A better understanding of rheumatology and arthritis

"Oh, my rheumatism!” You’ve probably heard this phrase from time to time. It’s quite an old saying, with the word rheuma first recorded in the first century A.D. in Greece. Many centuries ago, people believed that flowing substances in the body, like phlegm, were the culprit of most body ailments and pains.

Modern understanding has changed over several thousands of years. Today’s rheumatology practice diagnoses and manages autoimmune and inflammatory diseases. Some examples include rheumatoid arthritis, lupus, gout, psoriatic arthritis, polymyalgia rheumatica and ankylosing spondylitis. Medical professionals have also since discovered it’s our immune system and not flowing substances that is the source of rheumatic disease. 

Under normal conditions, the immune system recognizes foreign invaders, like bacteria and viruses, and sweeps them away. However, when the immune system gets confused, it can attack normal body tissues, producing pain and swelling known as inflammation.

Often, these inflammatory effects are first felt in the joints and are referred to as arthritis. A deeper understanding made by practitioners has found that inflammation from a confused immune system can go beyond the joints and also attack the connective tissues, muscles, blood vessels and organs in the body. In some cases, inflammation may even be life-threatening. 

Osteoarthritis or rheumatoid arthritis

We need to be careful with the term arthritis, because like the word rheuma, it’s an old, very general word. Interestingly, there are more than 100 types of arthritis, and they’re all treated quite differently. Many people are only familiar with one type of arthritis: osteoarthritis. Osteoarthritis, often described as wear-and-tear arthritis, is the most common form of arthritis, affecting 27 million people in the United States. However, osteoarthritis is not an autoimmune inflammatory disease, and it’s not the type of arthritis usually managed in a rheumatology practice. 

Rather, an inflammatory arthritis like rheumatoid arthritis has these types of features:

1. Severe pain in the joints, muscles or bones that lasts more than three to four days. Commonly, walking or lifting a spoon to eat is difficult during a flare.
2. Stiffness in the joints lasting more than an hour in the early morning.
3. Swelling and redness in one or more joints.

Who can develop an autoimmune condition?

While no one knows exactly what triggers the immune system to make the mistake of attacking healthy tissue, some studies indicate a genetic component, combined with environment, may increase the risk for certain arthritis. This explains why people who experience symptoms associated with inflammatory arthritis usually have a relative who also has some form of autoimmune disease. Smoking tobacco can also be a trigger and should be avoided for numerous reasons.

An inflammatory autoimmune condition can occur at any age. Right now in the United States, there are 300,000 children with inflammatory juvenile arthritis. In fact, rheumatic disease often strikes at the prime of life, with two-thirds of patients under age 65.

In many cases, the diseases are dramatic and debilitating at the time of onset. These are chronic conditions that cannot be cured. As a result, a diagnosis of an autoimmune or inflammatory disease can be stressful for the patient and his or her family.

Steps to take

If you or someone you know is experiencing signs or symptoms of an autoimmune or inflammatory condition, your primary care provider can refer you to Rheumatology for a detailed history and examination. In addition, laboratory tests on blood and urine, X-rays and sometimes samples of joint fluid are used to reach a diagnosis. Rheumatologic conditions can be challenging to diagnose and, in most, cases take several visits.

Many times, rheumatic diseases are treated with medications, which have an effect on the immune system. Additionally, exercise, physical therapy, dietary modifications, adequate sleep, stress reduction and avoiding tobacco all play critical roles in successful treatment plans.

While rheumatic autoimmune and inflammatory conditions cannot be cured, current treatment aims to limit the symptoms of the diseases. Many people with rheumatic disease lead productive, happy, satisfying lives. Your local rheumatology department is here to help.

Sarah Davis is a Mayo Clinic Health System in Mankato rheumatology nurse practitioner.