What is rheumatic disease?


Rheumatism, any of several disorders that have in common inflammation of the connective tissues, especially the muscles, joints, and associated structures. The most common symptoms are pain and stiffness. Specific diseases that are alternatively called rheumatism include rheumatoid arthritis; rheumatic fever; septic arthritis that accompanies such diseases as gonorrhea, tuberculosis, or mycotic diseases (caused by fungus); and osteoarthritis.

Near the beginning of the 2nd century ce, Greek physician, writer, and philosopher Galen of Pergamum appears to have coined the term rheumatismos, in which rheuma means “to flow” (an alternative meaning is “phlegm”). A common usage was a “defluxion of rheum” from the nose or mouth. Galen knew that respiratory diseases causing the production of phlegm often resulted in patients developing painful maladies, such as the conditions now described as arthritis and neuropathy. Parisian physician Guillaume de Baillou reintroduced the word rheumatismos to medicine in the 17th century, in a work that was published posthumously (Liber de Rheumatismo et Pleuritide Dorsali; 1642). He used the word to describe a form of muscular rheumatism and to describe what is now known as rheumatic fever. Baillou knew that a respiratory disease called catarrh, which is associated with inflammation of the upper respiratory tract, was connected to rheumatism and that rheumatism was systemic in nature, affecting many parts of the body. The rheumatic maladies as described by Galen and Baillou were later associated with Streptococcus infections.

In the third volume of the first edition of Encyclopædia Britannica; or, A Dictionary of Arts and Sciences, published between 1768 and 1771, the entry on medicine contains a paragraph “of the rheumatism,” in which the authors provide an account of acute rheumatic fever. The description of the condition is similar to that provided in 1666 by British physician Thomas Sydenham in his work Methodus Curandi Febres, Propriis Observationibus Superstructura. In the encyclopaedic discussion, the primary lesion of rheumatic fever and rheumatism is noted: “Its proximate cause seems to be inflammation of the lymphatic arteries.” This determination by early pathophysiologists depicted rheumatic vasculitis, an autoimmunological inflammation of the arterial system. Later in the text, chronic rheumatism is mentioned as “either the remains of a rheumatic fever, or a continuation of pains that proceeded at first from lesser but neglected colds.”

Thus, it appears that the early Scottish and English physicians had determined correctly that rheumatic fever was not only distinct from other respiratory and cardiovascular diseases but also in some instances clearly of infectious etiology. Later advances in knowledge of infectious agents revealed that acute rheumatic fever likely involves high-grade autoimmunological responses to infection with Streptococcus bacteria, whereas lower-grade inflammation may be associated with either chronic infection or lingering affects of acute immunological responses.

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What Are Rheumatic Diseases?

More than 100 rheumatic diseases exist.

Rheumatic diseases are characterized by inflammation that affects the connecting or supporting structures of the body — most commonly the joints, but also sometimes the tendons, ligaments, bones, and muscles. Some rheumatic diseases even affect the organs.

These diseases can ultimately cause loss of function in those body parts.

Rheumatic diseases include arthritis, which literally means “joint inflammation” and itself encompasses more than 100 different disorders. Rheumatic diseases that primarily affect the spine are considered spondyloarthropathies.

In all, rheumatic diseases affect more than 46 million Americans, including 294,000 children, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Types of Rheumatic Diseases

Some of the most common rheumatic diseases include:

