Consultant Rheumatologist MBBS, MRCP, FRCP, CESR Rheumatology Associate Professor & Head of Department Shalamar Hospital Board Member of Arthritis Care Foundation, Adjunct Faculty University Health Sciences, Lahore
Rheumatic diseases encompass more than 200 different diseases that span from various types of arthritis to osteoporosis and on to systemic connective tissue diseases.
A third of people of all ages and gender are affected at some point during their lifetime. Women, however, are more frequently affected than men.
You might suspect that you have a rheumatic disease if you have signs and symptoms, which include the following: Persistent joint pain, tenderness, inflammation indicated by joint swelling, stiffness, redness, and/or warmth, joint deformity, loss of range of motion or flexibility in joints, extreme fatigue, lack of energy, weakness, or a feeling of malaise.
There are many myths and misconceptions about arthritis. These are perpetuated by the spread of inaccurate information and can keep a person away from managing the disease properly. Here are some examples:
1) Arthritis is an old person's disease. Fact: Arthritis can occur at any age.
2) Arthritis is induced by a cold, wet climate. Fact: Climate itself is neither the cause nor the cure.
3) Arthritis is caused by a poor diet. Fact: There is little scientific evidence that specific food prevents or causes arthritis, there are few diseases, such as gout, where the intake of certain types of food or drinks (alcohol) can precipitate an attack.
Knee osteoarthritis commonly presents with deep, activity-related pain
around the joint line, morning or start‑up stiffness, and progressive
loss of function, particularly when using stairs or walking on uneven
ground. Patients often describe swelling, intermittent warmth, crepitus,
and a feeling of “giving way” that can erode confidence in the joint
and limit day‑to‑day independence.
From a rheumatologist’s perspective,
it is essential to distinguish mechanical symptoms of osteoarthritis
from inflammatory arthritis, as coexisting conditions such as rheumatoid
arthritis or crystal arthropathy may subtly alter the pattern of pain
and stiffness.
Diagnosis begins with a meticulous history and focused musculoskeletal
examination to assess gait, alignment, range of motion, joint line
tenderness, effusion, crepitus, and periarticular muscle strength.
Weight‑bearing knee radiographs remain the first‑line investigation,
demonstrating joint‑space narrowing, osteophytes, subchondral sclerosis,
and deformity, while MRI and ultrasound are reserved for more complex
cases or when soft‑tissue or inflammatory pathology is suspected.
Blood
tests, including inflammatory markers, rheumatoid factor and anti‑CCP
antibodies, are used selectively to exclude systemic inflammatory
arthritis and tailor long‑term management
Management with Dr Saira Khan at Lahore Rheumatology is structured,
evidence‑based and highly personalised, combining lifestyle
optimisation, targeted pharmacotherapy and advanced interventional
options.
Individualised programmes focus on weight reduction, quadriceps
and hip strengthening, and low‑impact exercise, supported by
analgesics, topical and oral NSAIDs, and joint‑protective bracing where
appropriate.
For patients needing more robust pain control, Dr Khan
offers image‑guided intra‑articular therapies, including corticosteroid,
hyaluronic acid and biologically‑based injections, with timely referral
for orthopaedic opinion when joint replacement becomes the most
effective solution
Rheumatoid arthritis (RA) is a chronic autoimmune
disease in which the immune system mistakenly attacks the lining of the
joints, causing pain, swelling and stiffness, often in the small joints
of the hands, wrists and feet.
It typically presents with prolonged
early-morning stiffness, symmetrical joint swelling and fatigue, and may
be associated with systemic features such as weight loss or low-grade
fever.
Without timely treatment, ongoing inflammation can lead to
progressive joint damage, deformity and functional disability, so early
recognition is critical.
Diagnosis of RA relies on a detailed clinical assessment supported by
targeted investigations.
Persistent synovitis in multiple joints,
especially when symmetrical and involving the small joints of the hands
and feet, raises strong suspicion, which is then reinforced by blood
tests such as rheumatoid factor, anti‑CCP antibodies and inflammatory
markers.
Imaging with ultrasound or MRI can detect synovitis and
erosions at an early stage, while plain radiographs help monitor
structural damage over time and guide long‑term management decisions.
From a rheumatologist’s perspective, optimal management of RA combines
rapid control of inflammation with long‑term protection of joint
structure and function.
Conventional disease‑modifying antirheumatic
drugs (DMARDs) such as methotrexate are usually introduced early, often
in combination with short‑term glucocorticoids, and escalated to
biologic or targeted synthetic DMARDs if disease activity remains high.
A
comprehensive plan also includes pain control, physiotherapy,
occupational therapy, joint protection strategies and close
disease‑activity monitoring, with the goal of achieving remission or low
disease activity and preserving patients’ independence and quality of
life.
Psoriatic arthritis is a chronic inflammatory arthritis
linked to psoriasis, where the immune system mistakenly attacks joints,
entheses and skin, causing pain, stiffness and swelling.
It can affect
any joint, but commonly involves the hands, feet, knees, ankles and
spine, and often presents with swollen, “sausage‑like” fingers or toes
(dactylitis), tendon and heel pain (enthesitis), fatigue and
characteristic nail changes such as pitting or onycholysis.
Symptoms
usually fluctuate, with flares of increased pain and stiffness
interspersed with periods of partial remission, and without treatment
can lead to progressive joint damage and disability.
