Outside of immune disorders, there are non-autoimmune conditions that are treated by the rheumatologist. These conditions are also often co-managed by other specialists including an orthopedist, physical therapist, and the primary care provider. Common forms of non-autoimmune soft tissue rheumatism conditions treated include:
Tendinitis and bursitis are terms to describe inflammation of the supporting connective tissue around the joints, bones, and muscle. If the inflammation persists long enough, it can cause breakdown and weakening of the connective tissue. This results in pain and diminished range of motion of the affected area.Tendinitis typically occurs from overuse of a joint that subsequently causes inflammation of the supporting tendons and sometimes referred pain to the attached muscle. A bursa is a small protective cushion like a water balloon that helps facilitate the gliding motion between tendons, ligaments, muscle, bone and skin. Bursitis is when the bursa becomes inflamed and swollen. Tendinitis and bursitis are benign (not dangerous) and self-limiting conditions.
This is a common condition whereby the smallest sensory nerve endings in the skin cause pain amplification due to central sensitization. Pain amplification can be understood like when your speakers’ volume are turned all the way up on the loudest setting. Central sensitization refers to when the nervous system undergoes a wind-up process and becomes regulated into a chronic state of high reactivity. Fibromyalgia is not from an autoimmune, inflammation, or primary joint or muscle disorder. Patients can have symptoms all over the body such as head to toe pain, fatigue and feeling ‘hit by a bus,’ muscle and joint pain, cognition and memory problems, migraine, anxiety and depression, temporomandibular joint dysfunction, irritable bowel syndrome, urinary and pelvic problems. Fibromyalgia is a diagnosis of exclusion and the role of the rheumatologist is to rule out potentially dangerous mimics such as lupus, myositis, or rheumatoid arthritis etc. There is no cure for fibromyalgia and the best treatment is a multifactorial approach.
Also simply known as trigger points, these are extremely irritable knots that form within skeletal muscle. The knots develop when muscle fibers are chronically overstimulated, shortened, and contracted, and become unable to release from their contracted state. The muscle contraction reduces blood flow to the tissue which results in a diminished oxygen supply and subsequent build up of metabolic waste. The contracted muscle forms a trigger point which reacts by sending out pain signals.
All of these conditions benefit from gentle stretching, massage, hot and cold therapies. Physical therapy (PT) may be prescribed if self exercises are not enough. In particular, aquatic therapy, tai chi, and yoga are useful types of PT for fibromyalgia. Short term use of anti-inflammatories such as NSAIDs and steroids can be helpful for tendonitis, bursitis, and trigger points, as well as injection of anti-inflammatory medication into the affected area. While there are FDA approved medications for treatment of fibromyalgia, they are often ineffective and/or cause adverse effects. Thus, Lomibao Rheumatology & Wellness Care focuses on treatment with non-drug, lifestyle and holistic modalities for fibromyalgia that improve symptoms naturally and promote better outcomes. Wellness services for soft-tissue rheumatism conditions – coming soon!