  • Osteoarthritis, the most prevalent type of arthritis, which primarily affects and destroys cartilage, the soft tissue that cushions the ends of bones within joints
  • Rheumatoid arthritis, an autoimmune disorder in which the immune system mistakenly attacks the synovium, a soft tissue that lines the joints, leading to inflammation
  • Fibromyalgia, a chronic condition marked by tender points and localized pain throughout the musculoskeletal system
  • Systemic lupus erythematosus, or simply lupus, an autoimmune disorder that causes inflammation in numerous parts of the body, including the joints, skin, kidneys, blood, lungs, heart, and brain
  • Gout, a type of arthritis that develops when needle-like crystals of uric acid deposit in the joints, most often those of the big toe
  • Juvenile idiopathic arthritis, the most common form of arthritis in children, which may be accompanied by fevers and rashes
  • Infectious arthritis, or arthritis that’s caused by an infection, such as Lyme disease or Neisseria gonorrhoeae, the bacteria behind gonorrhea
  • Psoriatic arthritis, a type of arthritis (and also considered a spondlyoarthropathy) that affects the fingers and toes and is associated with the skin disease psoriasis
  • Polymyositis, which affects the muscles and can affect the entire body
  • Bursitis, an inflammation of the bursas small fluid-filled sacs that reduce friction between bones
  • Ankylosing spondylitis, the most common spondyloarthropathy, which may affect the hips, shoulders, and knees, in addition to the spine
  • Reactive arthritis, or Reiter’s syndrome, a spondlyoarthropathy that develops after an infection of the urinary tract, bowels, or other organs
  • Scleroderma, or systemic sclerosis, an autoimmune rheumatic disease that leads to a thickening and tightening of the skin and inflammation and scarring in various other parts of the body, including the blood vessels, joints, and certain organs
  • Polymyalgia rheumatica, which causes pain and stiffness in tendons, muscles, ligaments, and tissues around joints

Rheumatic Disease Causes and Risk Factors

Experts believe rheumatic diseases are caused by a combination of genes and environmental factors. In general, having certain gene variants can increase a person’s susceptibility to rheumatic diseases, and factors in the environment may trigger the onset of the disease.

For instance, studies suggest that people with certain variations of human leukocyte antigen (HLA) genes — which help control immune responses — have an increased risk of developing rheumatoid arthritis. In these people, the disease may develop due to some kind of triggering event, such as hormonal spikes, infections from bacteria or viruses, or obesity.

Similarly, an inherited cartilage weakness combined with excessive joint stress may play a role in the development of osteoarthritis.

Various factors can put you at greater risk for developing one or more rheumatic diseases. For example:

  • Osteoarthritis is more common in older adults than younger adults
  • Women are far more likely than men to develop rheumatoid arthritis, scleroderma, fibromyalgia, and lupus
  • Gout and spondyloarthropathies are more common in men
  • Lupus most often affects African-Americans and Hispanics
  • Obesity and smoking increases your risk for a number of rheumatic diseases
  • Dietary factors may increase or decrease your risk for certain rheumatic diseases — gout is associated with diets high in purines, which are found in various types of meat

Rheumatic Disease Symptoms

The hallmark of these rheumatic diseases is inflammation.

For arthritis, inflammation typically causes one or more symptoms in the joints, including:

  • Pain
  • Stiffness, especially in the morning
  • Swelling
  • Warmth and redness
  • Tenderness
  • Difficulty using the joint normally

Rheumatic diseases may produce a wide variety of other symptoms, such as:

  • Fatigue
  • Eye inflammation or infections
  • Rashes and sores
  • Pain in the neck, spine, or back
  • Difficulty taking a deep breath
  • Muscle pain

Learn More About Rheumatic Diseases Diagnosis and Treatment

Types of Arthritis and Rheumatic Diseases

There are numerous types of arthritis and other rheumatic diseases, including:

