Rheumatic diseases include a wide range of diseases that occur with a predominant lesion of the joints and periarticular tissues. A special group among them are systemic diseases – collagenoses and vasculitis, characterized by autoimmune genesis, local or diffuse damage to connective tissue. Rheumatic diseases are studied by a specialized section of internal diseases – rheumatology. The course is often accompanied by multiple organ damage with the development of cardiac, renal, pulmonary, cerebral syndromes, the treatment of which involves not only rheumatologists, but also narrow specialists – cardiologists, nephrologists, pulmonologists, neurologists. These diseases have a progressive course, disrupt the functional activity of the patient and can lead to disability.
Rheumatic diseases such as gout and arthritis have been known since the time of the ancient Greek physician Hippocrates. In the II century AD, the Roman philosopher and surgeon Galen introduced the term “rheumatism”, which denoted a variety of diseases of the musculoskeletal system. It was only in the XVIII – XIX centuries that descriptions of individual rheumatic diseases began to appear. Currently, according to the American Rheumatology Society, there are over 200 types of rheumatic pathology.
Depending on the predominant lesion, the whole variety can be divided into three large groups: joint diseases, systemic vasculitis and diffuse connective tissue diseases. Joint diseases are mainly represented by arthritis (rheumatoid, psoriatic, gouty, reactive, infectious, etc.), as well as osteoarthritis, ankylosing spondylitis, of the periarticular soft tissues. The group of systemic vasculitis includes hemorrhagic vasculitis, nodular periarteritis, Wegener’s granulomatosis, Horton’s disease, Goodpasture syndrome, Takayasu’s disease, obliterating thrombangiitis. Diffuse connective tissue diseases, or systemic diseases, are represented by systemic lupus erythematosus, scleroderma, dermatomyositis, Sjogren’s disease, Sharpe syndrome, etc. Separately in the classification is rheumatism, in which there is a simultaneous rheumatic lesion of the joints, connective tissue and blood vessels.
Currently, the etiology is considered from the perspective of a multifactorial concept, according to which their development is explained by the interaction of genetic, environmental and endocrine factors. At the same time, the genetic factor acts as a predisposing factor, and the external and endocrine factors act as producing, triggering moments. The most frequent provoking factors are infections caused by Epstein-Barr viruses, cytomegaly, herpes simplex, picornaviruses, etc.; intoxication, stress, insolation, hypothermia, trauma, vaccination; pregnancy, abortions. The unifying links of pathogenesis for all rheumatic diseases are a violation of immune homeostasis and the development of a severe immuno-inflammatory process in connective tissue, microcirculatory bed and joints.
Rheumatic diseases occur among patients of various age groups, including among children and adolescents (for example, arthritis in children, rheumatism in children, juvenile rheumatoid arthritis, connective tissue dysplasia, etc.). Nevertheless, the peak incidence falls on the mature age – from 45 years and older. Some rheumatic diseases develop more often in persons of a certain gender: for example, systemic diseases, rheumatoid arthritis, rheumatic polymyalgia are more characteristic of women, but gout, psoriatic arthritis, ankylosing spondylitis usually affect men.
Clinical manifestations of rheumatic diseases are extremely diverse and changeable, however, it is possible to identify certain symptomatic markers, in the presence of which you should immediately consult a rheumatologist. The main ones include: prolonged causeless fever, arthralgia, swelling and changes in the configuration of joints, morning stiffness of movements, muscle pain, skin rash, lymphadenitis, a tendency to thrombosis or hemorrhage, multiple lesions of internal organs. Systemic diseases are often disguised as diseases of the skin, blood, musculoskeletal system, oncopathology, which require differentiation in the first place.
Significant progress has been made in the diagnosis and treatment of rheumatic diseases in recent years, due to the development of genetics, immunology, biochemistry, microbiology, pharmacology, etc. The basis for making a correct diagnosis is immunological studies that allow to identify antibodies corresponding to a certain nosology. Radiography, ultrasound, CT, MRI, scintigraphy, arthroscopy, and biopsy are also widely used for the diagnosis of rheumatic diseases.
Unfortunately, to date, a complete cure of rheumatic diseases is impossible. Nevertheless, modern medicine in most cases is able to help alleviate the course of the disease, prolong remission, avoid disabling outcomes and severe complications. Treatment of rheumatic diseases is a long, sometimes lifelong process and consists of drug therapy, non-drug methods, orthopedic treatment and rehabilitation. The basis of the therapy of most rheumatic diseases are basic anti-inflammatory drugs, glucocorticosteroids and biological drugs. An essential role in complex therapy is assigned to extracorporeal hemocorrection – plasmapheresis, hemosorption, cytapheresis, plasmosorption, etc. Such non-drug methods of treatment of rheumatic diseases as physiotherapy, balneotherapy, physical therapy, acupuncture, kinesiotherapy, can significantly improve the functional status of patients. Orthopedic treatment (orthotics, surgical correction of joint function, endoprosthetics) is indicated mainly in the late period of rheumopathology to improve the quality of life of patients.
Prevention of rheumatic diseases is of a non-specific nature. To prevent them, it is important to avoid provoking factors (stress, infections, other loads on the body), pay sufficient attention to physical activity and taking care of your health, exclude bad habits. The rapid development of medical technologies allows us to hope for a speedy resolution of unclear issues concerning the occurrence and course of rheumatic diseases.
On the pages of our medical reference book, rheumatic and systemic diseases are separated into an independent section. Here you can get acquainted with the main diseases of the rheumatic profile, the causes of their occurrence, symptoms, advanced diagnostic methods, modern views on treatment.