Thursday, May 23, 2024

Rheumatism: How seniors can cope better

On 3 Dec, 2022, Seniors Today hosted their weekly Health Live webinar with Dr Tanoy Bose, a Leading Rheumatologist & Internal Medicine Specialist who spoke on Rheumatic Disease and Care for Seniors.


About Dr Tanoy Bose:

Dr. Tanoy Bose is a Senior Consultant Rheumatologist and Internal Medicine Specialist at Medica Superspecialty Hospital, Kolkata. He has been the head of the Rheumatology department at Medica for the past four years.  Besides Rheumatology, Dr. Bose is a prominent practitioner of Internal Medicine, Diabetes, and Interventional Musculoskeletal Ultrasonography in Kolkata.

He received his MBBS and MD (General Medicine) degrees from Nil Ratan Sircar Medical College in Kolkata and Assam Medical College in Dibrugarh, respectively. Besides, he also completed the MRCP UK Diploma Part 2 programme. In 2017, he was awarded the prestigious EULAR (European League Against Rheumatic Diseases) Certificate in Rheumatic Disease (Amsterdam). He also serves on the editorial board of the Indian Journal of Rheumatology (Indexed).

While he is not an avid researcher, he keeps up with the newest studies, trials, and recommendations in the treatment of medical and rheumatological disorders. He spends most of his time researching the pain mechanism, pain neuraxis, and pharmacological and percutaneous intervention in pain management. For patients experiencing rheumatological disorders, he can use a High-Resolution USG machine as a stethoscope. Diabetes, Rheumatology, Critical Care, and Chronic Diseases are some of his specialisations.

Rheumatology is a lesser known term and branch which is why most patients bank on different doctors from branches other than rheumatology, and most of the cases remain either undiagnosed and sometimes even misdiagnosed and so they are being treated with calcium and vitamin supplements, and analgesics without reaching a definitive diagnosis. 

Some common diseases which come under the umbrella of rheumatology: 

  1. Osteoarthritis- it is also the most common complaint in the elderly age group which usually presents as knee pain. 
  2. Osteoporosis- this is fragility of the bones. It is age related, often familial.
  3. Gout- if you have a pain in your big  toe, it is likely to be gout. More common in males than females below the age of 45. 
  4. Rheumatoid arthritis- pain in your small joints such as the wrist joint, joints of the hand, finger, elbow and feet. This can also cause early morning stiffness and if not treated/ diagnosed early, it can lead to bony deformities. 
  5. Post viral arthritis- many patients after recovering from Covid 19 have now started presenting with scattered joint pain. 

Most of the autoimmune arthritis are hereditary. This includes rheumatoid arthritis, ankylosis spondylitis, arthritis with bowel disease, osteoarthritis of the base of thumb. If both father and mother are suffering from hereditary arthritis, there is a significantly higher chance of the disease getting passed down to the children, however, if just one of the parents suffers from the disease, there is a chance that there will not be definitive transmission of the genes to the offspring.  


Different arthritis shows us/ present with symptoms at different ages. For example-

  • Ankylosing spondylitis- common in young males, the age where the symptoms start showing up is as young as 15- 16 years. It can come at any age beyond that as well 
  • Rheumatoid arthritis appears in the late 30- 40s
  • The symptoms for hand arthritis present by the age of 40s and 50s. 

Age however cannot be the only factor, it also depends on genetics, external/ environmental factors.

The shoulder is a hyper mobile joint. And mobility comes in lieu of stability. Frozen shoulder is a complication occurring in the shoulder joint. It particularly occurs in patients who are diabetic, the joint fluid in the shoulder joint becomes thicker in density which restricts mobility and causes pain. It accelerates quickly. 

We cannot treat a frozen shoulder with exercises or physiotherapy when the patient is in acute pain. 

The best way is an ultrasound guided injection of the steroid deep inside the joint. It is a one time treatment. 

CRP is a very precise test that decides the state of inflammation in the body at the time of sample collection. CRP can change within a span of 24 hours. 

ESR depends on multiple factors. And is thus not a reliable test and is less specific. 

However both tests are carried out, correlated clinically and then a final diagnosis is decided upon. 

Dr Noor Gill
Dr Noor Gill, MBBS, deciphers the space between heartbeats, figuratively and literally. Powered by frequent long naps and caffeine, she believes that “knowledge without giving back to society is meaningless” and works to make caring cool again.

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