  • Osteoarthritis: the most common type of arthritis, damages both the cartilage (the tissue that cushions the ends of bones within the joint) and the underlying bone. Osteoarthritis can cause joint pain and stiffness. Disability results most often when the disease affects the spine, knees, and hips.
  • Rheumatoid arthritis: a less common type of arthritis that occurs when the immune system attacks the lining of the joint (synovium). This produces pain, swelling and loss of joint function. The most commonly affected joints are those in the hands and feet.
  • Gout: a type of arthritis caused by needle-like crystals of uric acid that gather in the joints, usually beginning in the big toe. Symptoms may come and go and include inflammation, swelling, and pain in the affected joint(s).
  • Infectious arthritis: caused by infectious agents such as bacteria or viruses. Parvovirus arthritis and gonococcal arthritis are examples of infectious arthritis, as is the arthritis that occurs with Lyme disease, a bacterial infection caused by the bite of infected ticks.
  • Juvenile idiopathic arthritis: the most common form of arthritis in childhood. Symptoms include pain, stiffness, swelling, and loss of joint function. It may be associated with rashes or fevers and may affect various parts of the body.
  • Spondyloarthropathies: a group of rheumatic diseases that usually affect the spine. There are a few forms:
    • Ankylosing spondylitis may also affect the hips, shoulders, and knees.
    • Reactive arthritis is caused by infection of the lower urinary tract, bowel, or other organ. It is commonly associated with eye problems, skin rashes, and mouth sores.
    • Psoriatic arthritis is a form of arthritis that occurs in some patients with the skin disorder psoriasis. Psoriatic arthritis often affects the joints at the ends of the fingers and toes and is accompanied by changes in the fingernails and toenails. Back pain may occur if the spine is involved.
  • Bursitis: occurs due to inflammation of the bursae (small, fluid-filled sacs that help reduce friction within the joint). Symptoms include pain and tenderness. Movement of nearby joints may also be affected.
  • Fibromyalgia: symptoms include widespread muscle pain and tender points—areas on the body that are painful when pushed. Many people also experience fatigue and sleep disturbances.
  • Polymyalgia rheumatica: involves tendons, muscles, ligaments, and tissues around the joint. Symptoms include pain, aching, and morning stiffness in the shoulders, hips, neck, and lower back. It is sometimes the first sign of giant cell arteritis, a disease of the arteries characterized by headaches, inflammation, weakness, weight loss, and fever.
  • Polymyositis: causes inflammation and weakness in the muscles. The disease may affect the whole body and cause disability.
  • Scleroderma: also known as systemic sclerosis. The disease is caused by excessive production of collagen (a fiber-like protein), leading to thickening of and damage to the skin, blood vessels, joints, and sometimes internal organs such as the lungs and kidneys.
  • Systemic lupus erythematosus: also known as lupus or SLE. This disease is caused when the immune system attacks the body’s own healthy cells, resulting in inflammation of and damage to the joints, skin, kidneys, heart, lungs, blood vessels, and brain.
  • Tendinitis: inflammation of tendons (tough cords of tissue that connect muscle to bone). This is caused by overuse, injury, or a rheumatic condition and may restrict movement of nearby joints.

Treatment for Arthritis and Other Rheumatic Diseases in Children

Unfortunately, there is no cure for rheumatic disease (with the exception of infectious arthritis, which can be cured with antibiotics if detected or diagnosed early). The goal of treatment is to limit pain and inflammation, while ensuring optimal joint function. Each treatment plan designed by a doctor should be specifically tailored to the patient’s type of rheumatic disease, as well as the severity of the disease. Treatment plans often involve both short-term and long-term relief approaches, including the following:

Short-term relief:

  • Medications. Short-term relief for pain and inflammation may include pain relievers, such as acetaminophen, ibuprofen, or other nonsteroidal anti-inflammatory medications. Ask your child’s doctor for more information before giving a medication to a child.

  • Heat and cold. Whether to use hot or cold applications on affected joints depends on the type of arthritis present and the recommendation of your doctor. Pain relief may be obtained temporarily by using moist heat (warm bath or shower) or dry heat (heating pad) on the joint. Pain relief may also be obtained by placing an ice pack wrapped in a towel on the joint. Cold applications help reduce swelling, as well. However, people who have poor circulation should not use ice packs. Consult your doctor regarding the type of application and application time before use.

