The department of Clinical Immunology and Rheumatology cares for people with various types of arthritis (painful joints) & systemic autoimmune connective tissue diseases. There are more than 100 different types of such disorders and  patients with such diseases, upon early diagnosis and treatment, can look forward to a better life.  Thus, it is also evident that life-long treatment and follow up is also necessary for such diseases.

Description of the diseases

What happens in arthritis and autoimmune diseases?

Most inflammatory arthritis is caused when body’s defense system (immune system) attacks itself, which leads to problems in human organ systems.  Young people are the most affected apart from children. 

What are the types?

There are different types, which include the following:

Connective tissue disorders:

Rheumatoid Arthritis i.e. RA

Juvenile Idiopathic Arthritis (JIA)

SLE i.e. Systemic Lupus Erythematosus

Scleroderma i.e. Systemic sclerosis

Polymyositis / Dermatomyositis

Overlap connective tissue diseases like MCTD and Sjogren’s syndrome

Spondyloarthritis:

Ankylosing spondylitis

Psoriatic arthritis

Reactive arthritis including Reiter’s syndrome

Undifferentiated spondyloarthritis and Spondyloarthritis associated with inflammatory bowel diseases like ulcerative colitis and Crohn’s disease

Crystal arthropathies:

Gout and Pseudo gout 

Vasculitic disorders like: 

Takayasu’s arteritis or aortoarteritis

Polyarteritis nodosa i.e. PAN

Kawasaki disease

Anti-Neutrophil Cytoplasmic Antibody (ANCA) associated vasculitis:

Wegener’s granulomatosus

Churg Strauss syndrome

Microscopic polyangitis

Henoch-Schonlein purpura

Small vessel vasculitis associated with RA, SLE, Sjogren’s syndrome, Hepatitis B or C, cryoglobulinemia

Mixed Vasculitis

Behcet’s syndrome

Polyangitis overlap and Buerger’s syndrome

Granulomatous diseases like Sarcoidosis etc. and many more.

Other types include:

Osteoarthritis (OA), which is mostly found in older people, caused due to “wear and tear” and low grade inflammatory process in the joint cartilage.  They can also affect young people with overuse, overweight people and in genetically susceptible individuals. Although, medical treatment is not very effective in OA, multidisciplinary approach with allied specialties can come to their aid.

Infective arthropathies: There can also be rheumatic and musculoskeletal problems related to infections such as: viral agents like Hepatitis B or C, chikungunia, HIV, parvo virus, coxackie, Echo, etc and septic arthritis with bacteria, mycobacteria like uberculosis, fungal, parasitic etc.

Metabolic diseases like Hypovitaminosis D, which is commonly found in India, thyroid disorders, parathyroid diseases etc. which can cause highly treatable rheumatic presentation.

Osteoporosis is another common problem, which we diagnose and treat and , which goes a long way in improving the quality of life and preventing fractures. It is a silent ongoing epidemic. The symptoms tend to appear only after an irreversible damage like fracture has already happened. Proactive measures are taken to pick up cases in susceptible situations, related with wide range of drugs.

Similarly, severe  malignant diseases also can present with rheumatological manifestations like leukemias, lymphomas, myelomas and many solid tumors.

Common genetic disorders like: Benign Hypermobile Joint Syndrome can cause joint symptoms, often masquerading as arthropathies.

Rare genetic disorders like Marfan’s, progressive pseudo rheumatoid arthritis of childhood, and

Infiltrative disorders like mucopolysacharidosis are some of the rare disorders which need adequate counseling.

Chronic pain disorders like, fibromyalgia, myofascial pain syndrome, repetitive strain injury / regional fibromyalgia and chronic fatigue syndrome are modern day rheumatic disorders which are collectively, often called as central pain sensitization syndrome. Patients with these disorders can often be helped by adopting a multi-disciplinary approach.   

Patient education

Drug therapy is started only after patient education about disease, drugs, outcome, complications, toxicity and need for follow up has been done. Close monitoring of the treatment is essential; as in scientific medicine all adverse events and efficacy are often predictable, unlike those in many unproven alternative systems which are not evidence based.

Patient and relatives must remember that we practice scientific medicine and all agents used by us have gone through studies for safety norms and has been approved by International Authorities like FDA (Food and Drug Authority). We explain all harm possible by any drug, but it does not mean that they all happen in real life and close monitoring can often predict things well in advance.

Few treatments like the biological therapies and IVIG (intravenous immunoglobulin) are tailored to be given according to the need and financial status of patient.

Patient care

The Department  has a large number  of patients with both systemic autoimmune rheumatic disease and patients with other rheumatological disorders.  They come from all over  India and from  neighboring countries like Bangladesh, Bhutan,  Nepal etc.  We see more than 60,000 patients every year (approximate 8000 new patients & 60,000 old patients).

Outpatient services

Different patient care services include:

Rheumatology clinics on Mondays and Thursdays (full day), Tuesdays & Wednesdays – General OPD 9.30am to 3.30pm, Fridays –Private Clinic  12.30pm to 3.30pm, Saturdays – General OPD 9.30am to 12.30pm

and four half day special clinics every week, namely,

Early Arthritis Clinic (EAC) on Tuesday afternoon

Primary Fibromyalgia Clinic (Wednesday afternoon)

Lupus & Vasculitis and scleroderma Clinic (LVAS) on Wednesday afternoon

Pediatric Rheumatology (PRH) clinic on Friday afternoon

Combined Psoriatic Arthritis Clinic on Friday afternoon and Spondyloarthritis & Crystal arthritis (SCA) clinic on Saturday mornings. 

Our doctors go to see patients in Primary care Rheumatology clinic in Kotagiri Medical Fellowship Hospital, Nilgiris on 2nd  Friday & Saturday of every month.

Our Secondary care Rheumatology clinics are mentioned below:

CMC Chittoor Campus – Monday, Tuesday, Thursday & Friday 9.00am – 4.00pm

CFH Odanchatram- Last Tuesday & Friday of every month:  9.00am – 5.00pm

CMC Ranipet Campus- Monday – Friday 9.00am – 4.00 pm

We also do tele-consultations on Tuesdays, Wednesdays, Fridays & Saturdays

We carry out many procedures (more than 4000 per year) like joint injections , relevant biopsies, synovial fluid aspirations in our procedure clinic on four days a week at Alpha clinic treatment room.

We have some of the largest cohort of systemic autoimmune connective tissue diseases in the world under our follow up. To mention a few, we have more than 5000 SLE  (Lupus), more than 500 primary sjogren’s syndrome,  > 500 systemic sclerosis and more than 500 Takayasu arteritis patients, apart from tens of thousands of rheumatoid arthritis and spondyloarthritis patients under our follow up;

Appointments are full often up to 3 months in advance for consultants and up to 2 weeks for general OPD.  Full work up of new cases may take up to 10 days. Patient should come prepared for this period. Follow up of our old patients require only a few days for review and regular follow-ups are recommended. Patients can book appointments on line or contact our secretary for the procedures.

In-patient services

In addition to these, we also have inpatients services both in general and private ward; usually about 25 patients are in the wards at any time.  In patient admission for full evaluation, is also a good way of evaluation, as doctors can evaluate and observe them on daily basis.  Seriously ill patients must go to casualty without waiting for appointments.