deal with bone diseases, especially osteoporosis, joint diseases, arthritis as long as there is no traumatic antecedent, non-oncological chronic pain diseases such as fibromyalgia, non-specific back pain and chronic fatigue.
What is the most common rheumatologic disease at present?
Osteoporosis is a disease to which rheumatologists have been and are dedicated because of its importance in the prevention of fractures. But perhaps at this time, we have a very significant percentage of our practice with patients who present with chronic non-oncologic pain, I am referring to fibromyalgia and back pain of unknown cause. It is not always when there is a fiscal hernia, nor always when there is osteoarthritis that they can be blamed for back pain. Chronic fatigue syndrome also occupies a percentage of our daily work activity.
What is new about fibromyalgia and chronic fatigue?
For me, the most important discovery that has been made in the field of the study of fibromyalgia and chronic fatigue has been their direct relationship with situations of stress, that is to say, suffering. Patients who develop fibromyalgia or chronic fatigue or even back pain with contractures have a previous history of a stressful situation, a situation of suffering. Our group has worked intensively on this with items such as cortisol, testosterone or the determination of enzyme alpha-amylase in saliva.
What treatments exist for fibromyalgia and chronic fatigue?
The treatment of fibromyalgia and chronic fatigue has been fully demonstrated to be multidisciplinary. When we say multidisciplinary we mean that it should be a treatment that starts with diet, because today we know that there are foods that cause the patient anxiety and there are foods that cause relaxation, followed by exercise, the patient with chronic pain avoids exercise and ends up developing a syndrome of acquired non-use, it is necessary to do an exercise program. Also relaxation techniques, the relaxation technique is basic, any of them, Schultz, Jacobson, even hypnosis. It is very important to improve the quality of sleep of our patients, if they do not improve their sleep, it is difficult for fatigue to disappear and the patient with pain has a painful tiredness, he cannot even move. To do this we use many factors such as diet, but we also use music, which has the power to relax and modify the mood of patients that we cannot forget and which today forms part of any working group dedicated to these diseases, as stated in the Cochrane Library. Drugs are indispensable but to think that only with drugs we are going to treat and improve a patient with fibromyalgia or chronic fatigue is wrong. We also use invasive techniques such as platelet growth factors with intra-articular or soft tissue infiltrations as in bursitis and enthesitis, or even the use of the Kovacs technique for the improvement of back pain.