  • Joint immobilization. The use of a splint or brace can help a joint rest and protect it from further injury. Walking devices, such as canes, crutches, and assistive devices with extra large or longer handles help keep stress off certain joints.

  • Massage. The light stroking and/or kneading of painful muscles may increase blood flow and bring warmth to the muscle.

Long-term relief:

  • Medications. There are several types of medications that may be used long-term to reduce pain and symptoms, including the following:

    • Nonsteroidal anti-inflammatory medications. These medications, such as aspirin and ibuprofen, help to reduce pain and inflammation.

    • Disease-modifying antirheumatic medications (DMARDs). These prescription medications may affect the course of the disease, by slowing down its progress and influence, and/or by correcting immune system abnormalities that are linked to the disease. Examples of disease-modifying anti-rheumatic medications include methotrexate, hydroxychloroquine, penicillamine, and gold injections.

    • Corticosteroids. Corticosteroids are medications that contain hormones to treat rheumatic diseases. These medications, such as prednisone, can be taken orally or as an injection.

    • Biologics. These are genetically engineered drugs to decrease and interrupt the inflammation process. These include etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), adalimumab (Humira), anakinra (Kineret), rituximab (Rituxan), and abatacept (Orencia).

  • Weight reduction. Extra weight puts more stress on weight-bearing joints, such as the hips and knees. Weight loss in overweight people has shown to reduce the chance of developing certain types of rheumatic disease, including osteoarthritis.

  • Exercise. Certain exercises, such as swimming, walking, low-impact aerobic exercise, and range-of-motion exercises, may help reduce joint pain and stiffness. Stretching exercises may be helpful in keeping the joints flexible.

  • Surgery. In severe cases of rheumatic disease, surgery may be necessary to repair or replace a joint. There are two main types of surgery for arthritis and other rheumatic diseases, including the following:

    • Repair. Surgery to repair a damaged joint may include removing debris in the joint, fusing bones, or correcting a bone deformity.

    • Replace. If a joint is too damaged for repair, it may need to be replaced with an artificial joint.

