Rheumatism: what are they and how are they treated?

By Cristiano Antonino On Jun 14, 2023

Rheumatisms, or rheumatic diseases, are pathologies characterized by a local or generalized inflammatory state mainly affecting joints, ligaments, tendons, bones, muscles; rarely, the inflammation can extend and also affect the internal organs

The word “rheumatism”, which has always been commonly used in colloquial language, does not actually find its precise and defined equivalent in the medical-technical field; the professional doctor generally does not use this term to define rheumatic pathologies because it can easily create confusion among patients, as the term is too generic and non-specific.

This confusion is increased by differences in the language of different geographical areas: in some countries, for example, the term “rheumatism” defines fibromyalgia syndrome, while in other areas of the world it identifies arthritis.

It would therefore be more correct, ultimately, to refer to these inflammatory states with the more appropriate terms of “rheumatic disorders” or “rheumatic diseases”.

Among the most common rheumatic disorders – currently more than a hundred are known – we find:

Ankylosing spondylitis: a form of arthritis of the spine of probably autoimmune etiology that affects genetically predisposed individuals.
Dorsopathy: non-specific painful state affecting the spine.
Neck pain, when pain affects only the upper (cervical) part of the spine.
Bursitis and tendonitis: pain due to inflammation of structures such as serous bags and tendons, spread throughout the body; therefore, one may suffer from bursitis/tendonitis in the shoulders, wrists, legs, knees, ankles, hips.
Tenosynovitis: When inflammatory fluid forms within the tendon sheaths.
Capsulitis, when pain affects the joint and its joint capsule.
Fibromyalgia: rheumatic syndrome of unknown etiology that causes an increase in muscle tension throughout the body.
Osteoarthritis: degenerative disease affecting the cartilage of the joints.
Psoriatic arthritis: chronic inflammatory arthritis often associated with the onset of psoriasis.
Rheumatic fever: acute inflammatory disease linked to infection with some types of Streptococcus.
Rheumatoid arthritis: chronic inflammatory polyarthritis.
Connective tissue disease (systemic lupus erythematosus, scleroderma, Sjögren’s syndrome): chronic systemic autoimmune diseases.
Temporal arteritis and polymyalgia rheumatica: Often associated rheumatic diseases affecting the temporal arteries and the shoulder/pelvic girdle, respectively.

Rheumatism: symptoms and incidence

The incidence of rheumatic diseases is quite high: they can affect patients of any age – therefore including children – and generally have a higher incidence in female patients.

The most common symptoms through which the rheumatic diseases listed above manifest themselves depend on the site that is affected from time to time.

If rheumatic disorders affect bones, muscles and ligaments, the affected patient may complain of persistent muscle and joint pain, combined with widespread joint stiffness and, in the most serious cases, even joint swelling.

If, on the other hand, rheumatic disorders involve internal organs (as occurs mainly in connective tissue diseases), the patient could complain of variable symptoms depending on the organ involved: serious difficulty in breathing, inability to ingest food correctly, renal failure; this organ symptomatology is generally associated with non-specific systemic symptoms, characterized by fever and anomalous and excessive tiredness, alarm bells of an ongoing systemic inflammation.

Psoriasis could also be an alarm bell for the appearance of rheumatic disorders, especially if other cases of psoriasis associated with widespread osteo-articular pain have been found in the family.

Rheumatic disorders: what are the causes and who suffers from them

Most Italians – it is estimated at least 70% of the population – mistakenly think that rheumatic disorders are due to a cold and humid climate.

Unfortunately, living by the sea or in the heat is not enough to prevent the appearance of these ailments.

The so-called rheumatisms arise from a combination of genetic factors and environmental factors

If an individual is born genetically predisposed to the development of one of the rheumatic disorders described, he is at a higher risk than the general population of developing the disease, but this does not necessarily happen, since, in addition to the genetic predisposition, it is generally also necessary intervention of an external stimulus, called environmental factor.

The environmental factors now recognized as risk conditions for rheumatic diseases are only: viral infections, alterations of the hormonal balance, cigarette smoke.

The diagnosis of rheumatic disorders

At the outset, rheumatic disorders can be characterized by rather mild symptoms, which are easily underestimated: the presence of any fatigue or a slowdown in motor skills is, for example, attributed to stress or excessive physical effort.

Without creating alarmism, it is good to consider that these pathologies currently affect at least 5 million Italian citizens and it is estimated that one in three people over the age of 65 is affected by them.

Joint pain and movement difficulties should therefore not be underestimated; it is therefore advisable to organize a specialist visit to a rheumatologist in a short time.

During the rheumatological visit, an accurate anamnesis is first performed; which means that the doctor will collect information on the patient’s clinical history in order to be able to establish the time of onset of the complained joint pain, its characteristics, its intensity and any other therapies already undertaken.

The patient’s life habits will then be investigated, trying to understand if he leads a healthy and active life or a predominantly sedentary one; recent traumatic events will be excluded.

During the visit, specific tests may be carried out or prescribed.

For example, if the presence of synovial fluid is found inside the joints, it will be useful to aspirate this liquid with a syringe – through an examination called arthrocentesis – to examine it under the microscope.

The examination of the synovial fluid allows to evaluate whether the liquid is inflammatory or degenerative; it also allows you to evaluate the presence of any uric acid microcrystals – to exclude or confirm the diagnosis of gout – or calcium pyrophosphate – to exclude or confirm the diagnosis of chondrocalcinosis -.

To undergo a rheumatological visit, which will last around 20 or 30 minutes, no particular preparation is necessary.

How to cure rheumatism: the most appropriate therapy

Depending on the type and severity of the rheumatic disorder diagnosed, the rheumatologist specialist will evaluate the most appropriate therapeutic procedure for the individual case.

However, it should be remembered that rheumatic diseases are often chronic, therefore the therapies are prescribed to obtain a clinical remission of the disease (i.e. the absence of symptoms), but it will be difficult to obtain a definite and complete recovery.

Where necessary, pharmacological therapy could be prescribed to the patient – with analgesics, anti-inflammatories, corticosteroids, basic drugs and biological drugs – to try to improve the symptoms and keep the disease under control, allowing the patient to recover joint function and performance of normal daily activities.

In selected cases, very rarely, if there are irreversible alterations of a joint site, the rheumatologist could recommend that you contact an orthopedic surgeon to evaluate surgery.

Rheumatism: can it be prevented?

If we talk about “prevention” in the medical sense of the term then the answer is “no, rheumatism cannot be prevented”.

However, it is advisable to lead a healthy and active life, carrying out regular physical activity, following a healthy and balanced diet, minimizing stress factors, avoiding cigarette smoke and exposure to sunlight during the hottest hours.