Rheumatism, rheumatic disorders, rheumatoid arthritis… It is easy to understand why a certain amount of confusion exists surrounding such terminology and the definition of each word. We take a look at some of the most frequently-asked questions regarding rheumatism and provide answers that hopefully help clear up some of the uncertainty.
1. What is Rheumatism?
In medical circles, the term rheumatism is considered rather antiquated and out-dated. However, it remains a part of many people’s vocabulary, so it’s worth taking the time to understand exactly what is meant by the word.
Rheumatism is not a disease. Rather, it is an umbrella term under which diseases that are categorized by inflammation to joints, muscles, ligaments, bones, and tendons fall.
Over 200 rheumatic disorders are known to exist, affecting at least 46 million people in the US.
A large number of rheumatic conditions, such as rheumatoid arthritis and lupus, are autoimmune diseases, which means the immune system mistakenly attacks healthy tissue within the body. Quite why the immune system does this is not yet fully understood. A combination of genetics and environmental factors are believed to play a role in the development of autoimmune diseases, while certain infections could act as triggers.
Not all rheumatic conditions are autoimmune disease. Osteoarthritis, for example, is a degenerative disease that develops with age, while gout is caused by high levels of uric acid in the blood. Neither are classed as autoimmune diseases, but both fall under the category of rheumatic disorders.
Rheumatism, therefore, refers to a wide range of different disease, all of which are classed as rheumatic disorders because of the shared characteristics of the symptoms. It does not, however, indicate the mechanisms of any given disease; the biology of one rheumatic disease can differ greatly to the biology of another.
Rheumatic disorders are generally treated by rheumatologists, but certain diseases may require other specialists such as immunologists or cardiologists.
Under the umbrella of rheumatism is a sub-category containing the most common rheumatic diseases: arthritis.
2. Are Rheumatism and Arthritis the Same?
The words rheumatism and arthritis are often used interchangeably, but they do not mean the same thing.
As mentioned earlier, rheumatic diseases cause inflammation to joints, muscles, ligaments, bones, and tendons. Arthritis refers specifically to diseases that affect joints. As such, it can be considered the sub-category of rheumatic diseases that accounts for a large percentage of the overall conditions and cases.
Indeed, there are over 100 arthritic diseases, with an estimated 21 million people living with the most common form, osteoarthritis, in the US.
People may also use the word rheumatism when referring specifically to the autoimmune disease rheumatoid arthritis, with which over one million people in the US live.
It is understandable, therefore, why rheumatism and arthritis can be almost synonymous in their usage, as it is common for people to live with a disease that is both. However, there is a range of rheumatic diseases that are not arthritic. They may be referred to as non-articular (literally meaning not affecting the joints) rheumatic diseases.
The best-known example of a non-articular rheumatic disease is fibromyalgia, which is characterized by long-term pain all over the body.
Another condition that is not strictly speaking a form of arthritis (although does present symptoms that affect the joints) is rheumatic fever.
Other posts you may be interested in on the MyTherapy blog:
- Rheumatoid Arthritis: “You’re Too Young for That!”
- Living with Rheumatoid Arthritis: What I Wish for at Christmas…
3. What is Rheumatic Fever?
Rheumatic fever is a potentially serious condition, the cause of which is related to group A streptococcus bacteria, which are responsible for scarlet fever and strep throat. The latter can occur at any age but is most common in children between 5 and 15 years old.
When left untreated, strep throat can trigger (what is widely believed to be) an autoimmune response, causing the immune system to attack the body and cause inflammation of the joints, skin, the brain, and the heart. This is rheumatic fever.
Symptoms tend to occur a few weeks after the onset of strep throat and usually include painful, sore and inflamed joints, and fever, while symptoms affecting the heart, such as chest pain, may also occur.
While rheumatic fever is ‘acute’, meaning it usually lasts a matter of weeks or months, the symptoms affecting the heart are an indication of the most serious long-term complication: rheumatic heart disease.
Rheumatic heart disease is caused by inflammation to the heart causing permanent damage, primarily to heart valves, that can cause problems with blood flow. This can subsequently cause potentially life-threatening complications such as stroke.
In the big picture of rheumatic disorders, rheumatic fever is rather unusual insomuch as it has a quite clear trigger in strep throat – although why strep throat is liable to trigger an autoimmune response is not well understood.
Rheumatic fever is also different from other rheumatic disorders as the most serious long-term damage is usually done to the heart in the form of rheumatic heart disease.
Although strep throat is relatively common, fewer than 0.3% of people who have it develop rheumatic fever in the US. It is similarly uncommon in most developed countries. It is, however, a common condition in developing countries and remote parts of countries such as Australia.
Another rheumatic disease that people often search for is palindromic rheumatism.
4. What is Palindromic Rheumatism?
Given the rarity of the condition, which is a form of arthritis, the high search volume palindromic rheumatism receives can perhaps be attributed to its rather unusual name.
A palindrome is any word, phrase, number, or some other sequence of characters which reads the same forwards as it does backwards, such as racecar or the ever-popular A man, a plan, a canal, Panama.
The name refers to the way in which symptoms occur suddenly and spontaneously, last for hours or days, and then cease in an equally abrupt manner. Such attacks are usually of a sporadic and unpredictable nature.
