Rheumatology

Rheumatology Services at Da Medika Polyclinic

Diagnosis and treatment of all rheumatic diseases using the most advanced methods, as well as successful treatment of unexplained and inadequately treated medical conditions. The Rheumatology Center is led by Prof. Dr. Nemanja Damjanov, a European-recognized internist-rheumatologist with 42 years of experience.

What is rheumatology?

Rheumatology is a branch of internal medicine which is devoted to the diagnosing and treating degenerative inflammatory and systemic diseases. These are usually the diseases which affect joints, muscles, bones, tendons, ligaments and cause pain the musculoskeletal system. Rheumatology is also concerned with systemic autoimmune diseases when the intensified activity of the patient’s immune system causes an inflammatory process by attacking the healthy tissue of joints, muscles and bones as well as of certain internal organs, blood vessels, mucosa, eyes, the skin etc.

The most common diseases rheumatologists treat are:

  • The inflammation of tendons, ligaments and muscles (non-articular rheumatism)
  • Ostheoarthritis (arthrosis), i.e. a degenerative disease of knee and hip joints and small joints of hands
  • Rheumatoid arthritis, spondyloarthritis (psoriatic arthritis, Bechterew’s disease, enteropathic arthritis, reactive arthritis) acute arthritis (gout and pseudogout) and other inflammatory diseases of joints
  • Systemic lupus erythematosus, systemic sclerosis, polymyositis-dermatomyositis, vasculitis and other systemic diseases of the connective tissue.

 

The symptoms of rheumatic diseases for which you should visit a rheumatologist

  • Pain in joints and/or muscles when resting or caused by a movement, accompanied by limited movement, pain in the lumbar, sacrum thoracic and cervical spine
  • Stiffness and pain in small joints of fingers, wrists, feet (especially immediately after waking up in the morning, which lasts longer than 30 minutes)
  • Swelling, redness of skin which is warm to the touch in the region of joints (especially joints of the big toe or the ankle)
  • Skin rashes and (butterfly-shaped) redness on the face, accompanied by sensitivity to sunlight and hair loss
  • redness, rashes, scaly changes to the skin and nails,  pain in the heel and the foot, blurred vision
  • Dry eyes and mucosal dryness of the mouth and the throat.

What types of examinations can a rheumatologist at Da Medika Polyclinic perform?

1. An examination by a specialist in internal medicine – rheumatologist

Pregled kod interniste kardiologa obično započinje detaljnim razgovorom o zdravstvenoj istoriji pacijenta, uključujući simptome, porodičnu anamnezu i način života. Nakon toga, lekar obavlja fizički pregled koji može uključivati merenje krvnog pritiska, puls, auskultaciju srca i pluća te eventualno dodatne dijagnostičke testove kao što su EKG ili ultrazvuk srca. Cilj je proceniti funkciju srca i identifikovati eventualne kardiovaskularne probleme.

2. Ultrasound examination

An ultrasound examination is a completely painless diagnostic method. Each ultrasound examination requires that gel which helps ultrasound passes through tissues and the image is created on the screen of the ultrasound machine is applied to the skin which covers the part of the body which is being examined. Based on that image, a rheumatologist can see the changes or damage to tissues.

