Rheumatism

Last updated
Rheumatism
Other namesRheumatic disease
Specialty Rheumatology

Rheumatism [1] or rheumatic disorders are conditions causing chronic, often intermittent pain affecting the joints or connective tissue. [2] Rheumatism does not designate any specific disorder, but covers at least 200 different conditions, including arthritis and "non-articular rheumatism", also known as "regional pain syndrome" or "soft tissue rheumatism". [3] [4] There is a close overlap between the term soft tissue disorder and rheumatism. [5] Sometimes the term "soft tissue rheumatic disorders" is used to describe these conditions. [6]

Contents

The term "Rheumatic Diseases" is used in MeSH to refer to connective tissue disorders. [7] The branch of medicine devoted to the diagnosis and therapy of rheumatism is called rheumatology. [8]

Types

Many rheumatic disorders of chronic, intermittent pain (including joint pain, neck pain or back pain) have historically been caused by infectious diseases. Their etiology was unknown until the 20th century and not treatable. Postinfectious arthritis, also known as reactive arthritis, and rheumatic fever are other examples.

In the United States, major rheumatic disorders are divided into 10 major categories based on the nomenclature and classification proposed by the American College of Rheumatology (ACR) in 1983. [9]

Diagnosis

Blood and urine tests will measure levels of creatinine and uric acid to determine kidney function, an elevation of the ESR and CRP is possible. After a purine-restricted diet, another urine test will help determine whether the body is producing too much uric acid or the body isn't excreting enough uric acid. Rheumatoid factor may be present, especially in the group that is likely to develop rheumatoid arthritis. A fine needle is used to draw fluid from a joint to determine if there is any build up of fluid. The presence of uric acid crystals in the fluid would indicate gout. In many cases there may be no specific test, and it is often a case of eliminating other conditions before getting a correct diagnosis.

Management

Initial therapy of the major rheumatological diseases is with analgesics, such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs). Steroids, especially glucocorticoids, and stronger analgesics are often required for more severe cases. [13]

History

The term rheumatism stems from the Late Latin rheumatismus, ultimately from Greek ῥευματίζομαι "to suffer from a flux", with rheum meaning bodily fluids, i.e. any discharge of blood or bodily fluid.

Before the 17th century, the joint pain which was thought to be caused by viscous humours seeping into the joints was always referred to as gout, a word adopted in Middle English from Old French gote "a drop; the gout, rheumatism", not to be confused with the present day specific term referring to excess of uric acid. [14]

The English term rheumatism in the current sense has been in use since the late 17th century, as it was believed that chronic joint pain was caused by excessive flow of rheum which means bodily fluids into a joint. [15]

See also

Related Research Articles

<span class="mw-page-title-main">Arthritis</span> Type of joint disorder

Arthritis is a term often used to mean any disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, swelling, and decreased range of motion of the affected joints. In some types of arthritis, other organs are also affected. Onset can be gradual or sudden.

<span class="mw-page-title-main">Rheumatoid arthritis</span> Type of autoimmune arthritis

Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body. The disease may also affect other parts of the body, including skin, eyes, lungs, heart, nerves and blood. This may result in a low red blood cell count, inflammation around the lungs, and inflammation around the heart. Fever and low energy may also be present. Often, symptoms come on gradually over weeks to months.

<span class="mw-page-title-main">Uric acid</span> End product of nucleic acid degradation

Uric acid is a heterocyclic compound of carbon, nitrogen, oxygen, and hydrogen with the formula C5H4N4O3. It forms ions and salts known as urates and acid urates, such as ammonium acid urate. Uric acid is a product of the metabolic breakdown of purine nucleotides, and it is a normal component of urine. High blood concentrations of uric acid can lead to gout and are associated with other medical conditions, including diabetes and the formation of ammonium acid urate kidney stones.

<span class="mw-page-title-main">Gout</span> Medical condition that results in recurrent pain and swelling of joints

Gout is a form of inflammatory arthritis characterized by recurrent attacks of a red, tender, hot and swollen joint, caused by deposition of monosodium urate monohydrate crystals. Pain typically comes on rapidly, reaching maximal intensity in less than 12 hours. The joint at the base of the big toe is affected in about half of cases. It may also result in tophi, kidney stones, or kidney damage.

Rheumatology is a branch of medicine devoted to the diagnosis and management of disorders whose common feature is inflammation in the bones, muscles, joints, and internal organs. Rheumatology covers more than 100 different complex diseases, collectively known as rheumatic diseases, which includes many forms of arthritis as well as lupus and Sjögren's syndrome. Doctors who have undergone formal training in rheumatology are called rheumatologists.

