8th International Conference of Orthopedic Surgeons and Rheumatology March 22-23, 2017 Rome, Italy

The division of Pediatric rheumatology assess children with symptoms involving the pain or inflammation in joints, muscles or fibrous tissue and some present symptoms including Pain, weakness, rash and fever with other chronic inflammatory diseases and provide comprehensive diagnostic services for children with rheumatic disorders and its associated conditions. Juvenile Rheumatic Arthritis (JRA) is the common cause of Chronic Arthritis in Children but some other diseases in which arthritis is but one of many symptoms like dermatomyositis, lupus and vasculitis etc. Pediatric rheumatology section mainly focuses on teenagers and children who have arthritis and some other autoimmune diseases.

The group of diseases which affects the joints, muscles and connective tissues are categorise as Rheumatic Diseases. Some Rheumatic diseases considered as autoimmune diseases in which body’s own immune system attack on the parts of the body. Approximately there are 100 types of rheumatic disorders. It includes degenerative disorders like Osteoarthritis and inflammatory condition such as rheumatoid arthritis. Some major rheumatic disorders are Ankylosing Spondylitis, Gout, Osteoporosis, Rheumatoid Arthritis (RA) characterized by the inflammation of joints, Sjogren's Syndrome and Systemic Lupus Erythematosus which is a chronic diseases that affects the joints, muscles and other parts of the body and Lupus can be called as collection of autoimmune diseases in which body’s own immune system becomes hyperactive and attacks its own normal, healthy tissues. Treatment plan of Rheumatic disorders include medication like NSAID’s, DMARD’s and Biologic etc. and regular exercise and a healthy diet with stress management. Many rheumatic diseases are chronic in nature but with effective management, many people with rheumatic diseases lead happy and satisfy lives.

Lupus is one of disorders of immune system that are chronic in nature. It is an autoimmune disease which can affect any part of the body (skin, joints or any organ inside the body). In Lupus host antibodies does not able to understand the difference between the foreign invader to the body and body’s healthy tissues and starts damaging the own healthy tissues which creates inflammation. The people with lupus have many different symptoms like painful or swollen joints, extreme fatigue, dry mouth, skin rashes, fever, and kidney problems. At present there is no cure for lupus but I can effectively manage with treatment through drugs. 

Soft tissue rheumatism is a disease which is used to describe the group of conditions that cause due to the pain, swelling, stiffness or inflammation around the soft tissues around the joints, tendons, ligaments and muscles etc. This disease has a category of disorders include tendinitis, bursitis, tenosynovitis, Enthesitis, myofascial pain syndrome, fibromyalgia and capsulitis. Soft tissue rheumatic disorders refer to non-articular pain; patients often attribute their symptoms to nearby joints. This disease is treated by Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and non-narcotic drugs and corticosteroids injections for relieving pain. Physical and occupational therapy is promoted for swift body movements.

Arthritis is described as a cluster of more than 100 types of different joint disorders featuring inflammation of one or more joints. There are different cause of happening arthritis include injury (leading osteoarthritis), heredity factors, autoimmune (Rheumatoid Arthritis), by the effect of infections i.e. bacterial or viral, by metabolic abnormalities such a gout and pseudo gouts and Systemic Lupus Erythromatosus. Arthritis causes inflammation, Joint pain, swelling, redness, joint stiffness etc. The common form of arthritis is Osteoarthritis occurs due to the daily wearing and tearing of the joint, trauma to the joint, Infection of the joints and age related factors.  Due to the wearing of cartilage, it becomes rough and the space between the bones decreases and decrement in the lubrication of joints causes friction between the bones and produce painful spurs resulting joint destruction and deformity. I t can affect larger as well as smaller bones of the body like hip, wrist, knee etc. Women are more likely to have osteoarthritis than men. According to Arthritis foundation it is the leading cause of disability in America. Arthritis can be managed effectively; physical exercise and maintaining a healthy weight helps to reduce the pressure on your joints. It is the best way to prevent from arthritis. NSAID’s, DMARD’s and corticosteroids are used in medication treatment of Arthritis, Herbal medication also a good effect on arthritis. Surgery is the end stage treatment of arthritis.