  • The ultrasound of joints is performed when there is a swelling, inflammation or difficulty moving joints. The ultrasound of joints may reveal the ossification of joints (arthrosis) and the inflammation of the joints (arthritis). Changes to the joints of hands and feet (fingers and toes), the wrist, the shoulder, the elbow, the hip, the knee and the ankle as well synovitis are successfully discovered by the ultrasound of joints.
  • The ultrasound of tendons is performed when inflammation or the injury to tendons is suspected for pain and limited movements. The ultrasound of tendons help in establishing the exact place where the inflammation, damage or rupture of the tendon occurred as well as the degree of its damage (most often as a result of sports injuries or straining). Tendons connect the muscle and the bone, and thus the ultrasound of tendons also reveals injuries and fibrosis of the Achilles tendon, tendons of the shoulder and the elbow, inflammation of the tendons of the knee, the hip, the wrist. The ultrasound of tendons may also reveal tenosynovitis (the inflammation of the tendon sheath) in the region of the hand, the carpus and forearms and of ankles and feet.
  • The ultrasound of ligaments is performed when there is pain, a swelling and the limited movement of joints as the inflammation of the ligaments often coincides with the inflammation of joints. Ligaments join bones. Ligaments can be injured or inflamed with rheumatic diseases.
  • The ultrasound of bursae is performed when bursitis, i.e. the inflammation of the fluid-filled sacs, which, serve as cushions to absorb and reduce friction between the bones of the joint, tendons and ligaments,  is suspected. Bursitis occurs as a result of excessive strain of the joint of tendons or an infection.
  • The ultrasound of muscles is done in cases of painful conditions and when spraining and injuries related to tendons and ligaments as well as autoimmune polymyositis are suspected.  The most common rheumatic inflammatory diseases of muscles which the ultrasound of muscles may discover are dermatomyositis (also affects the skin) and polymyositis (affects the neck, shoulders and hips). 
  • The ultrasound of salivary glands is performed when Sjögren’s syndrome, i.e. a systemic disease of connective tissue accompanied with dry eyes and a dry mouth, is suspected. This syndrome often occurs in conjunction with systemic lupus and rheumatoid arthritis, and thus the ultrasound of salivary glands may also help in more precise diagnosing of systemic rheumatic diseases.
  • The ultrasound of the skin and subcutaneous tissue is performed when Scleroderma, i.e. systemic sclerosis, with which the thickening or tightening of the skin occurs, or psoriasis, i.e. psoriatic arthritis, are suspected.

 

3. Laboratory blood and urine tests

They are necessary for diagnosing certain rheumatic diseases, but also for monitoring treatment. Depending on the disease, a rheumatologist determines which the laboratory tests are to be done.

What types of treatment interventions can a rheumatologist in Da Medika Polyclinic perform?

Diagnostic and treatment interventions

  • A puncture of the joint with the help of ultrasound monitoring and the analysis of synovial fluid, if required. Punctures of joints are performed when there is a swelling of a joint, i.e. when there is excess synovial fluid. After the skin in the place where the needle is to be inserted has been disinfected, a puncture of the joint commences.  The needle is inserted into the joint with the help of ultrasound monitoring and the excess fluid is extracted with the help of a syringe. The syringe is used to extract excess fluid. Thus the sprain of the capsule of the joint is reduced and in that way the pain is alleviated at the same time. If synovial liquid is blurred, it is sent for a biochemical analysis so that a more precise diagnosis and treatment would be given. This diagnostic procedure is most usually accompanied by the infiltration, i.e. the administration of the injection with a medication through the same needle which was used for the puncture. Medications which are most usually used are from the group of glucocorticoids,  hyaluronate  or the Orthokine serum.
  • A puncture of the tendon sheath with the help of ultrasound monitoring and the analysis of synovial fluid, if required, are most usually done in case when de Quervain’s syndrome is the cause of a bacterial infection, which may affect the tendon sheaths in the palm and around the fingers (most usually the thumb, the movement of which is very painful which). The surface of the skin in the place where the needle is inserted is disinfected. A puncture of the tendon sheath is performed with the help of ultrasound monitoring so that the contents which have caused the inflammation would be extracted precisely, without damage being caused to the surrounding tissue and blood vessels. If a rheumatologist suspects a bacterial infection based on the appearance of synovial fluid, it is necessary that the analysis of synovial fluid should be conducted and that an antibiotic by which the infection would be treated should be prescribed. 

 

  • A puncture of bursae with the help of ultrasound monitoring and the analysis of synovial fluid, if required, are done in case of bursitis, i.e. the inflammation of sacs filled with synovial fluid, which serve to reduce the friction between bones and tendons, tendons and tendons, bone spurs and the skin. This is applied with the following types of bursitis: elbow bursitis, kneecap bursitis, Baker’s cyst (in the knee pit), thochanteric bursitis, sacroiliac bursitis (in the region of the sacrum). A puncture of a bursa under the ultrasound control starts with the disinfection of the place where the needle is to be inserted. Following that, the insertion of the needle into the very bursa is monitored with the help of an ultrasound machine, while excess contents are extracted with the syringe. If the contents are blurred, they are sent for a biochemical analysis so that synovial liquid would be analysed and so that the diagnosis would be established more precisely and the treatment prescribed.

