9^th European Congress on Rheumatology, Autoimmunity and Orthopedics October 16-17, 2018 Warsaw, Poland

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.

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.

Rheumatoid arthritis is a chronic, systemic inflammatory disorder that primarily affects joints. It happens when the immune system attacks your own tissues and causes joint pain, swelling, and stiffness. It’s not part of normal aging.  It may result in deformed and painful joints, which can lead to loss of function. The disease may also have signs and symptoms in organs other than joints. The cause of rheumatoid arthritis is not completely understood. The process involves inflammation and fibrosis of the capsule around the joints. It also affects the underlying bone and cartilage. Treatments include both medication and non-pharmacological measures - the goal being to control joint inflammation and prevent joint damage and disability. The causes of Rheumatoid arthritis are not completely understood. Juvenile rheumatoid arthritis is the most common type of arthritis in children under the age of 17. It causes persistent joint pain, swelling and stiffness. Some children may experience symptoms for only a few months, while others have symptoms for the rest of their lives. Some types of juvenile rheumatoid arthritis can cause serious complications, such as growth problems and eye inflammation. A TNF inhibitor is a pharmaceutical drug that suppresses response to Tumour (TNF), which is part of the inflammatory response. It is used in the treatment of rheumatic arthritis. Gene expression has recently been at the forefront of advance in personalized medicine, notably in the field of cancer and transplantation, providing a rational for a similar approach in rheumatoid arthritis. While Disease-Modifying Anti-Rheumatic Drug (DMARD) Therapy also have high impact for Active Rheumatoid Arthritis.

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.

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. 

Musculoskeletal ultrasonography has turned into an imperative indicative device in rheumatoid joint pain. In Germany it is a piece of the rheumatology preparing, and numerous ultrasound courses give facilitate instruction. Just over the most recent five years the global significance of ultrasound in rheumatology has expanded drastically. Sonography can be executed as a bedside system and as an expansion of the clinical examination. It is effectively endured by the patients, and it can be rehashed whenever. Schober's test is a test utilized as a part of rheumatology to gauge the capacity of a patient to flex his/her brings down back. The reason for the Schober test is to mirror the lumbar ROM amid flexion. An Arthrogram is a symptomatic test which inspects within a joint to evaluate damage or a side effect you might be encountering. The test is finished by first infusing contrast which traces the delicate tissue structures in the joint (e.g. tendons and ligament) and makes them clearer to see on the pictures or pictures that will be taken of the joint. This is typically done utilizing fluoroscopy. 

A Rheumatic ailment influences the joints, muscles and connective tissues. A few, similar to osteoarthritis, are the consequence of wear and tear. Others, for example, rheumatoid joint inflammation, are safe framework issues. Treatment design will probably incorporate prescriptions, general exercise, a sound eating regimen, push administration, and rest. Normal Rheumatic issue are Lyme infection, Systemic lupus Erythematosus, Behcet's Ailment, Polymyalgia Rheumatica, Rheumatic fever. Lupus erythematosus is a name given to an accumulation of immune system sicknesses in which the human resistant framework winds up plainly hyperactive and assaults ordinary, solid tissues. Rheumatic fever is a fiery illness that can include the heart, joints, skin, and cerebrum. Numerous rheumatic ailments are unending conditions. They are probably not going to leave. There may not be a cure for our condition, but rather viable administration is accessible for most.Many individuals with rheumatic ailment lead upbeat, fulfilling lives quite a long time. 

An orthopaedic mattress is a mattress intended to support the joints, back and complete body. As its name advocates, an orthopedic mattress has been influenced by the medical study of Orthopedics which emphases on disorders or defects of the spine and joints. Orthopaedic mattresses have, therefore, been created to combat the problems one might experience with a bad back or joints by providing a firm mattress which suggests targeted, tailored support. Orthopedic shoes are particularly designed shoes that provide support and pain relief for people suffering with some type of pain in the legs, ankles, or feet. The main function of orthopedic shoes is to provide more care for the feet and ankles than is accomplished by simple footwear. 