<span class="mw-page-title-main">Ankylosing spondylitis</span> Type of arthritis in which there is long-term inflammation of the joints of the spine

Ankylosing spondylitis (AS) is a type of arthritis characterized by long-term inflammation of the joints of the spine typically where the spine joins the pelvis. Occasionally areas affected may include other joints such as the shoulders or hips, eye and bowel problems may occur as well as back pain. Joint mobility in the affected areas generally worsens over time.

<span class="mw-page-title-main">Hyperuricemia</span> Medical condition

Hyperuricaemia or hyperuricemia is an abnormally high level of uric acid in the blood. In the pH conditions of body fluid, uric acid exists largely as urate, the ion form. Serum uric acid concentrations greater than 6 mg/dL for females, 7 mg/dL for men, and 5.5 mg/dL for youth are defined as hyperuricemia. The amount of urate in the body depends on the balance between the amount of purines eaten in food, the amount of urate synthesised within the body, and the amount of urate that is excreted in urine or through the gastrointestinal tract. Hyperuricemia may be the result of increased production of uric acid, decreased excretion of uric acid, or both increased production and reduced excretion.

Spondyloarthropathy or spondyloarthrosis refers to any joint disease of the vertebral column. As such, it is a class or category of diseases rather than a single, specific entity. It differs from spondylopathy, which is a disease of the vertebra itself, but many conditions involve both spondylopathy and spondyloarthropathy.

<span class="mw-page-title-main">Synovial fluid</span> Fluid found in the cavities of synovial joints

Synovial fluid, also called synovia,[help 1] is a viscous, non-Newtonian fluid found in the cavities of synovial joints. With its egg white–like consistency, the principal role of synovial fluid is to reduce friction between the articular cartilage of synovial joints during movement. Synovial fluid is a small component of the transcellular fluid component of extracellular fluid.

<span class="mw-page-title-main">Tophus</span> Medical condition

A tophus is a deposit of monosodium urate crystals, in people with longstanding high levels of uric acid in the blood, a condition known as hyperuricemia. Tophi are pathognomonic for the disease gout. Most people with tophi have had previous attacks of acute arthritis, eventually leading to the formation of tophi. Chronic tophaceous gout is known as Harrison Syndrome.

<span class="mw-page-title-main">Calcium pyrophosphate dihydrate crystal deposition disease</span> Medical condition

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, also known as pseudogout and pyrophosphate arthropathy, is a rheumatologic disease which is thought to be secondary to abnormal accumulation of calcium pyrophosphate dihydrate crystals within joint soft tissues. The knee joint is most commonly affected.

<span class="mw-page-title-main">Arthropathy</span> Medical condition

An arthropathy is a disease of a joint.

<span class="mw-page-title-main">Reactive arthritis</span> Medical condition

Reactive arthritis, also known as Reiter's syndrome, is a form of inflammatory arthritis that develops in response to an infection in another part of the body (cross-reactivity). Coming into contact with bacteria and developing an infection can trigger the disease. By the time the patient presents with symptoms, often the "trigger" infection has been cured or is in remission in chronic cases, thus making determination of the initial cause difficult.

Palindromic rheumatism (PR) is a syndrome characterised by recurrent, self-resolving inflammatory attacks in and around the joints, consists of arthritis or periarticular soft tissue inflammation. The course is often acute onset, with sudden and rapidly developing attacks or flares. There is pain, redness, swelling, and disability of one or multiple joints. The interval between recurrent palindromic attacks and the length of an attack is extremely variable from few hours to days. Attacks may become more frequent with time but there is no joint damage after attacks. It is thought to be an autoimmune disease, possibly an abortive form of rheumatoid arthritis.

<span class="mw-page-title-main">Knee effusion</span> Medical condition

Knee effusion, informally known as water on the knee, occurs when excess synovial fluid accumulates in or around the knee joint. It has many common causes, including arthritis, injury to the ligaments or meniscus, or fluid collecting in the bursa, a condition known as prepatellar bursitis.

<span class="mw-page-title-main">Hyperuricosuria</span> Medical condition

Hyperuricosuria is a medical term referring to the presence of excessive amounts of uric acid in the urine. For men this is at a rate greater than 800 mg/day, and for women, 750 mg/day. Notable direct causes of hyperuricosuria are dissolution of uric acid crystals in the kidneys or urinary bladder, and hyperuricemia. Notable indirect causes include uricosuric drugs, rapid breakdown of bodily tissues containing large quantities of DNA and RNA, and a diet high in purine.

<span class="mw-page-title-main">Anti–citrullinated protein antibody</span> Autoantibodies

Anti-citrullinated protein antibodies (ACPAs) are autoantibodies that are directed against peptides and proteins that are citrullinated. They are present in the majority of patients with rheumatoid arthritis. Clinically, cyclic citrullinated peptides (CCP) are frequently used to detect these antibodies in patient serum or plasma.