Diagnosis is based on a careful clinical assessment of joint, skin and
nail findings, supported by targeted investigations.
There is no single
diagnostic test; instead, rheumatologists look for patterns such as a
history of psoriasis, dactylitis, enthesitis, asymmetric oligoarthritis
or axial involvement, while using blood tests mainly to exclude other
causes such as rheumatoid arthritis.
Imaging with X‑ray, ultrasound or
MRI can demonstrate features typical of psoriatic arthritis, including
periosteal new bone formation, erosions and enthesitis, and helps in
monitoring long‑term structural change.
Management aims to control inflammation, protect joints and improve
overall quality of life through a combination of medication and
lifestyle measures.
Conventional DMARDs such as methotrexate,
leflunomide or sulfasalazine are often first‑line for peripheral
disease, while biologic and targeted synthetic agents (for example TNF,
IL‑17, IL‑23 or JAK inhibitors) are used when disease remains active or
when there is significant axial involvement or enthesitis.
Weight
optimisation, smoking cessation, tailored exercise, skin and nail care
and close, long‑term follow‑up with a rheumatologist are essential to
minimise flares, limit joint damage and maintain day‑to‑day function
Systemic lupus erythematosus (SLE) is a chronic
autoimmune disease in which the immune system loses tolerance and
attacks healthy tissues, causing widespread inflammation that can affect
skin, joints, kidneys, blood cells, lungs, heart and nervous system.
It
often presents with profound fatigue, joint pains and swelling,
photosensitive rashes (classically a “butterfly” rash over the cheeks
and nose), mouth ulcers and hair thinning. The course is typically
relapsing–remitting, with flares of disease activity interspersed with
quieter periods, and without appropriate treatment SLE can lead to
irreversible organ damage and significant impact on quality of life.
Diagnosis relies on careful clinical assessment supported by
immunological and organ‑specific investigations.
Rheumatologists look
for a combination of features such as characteristic rashes,
inflammatory arthritis, serositis, renal involvement and haematological
abnormalities, alongside autoantibody tests including ANA, anti‑dsDNA
and extractable nuclear antigens.
Complement levels, urine testing, and
imaging or biopsy (particularly renal biopsy when lupus nephritis is
suspected) help define the pattern and severity of organ involvement and
guide the intensity of immunosuppressive therapy.
Management of SLE aims to suppress active inflammation, prevent flares,
protect organs and minimise treatment toxicity through an
individualised, long‑term plan.
Hydroxychloroquine is a cornerstone for
most patients, usually combined with judicious use of glucocorticoids
and additional immunosuppressive agents such as azathioprine,
mycophenolate or methotrexate, with biologic therapies reserved for
refractory or severe disease.
Equally important are sun protection,
cardiovascular risk reduction, vaccination, pregnancy planning where
relevant, and close multidisciplinary follow‑up so patients feel
supported, understand their condition and can maintain the best possible
function and life goals.
Osteoporosis is a systemic skeletal disorder in which bone density and bone quality are progressively reduced, making bones fragile and more likely to fracture after minimal trauma.
It often develops silently over many years, with the first sign sometimes being a low‑impact fracture of the wrist, spine or hip, or a gradual loss of height and curvature of the spine.
Post‑menopausal women and older men are most at risk, particularly when additional factors such as family history, low body weight, steroid use, smoking, excess alcohol, vitamin D deficiency or inflammatory rheumatologic disease are present.
Diagnosis is centred on bone mineral density testing using DEXA scanning, which provides a T‑score to classify bone health and estimate fracture risk.
Clinical assessment also considers prior fractures, medications, endocrine status, lifestyle and co‑existing conditions, often supported by targeted blood tests to exclude secondary causes such as vitamin D deficiency, hyperparathyroidism or myeloma.
Fracture‑risk calculators and vertebral fracture assessment help stratify patients into low, moderate or high risk so that treatment at Dr Saira Khan’s clinic can be tailored, from intensive bone‑protective therapy to focused lifestyle and monitoring strategies.
At Dr Saira Khan’s clinic, osteoporosis care is holistic, evidence‑based and personalised, combining lifestyle optimisation with pharmacologic treatment when indicated.
Patients receive structured advice on calcium and vitamin D intake, safe weight‑bearing and resistance exercise, smoking cessation and alcohol moderation, alongside bone‑strengthening therapies such as oral or intravenous bisphosphonates, denosumab, or anabolic agents where appropriate.
Regular follow‑up, DEXA monitoring and fracture‑prevention planning allow Dr Khan and her team to adjust therapy over time, minimise side‑effects and support patients in maintaining mobility, independence and confidence in daily life.
We are working hard to provide the latest information relating to your rheumatic disease. The following documents have been translated in to Urdu to make it easier for you to understand your condition and to perform the required exercises correctly.
Practice Locations
Lahore Rheumatology Clinic
12-C White House Lane, Sundar Das Road Lahore
Tel: +923314402476 www.Lahore-Rheumatology.com
Integrated Medical Care Hospital
153 Street 1, F Block, Phase 5 D.H.A, Lahore 54792,
Tel: +9242-111-111-462 www.imchospital.com.pk
Shalamar Hospital
Shalimar Link Road, Shalimar Larechs Colony, Lahore, 54000
