Comprehensive Rheumatology Diseases and Joint Care

The rheumatology department at PACE Hospitals manages various disorders related to joints, connective tissues, and autoimmune conditions.
For easier navigation, the common rheumatologic diseases treated at our centre are listed and categorised below.

Autoimmune Rheumatic Diseases

These conditions occur when the immune system mistakenly attacks the body's own tissues, leading to chronic inflammation affecting joints, muscles, skin, and organs.

• Rheumatoid Arthritis (RA): Rheumatoid arthritis is a chronic autoimmune disease in which the body’s immune system mistakenly attacks the lining of the joints (synovium). This leads to inflammation, pain, swelling, and gradual damage to the joints, affecting the hands, wrists, and knees. The main cause remains unknown; it is thought to be a complication of genetic factors, immune system failure, and environmental triggers such as infections or smoking. Common symptoms include persistent joint pain, swelling, stiffness (especially in the morning), fatigue, and reduced joint mobility. If untreated, RA can lead to joint deformities and functional disability.

• Systemic Lupus Erythematosus (SLE): Systemic lupus erythematosus is a chronic and long-term autoimmune disorder in which the immune system attacks healthy tissues in various parts of the body, including the skin, joints, kidneys, brain, heart, and lungs. The main cause is unknown, but it is thought to involve genetic predisposition combined with environmental and hormonal triggers such as infections, sunlight exposure, or certain medications. 

• Sjögren’s Syndrome: Sjogren's syndrome is a long-term systemic autoimmune disease, meaning the immune system attacks the body's own cells and organs. It damages the glands that produce and control moisture, causing dryness throughout the body, especially the eyes and mouth. This disease causes inflammation of the lacrimal glands (which secrete tears) and the salivary glands (which secrete saliva). This leads to decreased tear and saliva production, causing dryness of the eyes and mouth.

• Systemic Sclerosis (Scleroderma): Scleroderma is a rare, chronic autoimmune connective tissue disorder in which the body's immune system causes excessive collagen production, leading to hardening and tightening of the skin and internal organs. Common symptoms include skin thickening and stiffness, shiny or tight skin on fingers, hands, or face, Raynaud's phenomenon, joint pain, fatigue, difficulty swallowing, shortness of breath, and digestive problems. The exact cause of this disease is not known. However, it is believed to be a combination of genetic predisposition, immunological dysfunction, and environmental triggers. If not treated on time, it may lead to pulmonary hypertension, kidney crisis, digestive dysfunction, and restricted mobility.

• Mixed Connective Tissue Disease (MCTD): Mixed connective tissue disease is an uncommon autoimmune disorder that shows features of several connective tissue diseases, mainly systemic lupus erythematosus, systemic sclerosis, and polymyositis. The exact cause is not clearly known but is believed to involve genetic susceptibility and immune system abnormalities. Symptoms include joint pain and swelling, muscle weakness, fatigue, swollen fingers, Raynaud’s phenomenon, and skin thickening. 

• Undifferentiated Connective Tissue Disease (UCTD): This is a condition in which patients show symptoms and laboratory features of connective tissue diseases but do not meet the diagnostic criteria for a specific disorder, such as lupus or rheumatoid arthritis. Symptoms such as joint pain, mild skin rashes, Raynaud's phenomenon, and dryness of the eyes or mouth. The cause is unknown but involves immune system dysregulation and genetic factors.

• Polymyositis: Polymyositis is a rare autoimmune inflammatory disease that causes chronic inflammation of the skeletal muscles, particularly those close to the trunk such as the shoulders, hips, and thighs. The exact cause is not fully known, but it is believed to occur when the immune system mistakenly attacks healthy muscle tissue. Common symptoms are progressive muscle weakness, difficulty climbing stairs or lifting objects, fatigue, and muscle tenderness. 

• Dermatomyositis: Dermatomyositis is an autoimmune inflammatory condition that affects both the muscles and the skin. It causes muscle weakness similar to polymyositis but is also associated with distinctive skin rashes. The exact cause is unknown, though immune system dysfunction, genetic factors, and environmental triggers such as infections may play a role.

Inflammatory Arthritis

These disorders cause inflammation of the joints, resulting in pain, swelling, stiffness, and reduced joint function.

• Psoriatic Arthritis: Psoriatic arthritis is a chronic inflammatory condition that affects the joints and is associated with the skin disease psoriasis. In this disorder, the immune system mistakenly attacks healthy joints and surrounding tissues, causing inflammation. The exact cause remains unknown; it is believed to involve a combination of genetic factors, immune system dysfunction, and environmental triggers. Common symptoms include joint pain, swelling, stiffness, fatigue, and skin changes such as red, scaly patches (psoriasis). Some patients may also develop swelling of fingers or toes (dactylitis) and nail changes like pitting or thickening.

• Ankylosing Spondylitis: Ankylosing spondylitis is a chronic inflammatory form of arthritis that mainly affects the spine and the sacroiliac joints (where the spine meets the pelvis). The condition causes inflammation in the spinal joints, which may lead to chronic pain and stiffness and, over time, can cause the vertebrae to fuse together. The exact cause is not known, but genetic factors, particularly the presence of the HLA-B27 gene, play a major role in increasing the risk. Risk factors include being male, having a family history of ankylosing spondylitis, and carrying the HLA-B27 gene.

