RHEUMATISM

A Brief Overview of the History of Rheumatism

What is Rheumatism?

In fact, under the designation 'rheumatism' are classified more than one hundred different diseases. Many people think of rheumatism when they experience pain along muscles and tendons (patients often mistake 'tendons' for 'nerves'). Others refer to joint diseases. They are all right, but a lot more is lacking…

In the modern textbooks of rheumatism there seems to be no concern in conceptualizing rheumatism. In fact, the diversity of existing rheumatic diseases hinders the development of a definition that adequately covers all of them, since the trigger mechanisms of the diseases and the affected organs vary considerably.

In order for the reader to become acquainted with the subject, we propose a brief overview of the history of rheumatism

Let us begin with Hippocrates, a Greek physician who lived in the VIth B.C, and is considered the father of medicine. He described diseases so precisely that today we are able to tell which are they.

He thought arthristis was caused by the fluids emanating from the bile and the brain. In Greek, to flow, run, means rheuma, and this word was used, later, to gather diseases coursing with arthritis

Hippocrates described podagra (podos= foot + agra= a seizure); therefore, he should be assisting patients with an acute seizure of inflammation in the foot. It was, probably, gout. This disease occurs, particularly, in adult men whose acid uric in the blood is higher than the normal level (women will only develop higher levels of acid uric after menopause; before is rather very rare). Gouty arthritis can occur in other joints, but it most commonly it strikes the big toe with the first metatarsian, and this where the word podagra is applied.

He also described gonagra (in Greek, gonos=knee). Acute arthritis of the knee may as well be gout, but many different infections, inflammatory diseases of unknown cause, such as rheumatoid arthritis, skin diseases, psoriasis, may begin this way and should also be recalled.

Hippocrates mentioned arthritis in the child which is curable. It is probably rheumatic fever. This is a secondary disease to a throat infection by a special type of streptococcus. Around 4% of children nontreated with antibiotics will develop arthritis in two weeks, which migrates through the joints and disappears, spontaneously, within weeks. The severe problem with the rheumatic fever is the simultaneous involvement of the heart, leading to irreversible valve lesions.

Arthritis in childbearing women make us think of purulent arthritis by the gonoccocus (if there is genitial infection, childbirth creates the conditions for the spreading of bacteria through the blood); as well as of lupus.

In this latter disease, inflammation can occur in any organ, but dermatitis and arthritis are the most frequent ones. The onset or exacerbation after childbirth are common.

Another interesting description is the rheumatism in hysterical women. It addresses women complaining of generalized pain, associated with an important psychiatric component. For a long time the term psychogenic rheumatism was used to designate this disease and, currently, it is known as fibromyalgia. Unrefreshed sleep, disseminated body pain and fatigue are the main features of fibromyalgia. It is certainly not a psychogenic condition, but the patients with fibromialgya have an associated psychiatric component, which is presumably resulting from the same defect triggering the organic symptoms.

What have we learned so far?

Distinct diseases can cause arthritis. Everytime there is nontraumatic arthritis, rheumatism will develop. Joints are the choicest sites for rheumatism, but it can affect other organs, too. Also, there are some rheumatic conditions that do not affect the joints. However, before closing this brief introduction, there is still some further information to be presentend, which should provide the reader with a better knowledge on this subject:

The most frequent joint disease is arthrosis (or osteoarthritis). The tissue primarily affected by this condition is the joint cartilage. The spinal column is a 'pile of joints', which are also affected by some rheumatic conditions. Back pain may be a sign of rheumatism. Rheumatoid arthritis, lupus, dermatomyositis (inflammation of the muscles and the skin), scleroderma/systemic sclerosis (inflammation and fibrosis of the skin and other organs), vasculitis (inflammation of the arteries or veins)have an autoimmune mechanism (antibodies attacking the organism's own tissues and causing inflammation). These diseases are rheumatic conditions as they course with arthritis or have similar mechanisms at their onset. Various rheumatic conditions may start at childhood or adolescence. Rheumatic fever is not the most frequent cause of arthritis in children. The phrase 'blood rheumatism' should not be used. Blood is utilized for laboratory testing that will identify inherent alterations of each disease.

Upon closing this article, the reader has acquired more knowledge that will allow him/her to identify or suspect any rheumatic manifestations and, therefore, to address the appropriate condition.

 

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