Rheumatoid Arthritis is an autoimmune disease(when body’s immune system attacks on its own healthy tissues) in nature which is triggered by the body’s own faulty immune system and effects the joints of the body mainly knuckles, wrist, knees and other body parts also like including the eyes, lungs, skin, heart and blood vessels. It is a chronic Inflammatory type of disorders that affects the lining of joints and cause a pain, swelling, fever, limping, stiff joints etc. that can resulted in bone erosion and permanent joint destruction and deformity. The cause of RA is not completely understood. Juvenile Rheumatoid Arthritis JRA most common type of arthritis in children or teenagers’ causes’ persistent stiffness, swelling, joint pain. It can be fatal sometimes and leads to serious problem such as growth problems and eye inflammations. There is no cure for RA till now but it can effectively managed by the proper treatment by using pharmacological treatment using Disease-modifying anti-rheumatic drugs DMARDs combines with Non-Steroidal Anti-Inflammatory Drugs NSAIDs, Injections of Glucocorticoids are highly effective, TNF alpha inhibitors, T-cell activation inhibitors, B-cell depletes, IL-6 inhibitors, JAK inhibitors, immunosuppressant’s, and steroids. Introduction of Gene expression is a new advancement in the treatment of rheumatoid arthritis. Another method is reconstructive surgery provides great improvements of patients with end stage rheumatoid arthritis.

Osteoarthritis is a sub type of Arthritis and a degenerative disorder in nature caused by the trauma, ageing joints and obesity etc. It is common chronic condition of the joints. A cartilage is a rubbery material found at covering of the bone provides a smooth motion of between the joints and act as a cushion between the Bones. In OA cartilage breaks down which results in inflammation, pain, swelling, stiffness etc. In worse condition cartilage wears away and rubbing of bone against which results in the deformity or joint destruction. I t can affect both larger and smaller joints of the body but more often occurs in knees, hips and lower back of the body.

Rheumatic Diseases is characterized by inflammation (redness, heat, swelling, pain etc.). Some form of rheumatoid arthritis such as lupus effect the other organs of the body, a complete physical examination of heart, abdomen, lungs, nervous system, eye, ear and throats etc. is necessary. The doctor may order some test to confirm diagnosis with the help of sample like blood, synovial fluid etc. some common test that are used in diagnosis are:- Antinuclear antibody (ANA), C-reactive protein test, Complete blood count (CBC), Erythrocyte sedimentation rate (sed. rate), Rheumatoid factor, Synovial fluid examination. X-Ray techniques are also used for the diagnosis; it provides the images of bones. Some non-invasive techniques are Computed Tomography, (magnetic resonance imaging) MRI, and arthrography shows the image of whole joint. Musculoskeletal ultrasonography becoming an important diagnostic tool in RA. Clinical investigation is done with the help of Sonography. Schobers test is used in these disorders for the measurement of ability of a patient to flex his/her lower back. An Arthrogram diagnostic test is used to examine the injury in the bones, Fluoroscopy technique is used to show the clear images of the bones. There are different types of tools and techniques available such as MR arthrography test, cytopathology, sonography and low bone marrow density and its association with disease and some other measurement in rheumatoid arthritis will be discussed under this track. 

Therapies for rheumatic diseases vary depending upon the type of diseases or condition. The treatment of rheumatic diseases includes: Exercise: - Physical activity help to reduce the joint pain, joint stiffness and increase the flexibility and mobility of the bones, strength of muscles and endurance. Exercise helps to reduce weight which in turn reduces the pressure on the joints. The physiotherapist plays a major role in the management of patients with rheumatic diseases and helps the patients to achieve and maintain optimal function and independence. Therapists help patients to manage pain and promote mobility and day to day activities and stay active in home, community and leisure settings.  A well balanced diet along with the exercise helps people to manage their weight and stay healthy. Medication plays a major role in the treatment of the people with rheumatic diseases; it depends on the condition and individual. The medication do not provide a cure but limits the symptoms of the diseases prevent the progress of disease for further damage to the joint and other parts of the body. A variety of drugs used in the medication some of these are: - DMARD’S, Disease-Modifying Anti-Rheumatic Drug, NSAID’s (Non-Steroidal Anti-Inflammatory Drugs) and glucocorticoids, steroids etc. are generally used in the medication. Arthroplasty is a surgical procedure in Orthopedics, or total joint reconstruction is the cure at the end stage of the diseases. Advancement in the field of biologics approved for the treatment of the rheumatoid arthritis, these genetically engineered proteins derived from human genes which play a pivotal role in fuelling inflammation, a main feature of rheumatoid arthritis.