Musculoskeletal Disorders or MSDs are injuries and sicknesses that affect the human body’s movement or musculoskeletal system (i.e. muscles, tendons, ligaments, nerves, discs, blood vessels, etc.). It can arise from the contact of physical factors with ergonomic, psychological, social, and occupational factors. When a worker is wide-open to MSD risk factors, they begin to fatigue. When fatigue outruns their body’s recovery system, they develop a musculoskeletal imbalance. Over time, as fatigue endures to outrun recovery and the musculoskeletal imbalance persists, a musculoskeletal disorder develops. In some cases, they cause pain and discomfort that interferes with your everyday activities. Early diagnosis and treatment may help ease your symptoms and progress your long-term outlook.

Autoimmunity is the system of immune responses of an organism against its own healthy cells and tissues. Any disease that results from such an aberrant immune response is termed an autoimmune disease. More freshly it has become accepted that autoimmune responses are an integral part of vertebrate immune systems (occasionally termed "natural autoimmunity"), normally prevented from causing disease by the phenomenon of immunological tolerance to self-antigens.[citation needed] Autoimmunity should not be confused with alloimmunity. Second, autoimmunity may have a role in permitting a rapid immune response in the early stages of an infection when the obtainability of foreign antigens limits the response (i.e., when there are few pathogens present). The idea of autoimmunity is abstractly similar to play-fighting. The play-fighting of young cubs (TCR and self-MHC) may result in a few scratches or scars (low-level-autoimmunity), but is valuable in the long-term as it primes the young cub for proper fights in the future.

Rheumatological conditions can sometimes present as emergencies. These can occur due to the disease process or may be iatrogenic. Some of the important articular emergencies are septic arthritis, acute polyarthritis, scleroderma renal crisis, erythema nodosum, acute gout and atlanto-axial dislocation. lassical polyarteritis nodosa may present with massive gastro-intestinal bleeding, intestinal perforation or acute pancreatitis. Adult respiratory distress syndrome, bilateral pneumonitis and diffuse alveolar haemorrhage due to systemic lupus erythematosus or systemic necrotising vasculitis and ventilatory failure due to polymyositis are some of the respiratory emergencies. Scleroderma is well known to cause renal crisis which can be fatal if not diagnosed and managed promptly. Microscopic polyangiitis and Wegener's granulomatosis may cause rapidly progressive renal failure. Cerebrovascular accident, cortical vein thrombosis, seizures and acute psychosis are important neurological complications of rheumatic disease. Cardiac emergencies include tamponade, acute myocarditis and acute myocardial infarction. Vision can be threatened in Behcet's disease, temporal arteritis and seronegative spondylarthritis. Catastrophic antiphospholipid syndrome is a devastating emergency. The management of above emergencies includes critical care, immunosuppression when indicated and withdrawal of the offending drug. Anticoagulants have to be used in the management of antiphospholipid syndrome. A good understanding of these conditions is of paramount importance for proper management.

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.

Autoinflammatory diseases are a comparatively new kind of diseases that are different from autoimmune diseases. Autoinflammatory diseases are produced by genetic mutations in molecules that are involved in regulating the innate immune response-a "hard wired" defense system that evolved to quickly recognize and act against infectious agents and other danger signals produced by our bodies. Freshly, the increased knowledge in the field of auto inflammation highlighted shared immune mechanisms in the pathogenesis of both classical monogenetic and multifactorial auto inflammatory diseases and a broad spectrum of chronic age-related inflammatory pathologies. The current growth in the prevalence of chronic inflammatory diseases makes this subject of topical interest.

Chronic pain is often defined as any pain enduring more than 12 weeks. Whereas acute pain is a normal feeling that alerts us to possible injury, chronic pain is very dissimilar. Chronic pain persists—often for months or even longer. This may arise from any injury, like a back strain, or there may be an ongoing cause, such as sickness. There are a variety of options for the treatment of chronic pain. Under the general category of medications, there are both oral and topical therapies for the treatment of chronic pain. Although technology can help health experts form a diagnosis, the best treatment plans are tailored to the person, with input from healthcare team members.

Physiotherapy helps renovate movement and function when someone is affected by injury, disease or debility. Physiotherapists help people affected by disease or debility through effort and exercise, manual therapy, education and guidance. They maintain health for people of all ages, helping patients to manage pain and avoid disease. The profession helps to inspire development and facilitate recovery, enabling people to stay in work while serving them to remain independent for as long as probable. At the core is the patient’s involvement in their own care, through education, alertness, empowerment and contribution in their treatment.