Diagnosis of Rheumatic Diseases

Sergio Schwartzman, MD: How do we diagnose rheumatic diseases? It’s really a panorama depending on the disease state. For example, it’s very easy to diagnose gout. If you aspirate an inflamed joint and you see uric acid crystals in the setting of an inflammatory response with many white blood cells, that diagnosis is completely clear.
However, for other rheumatic diseases there are challenges. We have classification criteria for many of our rheumatic diseases, but we don’t have very many diagnostic criteria. I would address the issue of diagnosis not so much on the basis of the individual components that are important in reaching a diagnosis, but by saying…it is steeped in experience in seeing these diseases, and using some of the parameters that have been outlined in classification criteria that have a completely different intent in the setting of getting a more global picture of the patient.
What elements then are important in helping us make the diagnosis of a rheumatic disease? For me, overwhelmingly the most important element is the history. A very careful and detailed history is very helpful with regard to making the diagnosis. When I was in medical school, we were told that 70% to 90% of your diagnosis should come from the history alone.
The history is a critical element. The physical examination, which unfortunately isn’t being done as detailed as it had been done in the past, is the second most important component of helping us with a diagnosis. After that, for laboratory markers, serological markers for example, in rheumatoid arthritis , we know that 80% of patients who have RA will be either rheumatoid factor- or CCP -positive. So, laboratory tests are helpful, but they’re not always diagnostic. For example, in this same type of instance, there are people who have positive rheumatoid factors, or CCPs, and don’t have rheumatoid arthritis. I think that you need to use these serological markers in the context of the history and the physical exam that you’ve done.
Imaging has become increasingly important. To that point, I think ultrasound is now becoming a tool frequently used by the rheumatologist to define inflammatory disease and to address the mechanical disease that’s not necessarily autoimmune. I think that the analogy of the ultrasound being the equivalent for the rheumatologist as the stethoscope is for the cardiologist has been raised, and for some rheumatologists, that’s correct. I believe that MRI has clearly changed the capacity to diagnose axial spondyloarthritis. It’s in fact 1 of the necessary components for the classification of axial spondyloarthritis. There’s a clinical arm where you have an HLA-B27, and then at least 2 features of spondyloarthritis, or an imaging arm, which is the MRI, or x-ray if that’s positive. But frequently, the MRI will be positive before the x-ray is and only 1 component of spondyloarthritis.
In summary, the diagnosis of a rheumatic disease is heavily dependent on a very good history, a very good physical, and supported by both laboratory studies and imaging studies. As we move into the next quantum change in understanding rheumatic diseases, I believe that our diagnostic tools will improve. I think that genomics will change that. I think that serologies will become much more sensitive, and even more important, much more specific as well.
Rheumatic illnesses are not static. They evolve and change over time. In the early phases of any of the rheumatic diseases, they will not present classically the way that they’re described in textbooks. Patients who have rheumatoid arthritis early on will present with a little bit of morning stiffness and arthralgias. The history will be significant for inflammatory type symptoms, but the exam may not yield very much. As diseases evolve over time, that same patient that on exam you don’t see anything, you’re going to see red hot swollen joints 1 year later when they come back. Early detection of rheumatic diseases can be challenging based on inconclusive history, a physical exam that is not diagnostic, and frequently the best diagnostician is time, and giving a disease time to evolve.
The challenge in that circumstance though is that the reason that we want to make an early diagnosis of a rheumatic disease is that we believe that intervening, and intervening aggressively early, is a critical element in preventing some of the permanent damage that some of these rheumatic diseases cause. For example, in rheumatoid arthritis, once you develop an erosion, there’s nothing that I can do to wipe away that erosion. We know that erosions are associated with quality of life, and disability. Making an early diagnosis can be challenging based on the clinical spectrum, but it is important to do. Sometimes we’re not sure of the diagnosis, and I think that probably happens in rheumatic diseases more frequently than it does in other subspecialties.
Transcript edited for clarity.

Rheumatology: Current ResearchOpen Access

Rheumatic Diseases

Rheumatic diseases are characterized by inflammation, swelling and pain in the joints and muscles. Rheumatic diseases are characterized to be associated with immune system. These conditions include more than 200 types of diseases, among which osteoarthritis, arthritis, lupus, ankylosing spondylitis are common. Rheumatic diseases affect the musculoskeletal system of the body thus resulting damage to the joints, muscles and connective tissues.

Rheumatic diseases mainly affect joints and muscles of human body. Osteoarthritis (OA), Rheumatoid Arthritis, Sjogren’s Syndrome, Ankylosing Spondylitis Lupus, Psoriatic arthritis, Polymyalgia rheumatic, Fibromyalgia, Infectious arthritis, Juvenile idiopathic arthritis are categorized under rheumatic diseases. Common symptoms seen are red, swollen joints, inflamed connective tissues such as cartilage, synovial tissue, and tendons.

Related Journals of Rheumatic Diseases

Rheumatology: Current Research, Acta Rheumatologica, Osteoarthritis, Osteoporosis and Physical Activity, Atherosclerosis: Open Access, Annals of the Rheumatic Diseases, International Journal of Rheumatic Diseases, Rheumatic Disease Clinics of North America, Clinics in Rheumatic Diseases, Clinical and Experimental Rheumatology.

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Are you suffering from joint pain? Do you constantly feel as if your joints are stiff or swollen? Many of these symptoms may be attributed to rheumatic diseases that cause inflammation in supporting and connecting structures of the body. There are many different kinds of rheumatic diseases, so working with a rheumatologist will help aid in diagnosing your particular disorder. Keep reading to learn about common rheumatic diseases below.