 

  • Precise administration of medications into joints, tendon sheaths, attachments of ligaments with the help of ultrasound monitoring is most usually done immediately after the puncture. Thanks to the image on the screen, an ultrasound machine enables a rheumatologist to insert the needle precisely to the place which is affected by inflammation, without injuring the surrounding tissue ans blood vessels,  inject an adequate medicine and thus enable the most efficient and the most effective treatment.

 

  • The application of the ORTHOKINE method with the help of ultrasound monitoring. The ORTHOKINE therapy is applied in the treatment of painful and damaged joints caused by osteoarthritis, but also of chronic inflammation of hips, knees and shoulders. The serum is produced from the blood of the very patient and thus there are no side effects nor allergic reactions. The Orthokine serum contains growth factors, and thus it regenerates tissue and induces the growth of new healthy tissue in a very short time, but with the long-term effect. 

 

The place where the needle is inserted is disinfected and then the ORTHOKINE serum is injected precisely and with the help of ultrasound monitoring to the spot which is painful and/or affected by inflammation.

 

What does an examination by a rheumatologist involve?

A clinical examination by a rheumatologist does not require any special preparation of a patient, but it is recommendable that jewellery should be taken off fingers prior to the examination (especially with rheumatoid arthritis, arthrosis of finger joints and inflammation of the tendons of hands).

The patient should bring all previous laboratory test results, scans, doctor’s reports and other medical documentation.

An examination by a rheumatologist starts with the data on complaints and the course of the disease as well as on other diseases (personal and family medical history) being taken. If rheumatic diseases to which there is an inherited tendency are suspected, you will be inquired about the diseases your close relations have suffered from.

In case you possess previous laboratory test results, scans and other medical documentation, a rheumatologist will review it.

An examination by a rheumatologist involves the examination of the skin in the parts of the body which are painful so that it would be established whether a rash, a swelling or atypical lumps are present. A rheumatologist will palpate swollen or red skin and joints so as to establish whether the skin in that part is warm to touch and whether it hurts when touched or pressed. A rheumatologist will also palpate your joints and will check their mobility and sensitivity to pain.  You will be often asked to walk before a rheumatologist.

 

The doctor will probably ask you some of the series of questions as well as part of the examination:

  • When did you feel the pain for the first time, how long did it last, what was the pain like and what were you doing at that time? Which of your joints is painful and how much does it hurt?
  • Is the pain dull, sharp, stabbing, shooting, burning or does it occur only when the affected area is touch or pressed, when you are seated or when making a movement?
  • Has the intensity of the pain changed over the past days or weeks?
  • How does the pain affect your regular daily activities?
  • Do the pain and stiffness occur in the morning as soon as you wake up and how long do they last?
  • Does the pain wear off or disappear if you take a medication? Which medication do you take?
  • Do you feel any other discomfort which seems to be linked to the main problem?

 

In the majority of cases, an examination by a rheumatologist  also involves the ultrasound examination of the parts of the body affected by the disease.

 

Eventually, an examination by a rheumatologist involves establishing the diagnosis, drafting a report and prescribing adequate treatment.  If a clinical examination is not sufficient,  a rheumatologist will provide you with the list of laboratory tests which you have to have done and/or  you will be asked to have certain scans done or be referred to other specialists. Upon that, you are to come for a check-up, when you will be given the diagnosis and treatment. 

 

Experts conducting rheumatological examinations at Da Medika Polyclinic

Rheumatology examinations at Da Medika Polyclinic are conducted by Prof. Dr. Nemanja Damjanov, internist-rheumatologist, and Dr. Nikola Roganović, internist-rheumatologist.

Our Team of Rheumatologists

Specialist in Internal Medicine
Specialist of Internal Medicine - Rheumatologist

Impressions of our patients

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