Sports medicine, also known as sport and exercise medicine (SEM), is a branch of medicine that deals with physical fitness and the treatment and prevention of injuries related to sports and exercise. Sports medicine focuses on helping people improve their athletic performance, recover from injury and prevent future injuries. It is a fast-growing health care field, because health workers who specialize in sports medicine help all kinds of people, not just athletes. Experts in sport and exercise medicine diagnose and treat any medical conditions which consistent exercisers or sports person’s happenstance. SEM consultants also provide clinical physical activity interventions, negating the burden of disease directly attributable to physical inactivity and the compelling evidence for the effectiveness of exercise in the primary, secondary and tertiary prevention of disease. Sports medicine professionals also treat unskilful athletes, those who want improved results from their exercise program, people who have suffered injuries and are trying to regain full function and those with infirmities who are trying to increase flexibility and capability.

Osteoarthritis (OA) is a most common type of Arthritis and a degenerative disorder in nature caused by the trauma, ageing joints and obesity etc. Sometimes it is called degenerative joint disease.  It is common chronic condition of the joints. In normal joints, a cartilage which 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. But in Osteoarthritis, 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. OA occurs most commonly after 40 years of age and typically develops gradually over a period of years. Patients with OAmay have joint pain on only one side of the body and it primarily affects the knees, hands, hips, feet, and spine. In early OA, the pain is minor and may take the form of mildstiffness in the morning. In the later stages of OA, inflammation develops; the patient may experience pain even when thejoint is not being used; and he or she may suffer permanent loss of the normal range of motion in that joint.Until the late 1980s, OA was regarded as an inevitable part of aging, caused by simple "wear and tear" on the joints. Thisview has been replaced by recent research into cartilage formation. OA is now considered to be the end result of severaldifferent factors contributing to cartilage damage, and is classified as either primary or secondary.

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.

Three-dimensional (3D) printing is a manufacturing method in which objects are made by fusing or depositing materials. On other hand, a printable organ is an artificially constructed device designed for organ replacement, formed using 3D printing techniques. Nowadays orthopedists have access to a variety of diagnostic tests with arthrography, dual-energy X-ray absorptiometry, CT scans, ultrasound, nerve conduction study, MRI, and electromyography just to name a few. All of them widen doctors’ perception and help them better understand patient’s condition before starting treatment. Orthopedics gets many benefits from planning on 3D models. Some of the most typical use cases are scoliosis or kyphosis surgeries and quite often evaluation of craniosynostosis cases. Some severe bone fractures may be better assessed with use of 3D models. Development of metallic implants and custom-made prostheses is the most significant and most valued direction when applying the 3D printing in the field of orthopedics. This is determined by the materials, equipment, and manufacturing capabilities available for 3D printing. This technology undoubtedly boosts surgeons’ confidence as it gives them the opportunity to evaluate all aspects of patient’s anatomy without losing time to do this in OR. Neither standard models nor 2D images can replace 3D printing as the first do not represent the specific case in debate and the latter may hide important details, especially in the spatial relationship between structures. 

Orthopedic trauma care covers the spectrum of simple isolated fractures to severe life threatening accidents with multiple broken bones. Osteochondrom as the most common benign tumor of the bones. The tumors take the form of cartilage-capped bony projections or outgrowth on the surface of bones (exostoses). It is characterized as a type of overgrowth that can occur in any bone where cartilage forms bone. Tumors most commonly affect long bones in the leg, pelvis, or scapula. Osteonecrosis is a process where the blood flow to the bone cells greatly decreases; the cells may die, causing the bone to collapse, because the bone and bone marrow of the human body are made of living cells that need a steady blood supply to stay healthy. Osteonecrosis can lead to pain, arthritis and limited use of affected joints. Some people may even need joint replacement surgery.Muscular dystrophy is a group of muscle diseases that weaken the musculoskeletal system and hamper locomotion. Muscular dystrophies are characterized by progressive skeletal muscle weakness, defects in muscle proteins, and the death of muscle cells and tissue. Atrophy and weakness of the limb muscles are extremely common in rheumatoid arthritis, the most likely causes being inhibition and disuse as a result of painful movement.