Symptoms typically resemble those of rheumatoid arthritis: pain and inflammation of joints and the surrounding tissue. Unlike rheumatoid arthritis (and other forms of arthritis), palindromic rheumatism does not appear to do lasting damage to the joints.
Like rheumatoid arthritis, palindromic rheumatism is an autoimmune condition. The similarities and differences between the two conditions fuel the debate about whether palindromic rheumatism should be classed as a subtype of rheumatoid arthritis or a condition in its own right.
Regardless, as the above article states, between 25%-50% of people diagnosed with palindromic rheumatism subsequently develop rheumatoid arthritis. It is estimated that between 105,000 and 262,500 people in the US live with palindromic rheumatism.
Like many rheumatic disorders, there are a number of factors that play a role in determining one’s risk of developing palindromic rheumatism.
5. Who is Most at Risk of Rheumatism?
Let’s look first at autoimmune rheumatic disorders, which includes palindromic rheumatism, rheumatoid arthritis, lupus, and many other conditions.
Almost every autoimmune disease affects women more than men, a trend that holds true for autoimmune rheumatic disorders. Rheumatoid arthritis affects more than 1.3 million people in the US, around 75% of whom are female. A similar percentage is true of the scleroderma, while around 90% of the 1.5 million people the US living with lupus are female.
Genetics are also believed to play a role in the development of autoimmune diseases, so having a relative with an autoimmune rheumatic disorder may increase your likelihood of developing one, but it is not known by how much. Researchers have also identified specific gene mutations that are linked to particular diseases. At present, this is of little practical use. However, it is a field of research that could eventually lead to a greater understanding of autoimmune diseases and hopefully to improved treatment.
Ethnicity certainly appears to play a role in one’s risk of developing an autoimmune disease. The prevalence of lupus, for example, is up to eight times higher in African-American and Afro-Caribbean population than in people of European descent. Likewise, the prevalence of rheumatoid arthritis is up to four times higher in Native Americans than poeple of European descent.
Although it varies from disease to disease, it is generally accepted that African-American, Afro-Caribbean, Native American, and Latino populations are more likely to develop autoimmune disease than Caucasian populations, a trend that holds true for the most common rheumatic disorders.
Environment & Lifestyle
Although a person may have a genetic predisposition to an autoimmune disease, it is widely believed that environmental factors play a key role in actually triggering the disease. However, quite what these factors are remains largely a mystery.
Certain viruses have been linked to the development of autoimmune diseases, such as the previous example of strep throat triggering rheumatic fever. Similarly, Epstein-Barr virus has been linked with a number of autoimmune diseases, including rheumatoid arthritis.
When it comes to lifestyle, smoking and obesity have both been linked to a wide range of autoimmune diseases, but little is known about the exact nature of the relationship.
The age at which you are most at risk of developing an autoimmune disease varies from condition to condition. For example, children are most at risk of rheumatic fever, symptoms of lupus usually begin between 15 and 40 years of age, while rheumatoid arthritis symptoms are most likely to begin between 30 and 50 years of age.
Clearly, there is no single risk profile that fits all types of autoimmune rheumatic disorders. However, certain trends that apply to autoimmune diseases in general, such as gender and ethnicity, hold true when it comes to rheumatic disorders. It is also true that if you have one existing autoimmune disorder, you are more likely to develop another (rheumatic or otherwise).
Risk Factors for Osteoarthritis
As previously mentioned, the most common rheumatic disorder is not an autoimmune disease. The biggest risk factor for osteoarthritis is age, occurring in around 10% of men aged 60 or above and 13% of women.
Additional risk factors include:
- Injury and surgery
- Gender (again, females are at increased risk, although not to the same extent as with autoimmune diseases)
- Muscle weakness
- Sports & Physical activity
The last one is the subject of debate. Some studies suggest elite athletes are at an increased risk of osteoarthritis and that even regular levels of exercise can increase one’s risk – particularly in the hip and knees. Other studies, however, suggest that (in the absence of acute injury), moderate level exercise does not increase risk.
Of course, being sedentary undoubtedly increases one’s risk of other health problems such as heart disease, so exercise is recommended as part of a healthy lifestyle.
Aside from osteoarthritis, each individual disease has its own risk profile. For example, gout is more common in men, due to higher uric acid levels, and the risk increases with age. An estimated 12% of men aged between 70 and 79 years old live with gout, compared to less than 3% of men under 50. Alcohol impairs the body’s ability to flush out uric acid, so is also a known risk factor.
What does all of this mean? Well, until more mysteries are solved regarding autoimmune diseases, there is little anyone can do to mitigate their risk of developing one. Gender, age, genetic disposition, and unknown environmental factors are all out of one’s control.
For other rheumatic diseases, sticking to a lifestyle that is generally regarded as healthy – a good diet, enough exercise, not smoking, and moderate or no alcohol consumption – remain your best option for mitigating risk.
Would you like to know more about autoimmune diseases? Our 3-part Autoimmune Series can enlighten you about a few of the most-searched for autoimmune disorders:
- Autoimmune Disease Series: What is Autoimmune Encephalitis?
- Autoimmune Disease Series: What is Autoimmune Hepatitis?
- Autoimmune Disease Series: What is Autoimmune Thyroid Disease?
Take a look at some of the other posts on the MyTherapy blog: