Common Rheumatic Diseases

Osteoarthritis (OA) is a disorder of the joints characterized by deterioration of the articular cartilage and secondary new bone formation. Onset is non-inflammatory, but secondary inflammation is common. Typically, the disease is slowly progressive; but OA may stop at any point and have remissions and even cartilage regeneration. When inflammation is not present, the condition is called osteoarthrosis. Generally people have painless OA for years before they experience inflammation. You cannot cure OA but you can often stop the inflammation and get back to a state of painless OA. So, if a doctor says “the pain in your joint is from OA” the next questions should be “how can I get rid of the inflammation and get back to having a painless joint; and what can I do to help my joint besides take medications?”

Rheumatoid arthritis (RA) is a chronic inflammatory disease, with inflammation and swelling in three or more joints, morning stiffness, malaise (feeling sick) and fatigue. RA is a disorder of the immune system in which some unknown mechanism triggers the synovial lining in the joints to become inflamed. The name “rheumatoid” refers to “fluids associated with illness,” “arth” means joint, and “itis” means inflammation. The disorder is considered “systemic,” which means it affects the entire body. Consequently when a person is in a flare, they feel sick, as if they have the flu. For most people, RA causes damage only in the joints and tendons. For some, RA affects their internal organs; this is referred to as “extra-articular involvement,” meaning outside the joint. RA often affects all of the hand and wrist joints, limiting functional ability. How you use your hands during periods of inflammation and swelling can reduce pain and risk of deformity. Ask your doctor to refer you to a therapist that can teach you “joint protection training” so you can learn how to perform activities without making your joints worst.

Systemic sclerosis (SSc) is a generalized disorder of the small blood vessels and connective tissues. It causes tightness and dryness in the skin and impaired circulation that causes skin ulcers. The systemic nature of SSc is evidenced by frequent involvement of the digestive tract, synovium, lungs, heart, kidneys. Scleroderma is an umbrella term for a group of disorders that includes sclerosis of the skin as a predominant feature. SSc is the generalized form. Morphea (patches) and linear scleroderma are the localized forms. Patients often prefer the term “scleroderma” because it is easier to say and to understand. Therefore, scleroderma is often used as the common term for systemic sclerosis.

Systemic lupus erythematosus (SLE) is a complex chronic inflammatory disease caused by regulatory abnormalities of the immune system. It can affect multiple organ systems, including the skin, renal, cardiovascular, pulmonary (lung), neuropsychiatric and musculoskeletal systems. People with SLE experience an unpredictable pattern of exacerbations (flares) and remissions of their disease, in which different systems may be affected at different times. Patients experience fatigue, joint pain and inflammation, rashes, and instability in circulation of the hands and feet (Raynaud’s phenomenon). They often have photosensitivity to the sun’s UV rays, where exposure to the sun actually makes their SLE worst. (Please see the fatigue treatment section for more info.)

Ankylosing spondylitis (AS) is an inflammatory disease primarily affecting the axial (spine and chest) skeleton. AS often starts in the sacroiliac (pelvic) and spinal joints, as well as the multiple tendon attachments along the spine. An enthesis is the portion of the tendon, ligament, or capsule that attaches into bone. During movement the greatest amount of stress occurs at the enthesis and it has special properties to be able to handle this stress. AS seems to attack the entheses first. Inflammation of the enthesis is called enthesopathy. One third of patients with ankylosing spondylitis have arthritis or enthesopathy in the limbs as well as the spine. In men it often starts in the low back and moves up the spine. In women it may start in the neck.

Polymyalgia rheumatica (PMR) is a syndrome that affects people over 50 years of age and can affect people over 80 years of age. It is common in white populations, and uncommon in blacks, Hispanics and Asians. Women are affected twice as often as men.

PMR can occur abruptly or slowly with pain and stiffness in the neck, shoulder girdle, and occasionally in the thighs and hips. There is no measurable weakness in the muscles; but pain and stiffness inhibit muscle strength making it difficult for a person to rise from a chair or get up from bed, put clothes on over the head, style or wash hair or step up on a curb. Other symptoms include feeling sick (malaise), weight loss, fever, muscle pain (myalgia), depression, morning stiffness, and pain at night with movement. Some patients may also develop inflammation of the temporal artery (temporal or giant cell arteritis) this causes pain and tenderness on the sides of the forehead and blurry vision. Early treatment is very important.

One method to diagnose PMR is with a low dose of an oral corticosteroid, such as prednisone. A daily dose at the beginning of the treatment is usually 10 to 20 milligrams a day. If the person does not improve in a few days, it is likely they have another disorder not PMR. Most people respond to one course of treatment, but some may need a longer period.