What are rheumatic diseases?

The term “Rheumatic” often sounds and feels a little outdated in the modern medical world which is partly explained by its ancient origins from the Latin term “Rheumaticus” – a problem with “flow”. This itself has even more ancient origins from the Greek language. This can make rheumatic conditions seem somewhat a mystery, since unlike other specialists (such as a cardiologist who manages the heart and circulation) there is no apparent organ system that a rheumatologist deals with.

Rheumatic conditions span a wide range of disorders that mainly affect the musculoskeletal system. This system includes the joints, bones, muscles, tendons and ligaments. However, rheumatic diseases can also affect other organs or systems, in fact there is barely a part of the body that cannot be affected by one rheumatic condition or another.

There are more than 200 known rheumatic diseases, some of these being extremely rare. In common practice, most rheumatologists specialise in the management of around a dozen or so conditions.

Problems in the musculoskeletal system can arise from a wide range of underlying causes. The most central set of disorders dealt with by a rheumatologist are those coming from the immune system – so-called “auto-immune” diseases where the body attacks itself. However, rheumatologists commonly encounter and manage other problems that can give rise to symptoms within the bones, muscles and soft tissues as well.

Some examples of the common conditions include:

• Arthritis – literally translated this means inflammation, “itis”, of the joint “arth”. This includes conditions like rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and gout. Osteoarthritis is the most common type of arthritis but, rather confusingly, does not actually involve much inflammation in the joint but rather abnormal wear, tear and repair of the joint.
• Pain conditions like fibromyalgia and complex regional pain syndrome
• Excessive flexibility such as hypermobility spectrum disorder and Ehlers-Danlos
• Connective tissue diseases – This includes a range of rarer conditions that might affect the joint as well as many other parts of the body such as the kidneys, skin and lungs. Examples include SLE (Lupus), Sjogren’s, scleroderma and myositis.
• Vasculitis – These conditions involve inflammation within the blood vessels and include a wide range of rare diseases such as Giant Cell Arteritis (sometimes called Temporal arteritis).
• Polymyalgia rheumatica – this condition causes muscle aches and pains and is sometimes classified as a vasculitis
• Metabolic conditions – these include conditions like osteoporosis and osteomalacia that can lead to soft or weekend bone 

What are the symptoms of rheumatic diseases?

Because rheumatic disease covers such a wide variety of conditions and complaints, there is no single set of symptoms that can occur. Some conditions, such as osteoporosis, can even be “silent”, presenting only when there is a negative outcome, such as a fracture, that results from the disease.

The common symptoms experienced by people with joint involvement of a rheumatic disease are:

• Pain, often becoming chronic (long lasting) pain
• Heat, redness and swelling in the joints, especially in the case of inflammatory conditions like rheumatoid arthritis
• Stiffness of the joints, particularly in the morning
• Generalised symptoms such as fatigue, tiredness, feeling unwell (malaise) and even fevers
• Sleep alterations
• Sensory disturbances like tingling and burning near the joint
• Loss of function of one or more joints
• Limited mobility (or excessive flexibility in some conditions)

Because the immune system travels everywhere, rheumatic diseases can cause symptoms in other organs systems. This could include the skin giving rise to a rash, the kidneys (resulting in protein or blood in the urine), the eyes (which could be painful or in some cases threaten vision), the lungs or the heart (chest pain or shortness of breath) and even the nervous system.

Causes of rheumatic diseases

There are a number of factors that can cause rheumatic diseases. These include:

• Autoimmune – the body’s immune system mistakenly attacks healthy cells, e.g. rheumatoid arthritis
• Degeneration (due to natural wear and tear, old injuries, stress on joints due to weight, etc.), e.g. osteoarthritis
• Genetics – some people may be predisposed to rheumatic diseases due to their genes.
• Metabollic – Some conditions are more common with metabolic disturbances, e.g. conditions like gout and osteoporosis
• Infections, e.g. rheumatic fever, reactive arthritis

Can rheumatic diseases be prevented?

A number of risk factors have been identified for rheumatic diseases and the importance of lifestyle interventions to prevent or support the treatment of these conditions cannot be understated. Unfortunately, the exact cause of most rheumatic diseases is not fully understood so in most cases it is not possible to fully predict or prevent these conditions. Reduction of risk factors (like smoking) and good care for the bones is certainly sound advice and this may delay or potentially even prevent the onset of these conditions for some individuals.

For this reason, it is crucial to obtain an early diagnosis to work at preventing the worsening of symptoms and the potential for long-term damage through a treatment programme.

What is the treatment?

Given the broad range of conditions listed, the treatment will depend on the specific condition. The most important part is obtaining a prompt diagnosis, especially if there is a chance it could be an inflammatory arthritis. After the initial consultation, it may be necessary to perform blood tests or imaging studies of the joints.

General joint care may include one or a combination of the following:

• Rest
• Painkillers, anti-inflammatories, and other medications as prescribed by the doctor
• Physiotherapy and supported exercise
• Healthy diet
• Support from other therapy services such as braces, splints and other orthopaedic devices
• Surgery in some cases

When encountering an inflammatory rheumatic disease, you may require disease-modifying anti-rheumatic drugs (DMARDs) or other preventative medications (for example in gout).

Those suffering from metabolic conditions like osteoporosis may need medication to slow the rate of bone thinning that will otherwise occur in this disease. Although there are helpful principles guiding the treatment of rheumatic diseases, each person afflicted with such conditions will need a tailored treatment program reflecting the unique nature and severity of the disease in that individual.