Mumbai can boast of the best specialists
in every field including rheumatology. We have some of the
best rheumatologists in Mumbai. Unfortunately, the family
physicians still send their patients with joint trouble to
orthopaedic surgeons for diagnosis. Many such patients are
not even aware of rheumatology as a speciality. I will define
a rheumatologist as a medical orthopaedic physician. Ideally,
the diagnosis should be made by the rheumatologist and the
operation should be done by an orthopaedic surgeon.
The field of rheumatology is expanding and in every speciality, the invasive
procedures are gaining popularity, compared to the simple old methods
of taking history, doing clinical examination and blood tests.
The time has come when even the rheumatologists should realise what the
public wants. The public would appreciate any invasive or interventional
procedures. A few of them are listed below
| 1. |
Aspiration of a joint :
Simple aspiration of a joint for diagnostic purposes
(e.g. to see crystals, to do culture for organisms
or for therapeutic purposes) should be offered in a
rheumatology clinic and the patient should no longer
be sent to an orthopaedic surgeon for this simple procedure. |
| 2. |
Sonography : Today the modern
cardiologists do 2D Echo cardiography in their clinics,
and the obstetricians keep a sonography machine to
look at every foetus, rather than employ old time method
of palpation. Similarly, the rheumatologist must keep
a small sonography machine, which can help in making
a diagnosis by visualising the synovial membrane or
fluid etc. |
| 3. |
Arthroscopy : Presently patients are
being sent to orthopaedic surgeons for the diagnostic
investigation of arthroscopy. It is time that diagnostic
arthroscopy should be done by the rheumatologists,
especially now that smaller flexible scopes are available.
I am convinced that with a strong clinical acumen,
the rheumatologist will be able to detect more information
than an orthopaedic surgeon. |
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