Rheumatic diseases are characterized by inflammation (signs are redness and/or heat, swelling, and pain) and loss of function. Common symptoms of rheumatic diseases include pain, swelling, and stiffness. They especially affect joints, tendons, ligaments, bones, and muscles, although some rheumatic diseases can also involve internal organs. An estimated 43 million people in the United States have arthritis or other rheumatic conditions; they are the leading cause of disability among adults age 65 and older.
Many people use the word "arthritis" to refer to all rheumatic diseases. However, the word literally means joint inflammation. There are more than 100 rheumatic diseases, and the many different kinds of arthritis are just a portion of the rheumatic diseases.
Osteoarthritis is the most common type of arthritis, affecting an estimated 21 million adults in the United States. When people talk about "arthritis," they are usually referring osteoarthritis. Osteoarthritis primarily affects cartilage, which is the tissue that cushions the ends of bones within the joint. The cartilage begins to fray and may entirely wear away. Osteoarthritis can cause joint pain and stiffness. Disability results most often when the disease affects the spine and the weight-bearing joints (the knees and hips).
Causes of Rheumatic Disease
Scientists are studying risk factors that increase the likelihood of developing a rheumatic disease. Some of these factors have been identified. For example, in osteoarthritis, inherited cartilage weakness or excessive stress on the joint from repeated injury may play a role. In other types of arthritis, a combination of genetic factors and environmental triggers are believed to be important. Gender is another factor in some rheumatic diseases.
Arthritis Symptoms
Different types of arthritis have different symptoms. In general, people who have arthritis feel pain and stiffness in the joints. Some of the more common symptoms include:
* Swelling in one or more joints
* Stiffness around the joints that lasts for at least 1 hour in the early morning
* Constant or recurring pain or tenderness in a joint
* Difficulty using or moving a joint normally
* Warmth and redness in a joint
Early diagnosis and treatment help decrease further joint damage and help control symptoms of arthritis and many other rheumatic diseases.
Diagnosing Rheumatic Diseases
Diagnosing rheumatic diseases can be difficult because some symptoms and signs are common to many different diseases. A general practitioner or family doctor may be able to evaluate patients or refer them to a rheumatologist (a doctor who specializes in treating arthritis and other rheumatic diseases).
The doctor will review the patient’s medical history, conduct a physical examination, and obtain laboratory tests and x rays or other imaging tests. The doctor might need to see the patient more than once to make an accurate diagnosis.
It is vital for people with joint pain to give the doctor a complete medical history. Answers to the following questions will help the doctor make an accurate diagnosis:
* Is the pain in one or more joints?
* When does the pain occur?
* How long does the pain last?
* When did you first notice the pain?
* What were you doing when you first noticed the pain?
* Does activity make the pain better or worse?
* Have you had any illnesses or accidents that may account for the pain?
* Is there a family history of any arthritis or other rheumatic disease?
* What medicine(s) are you taking?
The doctor will examine the patient’s joints for redness, warmth, damage, ease of movement, and tenderness. To see what the joint looks like inside, the doctor might order x-rays or other imaging procedures. X rays provide an image of the bones, but they do not show cartilage, muscles, and ligaments. Other noninvasive imaging methods such as computed tomography (CT or CAT scan), magnetic resonance imaging (MRI), and arthrography show the whole joint.
The doctor may look for damage to a joint by using an arthroscope, a small, flexible tube which is inserted through a small incision at the joint and which transmits the image of the inside of a joint to a video screen.
Because some forms of arthritis can affect other organs, a complete physical examination that includes the heart, lungs, abdomen, nervous system, eyes, ears, and throat may be necessary. The doctor may order some laboratory tests to help confirm a diagnosis.
Treatments
Treatments for rheumatic diseases include rest and relaxation, exercise, proper diet, medication, and instruction about the proper use of joints and ways to conserve energy. Other treatments include the use of pain relief methods and assistive devices such as splints or braces. In severe cases, surgery could be necessary. The doctor and the patient work together to develop a treatment plan, which usually combines several types of treatment.
Rest, Exercise, and Diet
One sign of many rheumatic conditions is fatigue. People who have a rheumatic disease should develop a comfortable balance between rest and activity. For example, when experiencing pain or fatigue, it is important to take a break and rest. Too much rest, however, might cause muscles and joints to become stiff.
People with a rheumatic disease such as arthritis can participate in a variety of sports and exercise programs. Physical exercise can reduce joint pain and stiffness and increase flexibility, muscle strength, and endurance. It also helps with weight reduction and contributes to an improved sense of well-being. Before starting any exercise program, people with arthritis should talk with their doctor. Exercises that doctors often recommend include:
* Range-of-motion exercises (e.g., stretching, dance) to help maintain normal joint movement, maintain or increase flexibility, and relieve stiffness.
* Strengthening exercises (e.g., weight lifting) to maintain or increase muscle strength. Strong muscles help support and protect joints affected by arthritis.
* Aerobic or endurance exercises (e.g., walking, bicycle riding) to improve cardiovascular fitness, help control weight, and improve overall well-being. Studies show that aerobic exercise can also reduce inflammation in some joints.
