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What
Are Rheumatic Diseases and What Is Arthritis?
Rheumatic diseases are characterized by inflammation
(signs are redness and/or heat, swelling, and pain) and loss of function
of one or more connecting or supporting structures of the body. They especially
affect joints, tendons, ligaments, bones, and muscles. Common symptoms
are pain, swelling, and stiffness. Some rheumatic diseases can also involve
internal organs. There are more than 100 rheumatic diseases. Many people
use the word "arthritis" to refer to all rheumatic diseases. However,
the word literally means joint inflammation. The many different kinds
of arthritis comprise just a portion of the rheumatic diseases. Some rheumatic
diseases are described as connective tissue diseases because they affect
the supporting framework of the body and its internal organs. Others are
known as autoimmune diseases because they occur when the immune system,
which normally protects the body from infection and disease, harms the
body's own healthy tissues. Throughout this fact sheet the terms "arthritis"
and "rheumatic diseases" are sometimes used interchangeably.
What
Causes Arthritis Pain? Why Is It So Variable?
The pain of arthritis may come from different sources.
These may include inflammation of the synovial membrane (tissue that lines
the joints), the tendons, or the ligaments; muscle strain; and fatigue.
A combination of these factors contributes to the intensity of the pain.
The pain of arthritis varies greatly from person to person, for reasons
that doctors do not yet understand completely. Factors that contribute
to the pain include swelling within the joint, the amount of heat or redness
present, or damage that has occurred within the joint. In addition, activities
affect pain differently so that some patients note pain in their joints
after first getting out of bed in the morning, whereas others develop
pain after prolonged use of the joint.
Each individual has a different threshold and tolerance for pain, often
affected by both physical and emotional factors. These can include depression,
anxiety, and even hypersensitivity at the affected sites due to inflammation
and tissue injury. This increased sensitivity appears to affect the amount
of pain perceived by the individual. Social support networks can make
an important contribution to pain management.
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Examples
of Rheumatic Diseases
Osteoarthritis--
This is the most common type of arthritis, affecting
an estimated 21 million adults in the United States. Osteoarthritis primarily
affects cartilage, which is the tissue that cushions the ends of bones
within the joint. In osteoarthritis, the cartilage begins to fray and
may entirely wear away. Osteoarthritis can cause joint pain and stiffness.
Disability results most often when the disease affects the spine and the
weight-bearing joints (the knees and hips).
Rheumatoid arthritis--
This inflammatory disease of the synovium, or lining
of the joint, results in pain, stiffness, swelling, joint damage, and
loss of function of the joints. Inflammation most often affects joints
of the hands and feet and tends to be symmetrical (occurring equally on
both sides of the body). This symmetry helps distinguish rheumatoid arthritis
from other forms of the disease. About 1 percent of the U.S. population
(about 2.1 million people) has rheumatoid arthritis.
Juvenile rheumatoid arthritis--
This is the most common form of arthritis in childhood,
causing pain, stiffness, swelling, and loss of function of the joints.
The arthritis may be associated with rashes or fevers, and may affect
various parts of the body. Fibromyalgia--
Fibromyalgia is a chronic disorder that causes pain
throughout the tissues that support and move the bones and joints. Pain,
stiffness, and localized tender points occur in the muscles and tendons,
particularly those of the neck, spine, shoulders, and hips. Patients may
also experience fatigue and sleep disturbances.
Systemic lupus erythematosus--
Systemic lupus erythematosus (also known as lupus
or SLE) is an autoimmune disease in which the immune system harms the
body's own healthy cells and tissues. This can result in inflammation
of and damage to the joints, skin, kidneys, heart, lungs, blood vessels,
and brain.
Scleroderma--
Also known as systemic sclerosis, scleroderma means
literally "hard skin." The disease affects the skin, blood vessels, and
joints. It may also affect internal organs, such as the lungs and kidneys.
In scleroderma, there is an abnormal and excessive production of collagen
(a fiber-like protein) in the skin or internal organs. Spondyloarthropathies--
This group of rheumatic diseases principally affects
the spine. One common form--ankylosing spondylitis--not only affects the
spine, but may also affect the hips, shoulders, and knees as the tendons
and ligaments around the bones and joints become inflamed, resulting in
pain and stiffness. Ankylosing spondylitis tends to affect people in late
adolescence or early adulthood. Reactive arthritis, sometimes called Reiter's
syndrome, is another spondyloarthropathy. It develops after an infection
involving the lower urinary tract, bowel, or other organ and is commonly
associated with eye problems, skin rashes, and mouth sores.
