Types of Chronic Rheumatic Diseases (3 Types)

The following points highlight the three main types of chronic rheumatic diseases. The types are: 1. Rheumatoid Arthritis 2. Osteoarthrosis 3. Non-articular Rheumatism.

Chronic Rheumatic Diseases: Type # 1. Rheumatoid Arthritis:

(a) It occurs in people of all ages. The peak incidence is at the age of 40. It occurs in women at least three times as in men.

(b) It is mainly a disease of temperate climates which are associated with cold and damp.

(c) The principal tissue affected is the syno­vial membrane of joints which becomes inflamed and thickened.

(d) Muscular stiffness develops first and is fol­lowed later by pain and swelling of many joints, starting frequently with the small joints of the hands and feet.

(e) During the active stage of the disease the patient suffers from general malaise and fatigue; fever is sometimes present and the appetite is poor.

(f) There is loss of weight and some degree of anemia.

Treatment:

(a) Anemia and loss of weight by diet should be corrected.

(b) Foods rich in protein, iron and ascorbic acid should be tried first; additional vita­mins and minerals should be prescribed.

Chronic Rheumatic Diseases: Type # 2. Osteoarthrosis:

(a) Osteoarthrosis is characterised by degene­ration of the articular cartilage and the for­mation of bony outgrowths at the edges of the joints. A generalized form of the disease occurs normally in middle-aged women in whom the small joints of the fingers, the carpometacarpal joint of the thumb and the interfacetal joints of the spine are particularly affected.

(b) When one joint is particularly affected, there is frequently a history of an injury to that joint some years before.

(c) Following fractures of the long bones gives rise to osteoarthrosis in adjacent joints.

(d) Symptoms are proved to develop in the weight-bearing joints or those joints sub­jected to excessive strain at work.

(e) Obesity imposes to ‘osteoarthrosis’ of the weight-bearing joints in the lower half of the body.

(f) The joints involved are those of the spine, the hips, knees, elbows, and the terminal joints of the fingers.

(g) The symptoms are gradual in onset. Pain is at first intermittent and of the aching character, appearing after the joint has been used, and relieved by rest.

(h) As the disease progresses, movement in the affected joints become increasingly limited, at first by muscular spasm and later by the loss of joint cartilage and the for­mation of osteophytes. General health is usually excellent.

Treatment:

(a) Rest, graduated physical exercises and physiotherapy.

(b) Analgesic should be advised according to the patient’s needs.

(c) Prevention and correction of obesity is needed.

Chronic Rheumatic Diseases: Type # 3. Non-articular Rheumatism:

(a) This is characterised by pain and stiffness, often of sudden onset, affecting mainly the neck, shoulders, back and gluteal re­gions.

(b) Exposure to cold and damp, excessive or unaccustomed muscular activity, injury to muscles and tendons and poor posture may each be held responsible.

(c) Muscular pain and stiffness arise from strain or injury to ligamentous or articular structures.

(d) Most cases of brachial neuralgia, lumbago and sciatica may result from degenerative changes in the intervertebral discs.

(e) In the acute stage the patient may be se­verely incapacitated by pain and stiffness.

(f) In the more chronic stage pain is felt most often after rest and improve with moder­ate activity.

(g) Muscular spasm may be marked and move­ment limited.

Treatment:

(a) Rest in bed is essential, together with heat to the affected part and analgesics in am­ple amounts.

(b) At a later stage physiotherapy (heat, mas­sage and graduated exercise) is essential.

(c) In cases with lesions of the intervertebral disc causing pressure, operation should be considered.

(d) Diet has no role in curative treatment but if the patient is obese, reduction in weight is the relief of symptoms.