Rheumatism

Rheumatism or rheumatic disorder is an umbrella term for conditions causing chronic, often intermittent pain affecting the joints and/or connective tissue. The study of, and therapeutic interventions in, such disorders is called rheumatology.^[1] The term "rheumatism", however, does not designate any specific disorder, but covers at least 200 different conditions.

Sources dealing with rheumatism tend to focus on arthritis, but "rheumatism" may also refer to other conditions causing chronic pain, grouped as "non-articular rheumatism", also known as "regional pain syndrome" or "soft tissue rheumatism".^[2] The term "Rheumatic Diseases" is used in MeSH to refer to connective tissue disorders.^[3]

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. In the Gospel of Mark 5:25 ῥύσις, from the same root, is used for "flow of (menstrual) blood", translated as "flux" in the King James Version of the Bible.

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.

The Anglosaxon 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.^[4]

Types

Many rheumatic disorders of chronic, intermittent joint pain have historically been caused by infectious diseases. Their etiology was unknown until the 20th century and not treatable, like Lyme disease (in the Northern and Northeastern US), coccidiomycosis or Valley fever (in the Western US), and Chikungunya in India and a myriad of causes for postinfectious arthritis also known as reactive arthritis like, for example, the once very common rheumatic fever after Group A Streptococcus infection up to the rare Whipple's disease.

Major rheumatic disorders currently recognized include

• Back pain
• Bursitis/Tendinitis of the shoulder, wrist, biceps, leg, knee cap (patella), ankle, hip, and Achilles tendon
• Capsulitis
• Neck pain
• Osteoarthritis
• Palindromic rheumatism has been theorized to be a form of rheumatoid arthritis.^[5]

Although these disorders probably have little in common in terms of their epidemiology, they do share three characteristics: they cause chronic, often intermittent pain, they are difficult to treat and are collectively very common.

Rheumatic diseases caused by autoimmunity include:

• Ankylosing spondylitis
• relapsing polychondritis^[6]
• systemic lupus erythematosus
• rheumatoid arthritis
• gout, inflammatory arthritis, pseudogout
• juvenile arthritis
• Sjögren syndrome
• scleroderma
• Polymyositis
• Dermatomyositis
• Behçet's disease
• Psoriatic arthritis^[7]

Treatment

A vast number of traditional herbal remedies were recommended for "rheumatism".^[8] Modern medicine, both conventional and alternative, recognises that the different rheumatic disorders have different causes (and several of them have multiple causes) and require different kinds of treatment.

Nevertheless, initial therapy of the major rheumatological diseases is with analgesics, such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), members of which are ibuprofen and naproxen. Often, stronger analgesics are required.

The ancient Greeks recorded that bee venom had some beneficial effects on some types of rheumatism. Bee and ant stings were known as a folk remedy in the late 19th century, and at least one physician developed a treatment consisting of repeated formic acid injections.^[9] Certain Amazonian tribes, including the Zo'é, use fire ant stings as a remedy for aches and pains.^[10]

Cod liver oil has also been used as a remedy.

Neem Tree Oil according to East Indian cultures has also been used as a remedy.^[11]

Weather

There has long been said to be a link between "rheumatic" pain and the weather. There appears to be no firm evidence in favour or against; a 1995 questionnaire given to 557 people by A. Naser and others at the Brigham and Women's Hospital's Pain Management Center concludes that "changes in barometric pressure are the main link between weather and pain. Low pressure is generally associated with cold, wet weather and an increase in pain. Clear, dry conditions signal high pressure and a decrease in pain."

See also

• Corbett's electrostatic machine

References

Further reading

• The Rheumatology Handbook (WSPC 2012) ISBN 978-1-84816-320-1

External links

• American College of Rheumatology
• EULAR - The European League Against Rheumatism
• Cloudy with a Chance of Pain - A smartphone-based study.
• National Institute of Arthritis and Musculoskeletal and Skin Diseases - US National Institute of Arthritis and Musculoskeletal and Skin Diseases