Gout--
This type of arthritis results from deposits of
needle-like crystals of uric acid in the joints. The crystals cause inflammation,
swelling, and pain in the affected joint, which is often the big toe.
Infectious arthritis--
This is a general term used to describe forms of
arthritis that are caused by infectious agents, such as bacteria or viruses.
Parvovirus arthritis and gonococcal arthritis are examples of infectious
arthritis. Arthritis symptoms may also occur in Lyme disease, which is
caused by a bacterial infection following the bite of certain ticks. In
those cases of arthritis caused by bacteria, early diagnosis and treatment
with antibiotics are crucial to get rid of the infection and minimize
damage to the joints.
Polymyalgia rheumatica--
Because this disease involves tendons, muscles,
ligaments, and tissues around the joint, symptoms often include pain,
aching, and morning stiffness in the shoulders, hips, neck, and lower
back. It is sometimes the first sign of giant cell arteritis, a disease
of the arteries characterized by inflammation, weakness, weight loss,
and fever.
Polymyositis--
This is a rheumatic disease that causes inflammation
and weakness in the muscles. The disease may affect the whole body and
cause disability.
Psoriatic arthritis--
This form of arthritis occurs in some patients with
psoriasis, a scaling skin disorder. Psoriatic arthritis often affects
the joints at the ends of the fingers and toes and is accompanied by changes
in the fingernails and toenails. Back pain may occur if the spine is involved.
Bursitis--
This condition involves inflammation of the bursae,
small, fluid-filled sacs that help reduce friction between bones and other
moving structures in the joints. The inflammation may result from arthritis
in the joint or injury or infection of the bursae. Bursitis produces pain
and tenderness and may limit the movement of nearby joints. Tendinitis
(Tendonitis)--
This condition refers to inflammation of tendons
(tough cords of tissue that connect muscle to bone) caused by overuse,
injury, or a rheumatic condition. Tendinitis produces pain and tenderness
and may restrict movement of nearby joints.
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What
Causes Rheumatic Disease?
Scientists are studying risk factors that increase
the likelihood of developing a rheumatic disease. Some of these factors
have been identified. For example, in osteoarthritis, inherited cartilage
weakness or excessive stress on the joint from repeated injury may play
a role. In lupus, rheumatoid arthritis, and scleroderma, the combination
of genetic factors that determine susceptibility and environmental triggers
are believed to be important. Family history also plays a role in some
diseases such as gout and ankylosing spondylitis. Gender is another factor
in some rheumatic diseases. Lupus, rheumatoid arthritis, scleroderma,
and fibromyalgia are more common among women. (See next section for details.)
This indicates that hormones or other male-female differences may play
a role in the development of these conditions.
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Who Is
Affected by Arthritis and Rheumatic Conditions?
An estimated 43 million people in the United States
have arthritis or other rheumatic conditions. By the year 2020, this number
is expected to reach 60 million. Rheumatic diseases are the leading cause
of disability among adults age 65 and older. Rheumatic diseases affect
people of all races and ages. Some rheumatic conditions are more common
among certain populations. For example: Rheumatoid arthritis occurs two
to three times more often in women than in men. Scleroderma is more common
in women than in men. Nine out of 10 people who have lupus are women.
Nine out of 10 people who have fibromyalgia are women.
Gout is more common in men than in women. Lupus is three times more common
in African American women than in Caucasian women. Ankylosing spondylitis
is more common in men than in women. What Are the Symptoms of Arthritis?
Different types of arthritis have different symptoms. In general, people
who have arthritis feel pain and stiffness in the joints. Some of the
more common symptoms are listed below. Early diagnosis and treatment help
decrease further joint damage and help control symptoms of arthritis and
many other rheumatic diseases.
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Common Symptoms of Arthritis
Swelling in one or more joints.
Stiffness around the joints that lasts for at least 1 hour in the early
morning.
Constant or recurring pain or tenderness in a joint.
Difficulty using or moving a joint normally.
Warmth and redness in a joint.
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