Knee replacement treatment, immunological therapy and chemo therapy for arthritis with the physiotherapeutic treatments, instruments and advancement will also be discussed under this track.

In medical terminology trauma refers to the critical bodily injuries and wounds. Orthopedic trauma means severe injury to the musculoskeletal system of the body such as bones, joints, ligaments, tendons etc. The fracture in musculoskeletal system becomes life threatening sometimes. Auto accidents are the most common cause of orthopaedic trauma. These types of injuries require an Orthopedic Surgeon and require an orthopaedic trauma care specialist. Impending dangers for patients can incorporate seeping out if significant supply routes are included or close to the trauma site, going into stun from agony and blood loss, and damage to internal organs brought about by cracked bones or pound wounds.

In this section we will discuss some important conditions related to the musculoskeletal system like Osteochondroma- A common benign tumour of the bones, Osteonecrosis-disease caused due to reduce of blood flow to the bones in the joints, bones starts to die and may break down. Muscular dystrophy- A disease that weakens the musculoskeletal system and hampers locomotion. Other bone disorder, Spine Orthopedics, and therapies, Scaffold support, bone tissue engineering and will also be discussed under this track.

Once in a while rheumatological associated problems present as emergencies. These emergencies are fairly common in clinical practice. Such types of emergencies are handled by the physicians. Rheumatic emergencies can occur due to the disease or by medical disorder caused by the diagnosis, treatment done by the physician. Patients with rheumatological emergencies are referred to the orthopedic surgeons. An orthopaedist has experience to tackle these types of acute problems and in most of the cases they can easily manage these problems. Some of these emergencies are septic arthritis: an infection of joint cause by the germs, it occurs due to the injury, during the surgery such as arthroscopy. Acute Polyarthritis: It is an autoimmune disorder include more than two joints simultaneously, it can happen at any age. Acute gout, acute monoarthritis and Lupus flare are some other rheumatic emergencies. These emergencies can be managed by critical care, by Pharmacological treatment like using of NSAID’s, corticosteroids, Cyclophosphamide etc. and immunosuppressive treatment. Anticoagulants must be utilized as a part of the administration of antiphospholipid disorder. A good comprehension of these conditions is of vital significance for appropriate management.

Orthopedics is the therapeutic speciality to fame that spotlights on wounds and diseases of your body's musculoskeletal framework. Orthopedic surgery will be surgery performed by a medical specialist, for example, an orthopedist or orthopedic specialist, prepared to manage issues that create in the bones, joints, and tendons of the human body. It involves surgical and non-surgical treatment of the diseases. Biomechanics is the investigation of the mechanical aspects of living life forms. From concentrating on the qualities and weakness of individual components, for example, bones, to inspecting how gatherings of tissues and embeds cooperate, biomechanical scientists are enhancing the comprehension of the body, as well as the plan of gadgets expected to repair the body. For studying musculoskeletal problems there is some experimentation including biomechanical tests, histological examinations, biochemical measures, and numerical model investigations.

In this section we shall also discuss joint replacement surgery, Pediatric orthopaedics, spine surgery, intensive care and other future aspects.

Pain management is the current area of increasing research and clinical effort in the field of rheumatology, pain management is turning into a region of expanding research and clinical exertion in the discipline of rheumatology. It is a very common symptom of patient with rheumatic disorders or musculoskeletal disease and it can happen in both inflammatory and non-inflammatory conditions. The pain associated with the rheumatic disorders is difficult to determine. Development of pain is the cause of tissue damage due to the inflammatory or non-inflammatory conditions. Effective pain management is an important issue to be overcome in future. Rheumatologist access to the pain from the proximal cause of pain such as inflammation, tissue injury and concentrated a therapy to reduce cause of pain by multimodal approach, integrating pharmacological as well as non-pharmacologic treatments. In the view of new concept pharmaceutical treatment has wider scope in comparison to the traditional methods of using analgesics and nonsteroidal anti-inflammatory drugs.