Another important part of a treatment program is a well-balanced diet. Along with exercise, a well-balanced diet helps people manage their body weight and stay healthy. Weight control is important to people who have arthritis because extra weight puts extra pressure on some joints and can aggravate many types of arthritis.
Medications
A variety of medications are used to treat rheumatic diseases. The type of medication depends on the rheumatic disease and on the individual patient. The medications used to treat most rheumatic diseases do not provide a cure, but rather limit the symptoms of the disease.
Medications commonly used to treat rheumatic diseases provide relief from pain and inflammation. In some cases, the medication may slow the course of the disease and prevent further damage to joints or other parts of the body.
Pain relievers such as acetaminophen (e.g., Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (e.g., Advil) are used to reduce the pain caused by many rheumatic conditions. NSAIDs have the added benefit of decreasing the inflammation associated with arthritis. A common side effect of NSAIDs is stomach irritation, which can often be reduced by changing the dosage or medication. Newer NSAIDs have been introduced to reduce gastrointestinal side effects and offer additional options for treatment.
Hyaluronic acid products like Hyalgan and Synvisc mimic a naturally occurring body substance that lubricates the knee joint. They are usually injected directly into the joint to help provide temporary relief of pain and flexible joint movement.
Heat and Cold
Heat and cold can both be used to reduce the pain and inflammation of arthritis.
Heat therapy increases blood flow, tolerance for pain, and flexibility. Physical therapists are needed for some of these therapies, such as microwave or ultrasound therapy, but patients can apply moist heat themselves by placing warm towels or hot packs on the inflamed joint or taking a warm bath or shower.
Cold therapy numbs the nerves around the joint (which reduces pain) and may relieve inflammation and muscle spasms. Cold therapy can involve cold packs, ice massage, soaking in cold water, or over-the-counter sprays and ointments that cool the skin and joints.
Capsaicin cream is a preparation put on the skin to relieve joint or muscle pain when only one or two joints are involved.
Hydrotherapy, Mobilization Therapy, and Relaxation Therapy
Hydrotherapy involves exercising or relaxing in warm water. The water takes some weight off painful joints, making it easier to exercise. It helps relax tense muscles and relieve pain.
Mobilization therapies include traction (gentle, steady pulling), massage, and manipulation. (Someone other than the patient moves stiff joints through their normal range of motion.) When done by a trained professional, these methods can help control pain, increase joint motion, and improve muscle and tendon flexibility.
Relaxation therapy helps reduce pain by teaching people various ways to release muscle tension throughout the body. Doctors and physical therapists can teach patients a variety of relaxation techniques.
Assistive Devices
The most common assistive devices for treating arthritis pain are splints and braces, which are used to support weakened joints or allow them to rest. Some of these devices prevent the joint from moving; others allow some movement. A splint or brace should be used only when recommended by a doctor or therapist, who will show the patient the correct way to put the device on, ensure that it fits properly, and explain when and for how long it should be worn. Incorrect use of a splint or brace can cause joint damage, stiffness, and pain.
A person with arthritis can use other kinds of devices to ease the pain. For example, the use of a cane when walking can reduce some of the weight placed on a knee or hip affected by arthritis. A shoe insert (orthotic) can ease the pain of walking caused by arthritis of the foot or knee. Other devices can help with activities such as opening jars, closing zippers, and holding pencils.
Surgery
In some cases, surgery might be required to repair damage to a joint after injury or to restore function or relieve pain in a joint damaged by arthritis. The doctor may recommend arthroscopic surgery, bone fusion, or arthroplasty (also known as total joint replacement, in which the damaged joint is removed and replaced with an artificial one).
Nutritional Supplements and Alternative Treatments
Nutritional supplements are often reported as helpful in treating rheumatic diseases. These include products such as S-adenosylmethionine (SAM-e) for osteoarthritis and fibromyalgia, dehydroepiandrosterone (DHEA) for lupus, and glucosamine and chondroitin sulfate for osteoarthritis. Reports on the safety and effectiveness of these products should be viewed with caution since very few claims have been carefully evaluated.
At this time, the only type of arthritis that can be cured is that caused by infections. Although symptoms of other types of arthritis can be effectively managed with rest, exercise, and medication, there are no cures. Some people claim to have been cured by treatment with herbs, oils, chemicals, special diets, radiation, or other products. However, there is no scientific evidence that such treatments cure arthritis. Moreover, some may lead to serious side effects. Patients should talk to their doctor before using any therapy that has not been prescribed or recommended by the health care team caring for the patient.
Limiting Your Pain
Changes in the home may help a person with chronic arthritis continue to live safely, productively, and with less pain. People with arthritis may become weak, lose their balance, or fall. In the bathroom, installing grab bars in the tub or shower and by the toilet, placing a secure seat in the tub, and raising the height of the toilet seat can help. Special kitchen utensils can accommodate hands affected by arthritis to make meal preparation easier. An occupational therapist can help people who have rheumatic conditions identify and make adjustments in their homes to create a safer, more comfortable, and more efficient environment.
The role you play in planning your treatment is very important. It is vital for you to have a good relationship with your doctor in order to work together. You should not be afraid to ask questions about your condition or treatment. You must understand the treatment plan and tell the doctor whether or not it is helping you. Research has shown that patients who are well informed and participate actively in their own care experience less pain and make fewer visits to the doctor.
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