The Difference Between Arthritis and Rheumatic Diseases

While many people often believe that arthritis and rheumatic diseases are the same thing, surprisingly, they are not always synonymous. Arthritis is the general term for disorders that cause joint pain, while rheumatic diseases usually deal with more than just joints. Along with joints, most rheumatic diseases affect tendons, ligaments, bones, muscles, and some internal organs.

Most people who have arthritis have pain in their joints—and not in just one specific location. Beyond pain, bones (and joints) may be hard to move, red at the joint site, or warm to the touch.

A-Z Rheumatic Diseases

Arthritis and rheumatic diseases come in all shapes, sizes, and severity. While there are over 100 known disorders, we’ve come up with a list of the more common conditions.

Ankylosing Spondylitis: Arthritis that affects the spine, causing pain in the pelvis and back.

Arthritis: A symptom of rheumatic diseases which cause joint inflammation.

Autoimmune Diseases: Diseases that affect immune cells and makes them attack your body.

Autoinflammatory Diseases: A disease that affects immune cells. Similar to an autoimmune disease, but autoinflammatory causes rashes, swelling, fevers, and more.

Behçet’s Disease: A chronic disease that causes mouth or genital sores and inflammation in the eye.

Bursitis: A disease that causes swelling and pain around the bursae or sack surrounding joints which contains fluid to help friction between the joint and movement.

Giant Cell Arteritis: Diseases that affects arteries in the scalp and neck. These arteries may become painful, hot, red, and swollen.

Gout: A type of arthritis that affects the joints, causing a painful buildup of uric acid.

Juvenile Arthritis: Arthritis that affects children and causes inflammation in joints.

Lupus: A disease that affects healthy cells and tissues when the body’s defense system attacks these areas rather than viruses and bacteria.

Osteoarthritis: Arthritis that affects the tissue on the ends of bones and causes loss of motion, swelling, and pain.

Osteoporosis: A disease that decreases bone density and mass, causing bones to become fragile and easily breakable.

Polymyalgia Rheumatica: A condition that causes severe muscle stiffness in the tendons, muscles, ligaments, and tissues around your shoulders, hips, neck, and back.

Psoriatic Arthritis: Arthritis that affects people with psoriasis, which is a buildup of skin cells that form itchy, dry, and scaly patches.

Reactive Arthritis: Joint pain caused by a reaction to an infection.

Rheumatoid Arthritis: A disease that affects many joints, resulting in stiffness, swelling, and pain.

Scleroderma: A group of diseases which cause patches of tightened, hard skin.

Shoulder Problems: Occurs after developing a disease in the shoulder region.

Sjögren’s Syndrome: A disease that affects glands causing a dry mouth and eyes.

Tendinitis: A condition where joint pain and swelling occurs and is caused by repeated injury to the tendons that connect your joints.

Living with a Rheumatic Disease

Having to deal with chronic pain can quickly decrease a person’s quality of life. To live a happy, healthy life, you’ll want to follow a few steps to keep your pain level down. Here are some quick tips to aid in living with arthritis or a rheumatic disorder:

  • Continue to exercise, as gentle movement reduces pain and stiffness in joints. We suggest discussing exercise plans with your rheumatologist, as they will be able to identify the right strategy to fit your particular diagnosis.
  • Consider losing weight, as the more mass you have, the more stress your joints experience. Speak with your provider about weight management plans.
  • Consider changing your diet if you have certain rheumatic diseases.
  • Specific therapies may reduce swelling and pain. These may include intermittent hot and cold elements on the joint site or relaxation therapy to relax muscles and ease stress.
  • If you need added support, discuss with your doctor about using splints, braces, or assistive devices like a cane or inserts for your shoe. Some of these devices may also assist with opening jars, closing zippers, and more.

Treating Rheumatic Diseases at Voyage Healthcare

Our rheumatology department is ready to consult, diagnose, and address whatever rheumatic disease you may have. Schedule an appointment with our rheumatologist and get back to living life without stiff, sore joints.

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