The Hundred Varieties of Rheumatic Diseases

Q1. Do rheumatic diseases only affect the middle-aged and elderly?
There are many types of rheumatic diseases, including lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, gout, psoriatic arthritis, dermatomyositis, vasculitis, scleroderma, etc. They can affect not only the elderly but everyone. Lupus erythematosus is most common in women aged 20 to 50. Rheumatoid arthritis is more common in people between 30 and 50, whereas vasculitis and gout mostly occurs after middle age. Children may also suffer from rheumatic diseases, the common of which include juvenile idiopathic arthritis, Kawasaki disease, etc.

Q2. Are women more likely to have rheumatic diseases?
As mentioned just now, rheumatology covers different types of autoimmune conditions. Some of them are more common in women. For example, the female-to-male ratio of lupus erythematosus is 9:1. Rheumatoid arthritis also affects more females than males with a ratio of 3:1. Some rheumatic diseases, e.g. ankylosing spondylitis and gout, are more prevalent in males. All in all, rheumatic diseases affect both genders.

Q3. Can rheumatic diseases be diagnosed by blood tests?
Unlike hyperglycemia or high cholesterol, rheumatic diseases cannot be diagnosed by a single index level. Rheumatologists will make diagnosis based on the patient’s symptoms, age, gender, clinical observation and laboratory reports. No single blood test can confirm the disease, e.g. we cannot say one has rheumatoid arthritis for nothing other than an elevated Rheumatoid factor, nor lupus erythematosus with a mere positive ANA (Antinuclear antibody) test. Sometimes patients bring along their blood test results and ask if a high inflammatory markers indicates rheumatism. It requires further assessment by a specialist. Like detectives, we Rheumatologists need to consider all kinds of information before making a diagnosis.

Q4. Can rheumatic patients do exercise?
Rheumatic diseases may cause inflammation in the joints, bones, skin, blood vessels, etc. While doctors often tell patients to avoid vigorous exercises when the disease is active, they can do it in moderation after receiving appropriate treatments. It helps improve bone flexibility, enhance well-being and maintain a healthy weight. Sometimes doctors may refer patients to occupational therapists or physiotherapists for assessment and exercise recommendations. Those with ankylosing spondylitis often suffer from morning stiffness and back pain, exercises such as swimming and hydrotherapy can help ease the pain and maintain flexibility.

Q5. Should rheumatic patients avoid certain food?
Gout patients should eat less high-purine food such as entrails, seafood and should avoid drinking alcohol. The rule of thumb is a healthy diet. For most of the rheumatic diseases, there is no need for patients to avoid certain food. But they should be cautious with food hygiene and avoid food that is not thoroughly cooked, e.g. raw fish (sushi), raw meat, raw eggs, etc. Bacteria and germs may adhere to food surfaces and consumption of such food may cause infection. When eating fruits, better peel off the skin as they may contain dirt or bacteria and cause infection. With weaker immunity, rheumatic patients are more likely to get infected.
Some patients like to take health supplements.  As doctors, we don’t recommend patients to take supplements or tonics on their own, as they may affect the immune system. These health products are often marketed as “immunity booster”, the consumption of which may cause adverse effects to the immune system of rheumatic patients. We do see some patients get worse due to these medications or products.

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