<span class="mw-page-title-main">Alfred Baring Garrod</span>

Sir Alfred Baring Garrod was an English physician.

Crystal arthropathy is a class of joint disorder that is characterized by accumulation of tiny crystals in one or more joints. Polarizing microscopy and application of other crystallographic techniques have improved identification of different microcrystals including monosodium urate, calcium pyrophosphate dihydrate, calcium hydroxyapatite, and calcium oxalate.

<span class="mw-page-title-main">Intermittent hydrarthrosis</span> Medical condition

Intermittent hydrarthrosis (IH), also known as periodic synoviosis, periodic benign synovitis, or periodic hydrarthritis, is a chronic condition of unknown cause characterized by recurring, temporary episodes of fluid accumulation (effusion) in the knee. While the knee is mainly involved, occasionally other joints such as the elbow or ankle can additionally be affected. Fluid accumulation in the joint can be extensive causing discomfort and impairing movement, although affected joints are not usually very painful. While the condition is chronic, it does not appear to progress to more destructive damage of the joint. It seems to affect slightly more women than men.

References

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  3. Altorok, Nezam; Nada, Shigeyuki; Nagaraja, Vivek; Kahaleh, Bashar (2016-06-15). "Chapter 17 - Epigenetics in Bone and Joint Disorders". In Tollefsbol, Trygve O. (ed.). Medical Epigenetics (Illustrated ed.). Academic Press. pp. 295–314. doi:10.1016/B978-0-12-803239-8.00017-X. ISBN   978-0-12803-239-8.
  4. Rao, Sudha (2019-01-24). Diamond, Herbert S. (ed.). "Nonarticular Rheumatism/Regional Pain Syndrome". eMedicine .
  5. Mahroos, Roaa (2021). "Soft Tissue Rheumatic Disorders". In Almoallim, Hani; Cheikh, Mohamed (eds.). Skills in Rheumatology. Singapore: Springer. pp. 461–474. doi: 10.1007/978-981-15-8323-0_22 . ISBN   978-9-81158-323-0. S2CID   234306241.
  6. Kushner, Irving. Isaac, Zacharia; Ramirez Curtis, Monica (eds.). "Overview of soft tissue rheumatic disorders". UpToDate .
  7. Rheumatic+Diseases at the US National Library of Medicine Medical Subject Headings (MeSH)
  8. " rheumatism " at Dorland's Medical Dictionary
  9. Decker, John Laws (August 1983). "American Rheumatism Association nomenclature and classification of arthritis and rheumatism (1983)". Arthritis & Rheumatology . 26 (8): 1029–1032. doi:10.1002/art.1780260813. ISSN   0004-3591. PMID   6603849.
  10. Puéchal, Xavier; Terrier, Benjamin; Mouthon, Luc; Costedoat-Chalumeau, Nathalie; Guillevin, Loïc; Le Jeunne, Claire (March 2014). "Relapsing polychondritis". Joint, Bone, Spine: Revue du Rhumatisme. Elsevier. 81 (2): 118–124. doi:10.1016/j.jbspin.2014.01.001. PMID   24556284.
  11. Murphy, Kenneth; Travers, Paul; Walport, Mark; Walter, Peter (2010). Janeway's Immunobiology (7th ed.). Taylor & Francis. ISBN   978-0-81534-457-5.
  12. Salvador, Georgina; Gómez-Centeno, Antonio Domingo; Viñas, Octavi; Ercilla, Guadalupe; Cañete, Juan De Dios; Muñoz-Gómez, José; Sanmartí, Raimon (August 2003). "Prevalence and clinical significance of anti-cyclic citrullinated peptide and antikeratin antibodies in palindromic rheumatism. An abortive form of rheumatoid arthritis?". Rheumatology (Oxford) . 42 (8): 972–975. doi: 10.1093/rheumatology/keg268 . PMID   12730510.
  13. Buttgereit, Frank (19 February 2020). "Views on glucocorticoid therapy in rheumatology: the age of convergence". Nature Reviews Rheumatology . 16 (4): 239–246. doi:10.1038/s41584-020-0370-z. PMID   32076129. S2CID   211194682.
  14. "Hyperuricemia: Symptoms, Treatment, and More | Is hyperuricemia common?". Healthline . 2017-01-25. Retrieved 2022-04-24.
  15. Barnhart, Robert K. (1988). Barnhart, Robert K.; Steinmetz, Sol; Wilson, Halsey William (eds.). "Barnhart Dictionary of Etymology". H. W. Wilson Company. The meaning of a disease of the joints is first recorded in 1688, because rheumatism was thought to be caused by an excessive flow of rheum into a joint thereby stretching ligaments{{cite journal}}: Cite journal requires |journal= (help)

Further reading