• Reactive Arthritis: Reactive arthritis is a kind of inflammatory arthritis that develops as a reaction to an infection in another part of the body, most commonly in the gastrointestinal or genitourinary tract. The immune response triggered by the infection leads to inflammation in the joints and sometimes in other tissues such as the eyes or urinary tract. Common infections associated with reactive arthritis include bacterial infections such as Salmonella, Shigella, Campylobacter, and Chlamydia. 

• Juvenile Idiopathic Arthritis (JIA): Juvenile idiopathic arthritis is the most common type of chronic arthritis in children under the age of 16. It is an autoimmune condition in which the immune system mistakenly attacks the joints, leading to persistent inflammation. The exact cause of JIA is not fully known. Symptoms generally include joint pain, inflammation, stiffness (in the morning), reduced joint movement, and sometimes fever or skin rash. In some children, the JIA also affect the eyes, causing inflammation called uveitis. 

Crystal-Induced Arthropathies

These conditions occur due to the deposition of crystals within joints, leading to sudden inflammation and severe joint pain.

• Gout: Gout is a common form of inflammatory arthritis caused by the accumulation of uric acid crystals in the joints. When uric acid levels in the blood reach extremely high, sharp crystals can develop and deposit in the joints, causing rapid and severe inflammation. The exact cause often involves reduced elimination or increased production of uric acid in the body. Gout commonly affects the joint at the base of the big toe but can also involve the ankles, knees, wrists, and fingers. Typical symptoms include sudden, intense joint pain, swelling, redness, warmth, and tenderness, often occurring at night.

• Pseudogout (Calcium Pyrophosphate Deposition Disease – CPPD): Pseudogout is a form of arthritis caused by the buildup of calcium pyrophosphate crystals in the joints. These crystal deposits cause inflammation comparable to gout, but with different types of crystals. The condition most commonly affects the knees but can also involve the wrists, shoulders, ankles, or hips. 

Degenerative Joint Disorders

These disorders are caused by wear and tear of the joints and are common with ageing.

• Osteoarthritis (OA): Osteoarthritis is the most common form of arthritis and occurs when the protective cartilage that cushions the ends of bones gradually wears down over time. This degeneration leads to friction between the bones, resulting in joint pain, stiffness, and reduced mobility. OA most frequently affects weight-bearing joints such as the knees, hips, and spine, as well as the hands. The condition usually develops slowly and worsens with age. Common symptoms include joint pain during or after movement, stiffness (especially after rest), swelling, and decreased flexibility. 

• Degenerative Disc Disease: Degenerative disc disease is a condition in which the intervertebral discs of the spine gradually lose their flexibility, hydration, and shock-absorbing ability as a result of ageing or wear and tear. The condition most commonly affects the cervical (neck) and lumbar (lower back) regions of the spine. Patients report chronic back or neck discomfort, stiffness, pain that worsens with movement or extended sitting, and occasionally numbness or tingling if neighboring nerves are involved.

Soft Tissue Rheumatic Disorders

These conditions affect muscles, tendons, ligaments, and surrounding soft tissues rather than the joints themselves.

• Fibromyalgia: Fibromyalgia is a chronic condition characterised by widespread musculoskeletal pain, fatigue, sleep disturbances, and tenderness in different parts of the body. The exact cause is not fully understood, but it is thought to involve abnormal pain processing in the brain along with genetic, physical, or emotional triggers such as infections or stress.

• Tendiniis and Bursitis: These are inflammatory conditions that affect the soft tissues around joints. Tendinitis develops when a tendon becomes inflamed as a result of overuse, injury, or repeated movements. Bursitis is characterised by inflammation of the bursa, a tiny fluid-filled sac that cushions joints and decreases friction between bones, tendons, and muscles. These conditions commonly affect the shoulders, elbows, hips, knees, and heels. Symptoms usually include localized pain, swelling, tenderness, stiffness, and difficulty moving the affected joint.

• Entheitis: Enthesitis is the inflammation of the entheses, which are the points where tendons or ligaments attach to the bone. It commonly occurs in inflammatory rheumatic diseases such as ankylosing spondylitis and psoriatic arthritis. Some general symptoms are pain, tenderness, swelling, and stiffness at tendon attachment sites, especially in the heels, knees, or elbows. Risk factors include autoimmune disorders, genetic predisposition (such as the HLA-B27 gene), and repetitive stress on joints.

Metabolic and Bone-Related Rheumatic Disorders

These diseases affect bone metabolism and structure.

• Osteoporosis: Osteoporosis is a disease in which bones become weak, fragile, and more likely to fracture due to decreased bone density. It usually develops when the body loses too much bone or does not produce enough new bone. Ageing, hormonal changes (especially after menopause), and low calcium or vitamin D levels are common causes. Symptoms do not appear until a fracture occurs, but some people may experience back pain, loss of height, or a stooped posture.

