Evolution of medical terminology
In the course of medical development, views on musculoskeletal disorders have undergone significant changes. Historically, the term «rheumatism» was used as a collective concept. It united virtually all joint pathologies known at the time under its wing. The only exceptions were two diseases—gout and osteoarthritis—which were traditionally considered separately.
However, in modern Russian medical practice, an important terminological shift has occurred. Today, by «rheumatism», specialists mean one very specific nosological entity—acute rheumatic fever. Since this disease primarily affects the heart, it was completely transferred to the cardiology service and is studied in detail precisely within the cardiology section.
General characteristics and systemicity of lesions
All other diseases affecting the musculoskeletal system are now grouped into a broad category of rheumatic diseases. They share a common denominator: the presence of a pronounced articular syndrome. This syndrome very rarely occurs in isolation and in the overwhelming majority of cases is accompanied by the involvement of surrounding soft tissues in the inflammatory process.
Of particular importance in rheumatology is the classification of diseases based on their systemic nature. The most severe category is represented by systemic connective tissue diseases (SCTDs). Their main feature is that internal organs are inevitably involved in the pathological process, and it is the degree of their damage that determines the further prognosis for the patient.
Classic examples of SCTDs include:
- Systemic lupus erythematosus (SLE)
- Systemic sclerosis
- Dermatomyositis
- Polyarteritis nodosa
A very special, isolated place in the classification of rheumatic diseases is assigned to rheumatoid arthritis.
Etiological factors: from infections to genetics
Despite the rapid development of science, the etiology of many rheumatic diseases remains unclear to this day. Due to this uncertainty, several key theories of the onset of pathologies are actively discussed in modern medicine.
- Infectious theory. Scientists are closely studying the role of various microorganisms as triggers of inflammation. Viruses, as well as bacteria—chlamydia (Chlamydia) and yersinia (Yersinia)—are considered as possible causative agents that trigger autoimmune reactions.
- Genetic predisposition. The role of hereditary factors in the development of rheumatological pathology is considered absolutely proven. In the course of large-scale studies, a direct and clear correlation was revealed between the carriage of certain antigens of the HLA genetic system and the risk of developing quite specific rheumatic diseases.
Current nosologies in specialized pathology
Due to their extremely high prevalence in the human population, not all diseases are studied with the same degree of detail. The main focus of clinicians and researchers in the section of specialized pathology is concentrated on three main nosologies:
- Osteoarthritis
- Rheumatoid arthritis
- Gout
It is these diseases that make up the lion's share of the daily practice of physicians dealing with musculoskeletal disorders.
Briefly: answers to topical questions
What clinical symptoms are included in the concept of «articular syndrome»?
The concept of «articular syndrome» includes inflammatory and pain manifestations in the joints, predominantly arthritis and arthralgia. It includes patient complaints and objective examination data:
- Pain syndrome — arthralgia or pain with movement and palpation.
- Inflammation — swelling, skin hyperemia, and local hyperthermia.
- Deformities — change in shape and disfiguration of joints.
- Functional disorders — restriction of active and passive range of motion, morning stiffness.
What diagnostic criteria are used to confirm rheumatoid arthritis?
To confirm rheumatoid arthritis, the criteria of the American Rheumatism Association (ARA, 1987) are used. Diagnostic criteria:
- Morning stiffness — lasting for at least 1 hour.
- Arthritis of 3 or more joints — having a chronic character (more than 6 weeks).
- Arthritis of hand joints — specific localization of inflammation.
- Symmetry — symmetrical joint involvement.
- Rheumatoid nodules — presence of specific subcutaneous nodules.
- Rheumatoid factor — detection of RF in the patient's blood serum.
Which joint groups are target organs in primary osteoarthritis?
Osteoarthritis affects large weight-bearing joints, hand joints, and the spine. The main target organs are:
- Knee joints — gonarthrosis and patellofemoral osteoarthritis.
- Hip joints — coxarthrosis.
- Hand joints — distal and proximal interphalangeal joints (with the formation of Heberden's and Bouchard's nodes).
- Spine joints — intervertebral and costovertebral joints (spondyloarthritis, disc degeneration).
How does the articular syndrome in acute rheumatic fever differ from joint involvement in rheumatoid arthritis?
Articular syndrome in acute rheumatic fever and rheumatoid arthritis differs in course, localization, and outcome.
| Sign | Acute rheumatic fever | Rheumatoid arthritis |
|---|---|---|
| Course | Acute onset, often with fever; volatile, migrating character of pain | Chronic arthritis of 3 or more joints lasting for more than 6 weeks |
| Localization | Predominant involvement of large joints; symmetrical involvement is possible | Arthritis of hand joints, symmetrical joint involvement; typically symmetrical involvement of small hand joints with morning stiffness |
| Objective signs | Swelling, tenderness upon palpation and movement; classical polyarthritis is rare, polyarthralgia is more common | Morning stiffness of at least 1 hour; limitation of mobility, swelling, and disfiguration of joints |
| Outcome | Benign course: absence of radiographic changes, complete restoration of functions | To confirm the diagnosis, rheumatoid nodules and the detection of rheumatoid factor in blood serum are taken into account |
Class and exam questions
What is meant by the term "rheumatism" in Russian medical practice today?
In modern Russian clinical practice, this term refers to acute rheumatic fever. This condition is managed as a cardiological pathology.
What is the key sign of rheumatic diseases?
The main unifying feature is the presence of articular syndrome. Very often it occurs together with the involvement of the soft tissues surrounding the joint.
What determines the prognosis in systemic connective tissue diseases (SCTD)?
The prognosis in SCTD directly depends on how severely the patient's internal organs are involved in the pathological process.
What else to study on this topic
- Acute rheumatic fever (within cardiology)
- Clinical presentation of osteoarthritis
- Rheumatoid arthritis: features of the clinical course
- Gout as a specific joint involvement
- Systemic lupus erythematosus and other CTDs
- The role of HLA antigens in rheumatology
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