• Osteomalacia: Osteomalacia is a condition characterised by the softening and weakening of bones due to inadequate mineralisation, most commonly caused by vitamin D deficiency. Without enough vitamin D, the body cannot properly absorb calcium and phosphorus, which are important for bone strength. Symptoms generally include bone pain, muscle weakness, difficulty walking, and an increased risk of fractures. Risk factors for developing osteomalacia are poor vitamin D intake, limited sunlight exposure, digestive disorders that impair nutrient absorption, and certain kidney or liver diseases.

• Paget’s Disease of Bone: Paget’s disease of bone is a chronic disorder in which the normal process of bone remodelling becomes abnormal, causing bones to become enlarged, weak, and structurally disorganised. The exact cause is not fully known but may involve genetic factors and possible viral triggers. The condition affects the pelvis, spine, skull, and long bones of the legs, which is accompanied by bone pain, joint pain, bone deformities, hearing loss (when the skull is affected), and an increased risk of fractures.

Vasculitis 

Vasculitis is a group of disorders in which blood vessels become inflamed, leading to thickening, weakening, narrowing, or scarring of their walls. This inflammation reduces blood flow and can damage vital organs and tissues. The condition may affect arteries, veins, or capillaries of any size, leading to symptoms such as fever, fatigue, weight loss, muscle or joint pain, skin rashes, and nerve problems. The cause of vasculitis is often unknown, but it may occur due to autoimmune reactions, infections, certain medications, or cancers. In some cases, it develops secondary to other autoimmune diseases like rheumatoid arthritis or lupus. Complications may depend on which organs are affected and can include organ failure, stroke, alveolar haemorrhage, aneurysms, or tissue death due to poor blood supply.

Other Rheumatologic Conditions

Additional conditions managed in rheumatology include:

• Raynaud’s Phenomenon: Raynaud’s phenomenon is a condition in which the small blood vessels in the fingers and toes temporarily narrow in response to cold temperatures or emotional stress. This reduced blood flow causes the affected areas to change color (white, blue, then red) and may be accompanied by numbness, tingling, or pain. The exact cause may involve abnormal blood vessel regulation and immune system activity. Risk factors include cold exposure, smoking, stress, and underlying autoimmune diseases such as systemic lupus erythematosus or scleroderma.



• Sarcoidosis: This is an inflammatory disease characterised by the formation of small clusters of immune cells called granulomas in various organs, most commonly the lungs and lymph nodes. The exact cause is unknown, but it may involve an abnormal immune response to environmental or infectious triggers in genetically susceptible individuals. Symptoms vary depending on the organs affected, but generally include persistent cough, fatigue, shortness of breath, skin lesions, joint pain, and swollen lymph nodes.

• Relapsing Polychondritis: Relapsing polychondritis is an uncommon autoimmune disorder characterised by recurrent inflammation of cartilage and other tissues throughout the body. It most commonly affects the ears, nose, joints, and respiratory tract. The condition occurs when the immune system mistakenly attacks cartilage structures. Symptoms are pain and redness of the ears, joint pain, nasal cartilage inflammation, breathing difficulties, and hearing problems. Risk factors generally include autoimmune diseases, immune system abnormalities and genetic susceptibility.

• Antiphospholipid Syndrome (APS): This is an autoimmune disorder in which the immune system produces abnormal antibodies that increase the risk of blood clots in arteries and veins. These antibodies affect normal blood clotting processes, leading to complications such as deep vein thrombosis, stroke, or pregnancy-related problems. Risk of developing APS is higher with autoimmune diseases (especially lupus), infections, genetic predisposition, and certain medications.

• Adult-Onset Still’s Disease: Adult-onset Still’s disease is a rare inflammatory autoimmune condition characterised by high fever, joint pain, and a distinctive salmon-colored skin rash. Common symptoms include recurring high fever, joint swelling and stiffness, sore throat, fatigue, and skin rash. The main cause is unknown, but it is believed to involve abnormal immune system activation triggered by genetic and environmental factors such as infections.

• Behçet’s Disease: Behçet’s disease is a chronic inflammatory disorder that affects blood vessels throughout the body. The condition occurs due to an immune system dysfunction that leads to widespread inflammation. Common symptoms include recurrent mouth ulcers, genital sores, skin lesions, eye inflammation, and joint pain.

• Cryoglobulinemia: Cryoglobulinemia is a condition in which abnormal proteins in the blood (cryoglobulins) precipitate at low temperatures and cause inflammation of blood vessels. This inflammation can lead to reduced blood flow and damage to the skin, joints, nerves, and kidneys. The condition may be associated with autoimmune diseases, chronic infections such as hepatitis C, or certain blood disorders.

• Polymyalgia Rheumatica: Polymyalgia rheumatica is an inflammatory disorder that causes pain and stiffness in the muscles and joints, particularly in the shoulders, neck, and hips. The exact cause is not clearly understood, but it is believed to involve immune system dysfunction and genetic susceptibility. Symptoms typically include severe morning stiffness, muscle pain, fatigue, mild fever, and difficulty with movement. The condition most commonly affects adults over the age of 50.