Chronic joint pain and stiffness.
One of the conditions that is frequently overlooked and under treated is “Rheumatism”.
It also goes by names of “autoimmune disease”, “mixed connective disorder” and somewhat by a mislabeled illness “fibromyalgia”.
Arthritis is a condition that implies inflammation of joint(s). In a general sense, soft tissue attached to joints may also be inflamed and maybe termed as tendinitis.
Looking at both the entities as one, there are two kinds of arthritis.
First one is called osteoarthritis.This is basically arthritis of wear and tear – thus it tends to afflict mature patients more so than the younger patients. It can be due to trauma, infection of joints – but basically it is loss of lubricating cartilage and reactive bone formation to protect the joint.
Second kind of arthritis where there is premature destruction of the cartilage. One of the conditions that causes this is damage caused by autoimmune disease. As defined above premature destruction of cartilage generally implies that this disease process occurs in much younger people.
Ultimately, this destruction results in osteoarthritis ,albeit ,premature osteoarthritis. Damage to soft tissue around the joint directly and indirectly makes the condition worse. We shall visit that complication later.
Arthritis or inflammation of the joint implies swelling and pain. With the swelling goes stiffness. With the pain goes insomnia.
Insomnia leads to generalized fatigue compounded by generalized fatigue due to insomnia. Chronic pain, generalized fatigue and lack of mobility leads to depression.
Chronic pain, generalized fatigue and depression leads to social issues including employment and marital issues. Accusations of being lazy and being nonproductive compound the issue. Medical attention is sought. Medical institution may fail the patient.
Blood tests are done and fail to identify the underlying disease process. Further frustration sets in hopelessness begins to take over.
Insomnia leads to generalized fatigue compounded by generalized fatigue due to insomnia. Chronic pain, generalized fatigue and lack of mobility leads to depression. Chronic pain, generalized fatigue and depression leads to social issues including employment and marital issues. Accusations of being lazy and being nonproductive compound the issue. Medical attention is sought. Medical institution may fail the patient.
What is of paramount importance is that Rheumatological diseases be diagnosed on clinical basis – that means from the history and physical findings. Blood tests, x-rays are only supplementary items to assist in making the diagnosis. Blood test do not make or disprove diagnosis.
Chronic joint pain, multiple joint pain fleeting joint pain and most importantly stiffness lasting for more than a half an hour in the morning for more than 3 months should be investigated for rheumatism. Appropriate clinical examination should be carried out. Appropriate ancillary testing should be carried out.
There are 2 kinds of Rheumatological diseases-seronegative and seropositive. Seropositive – blood test positive, illnesses are easier to diagnose and therefore get treated quicker. These include rheumatoid arthritis and lupus.
The seronegative arthritis are harder to diagnose and get overlooked-these include ankylosing spondylitis, psoriatic arthritis, enteric arthritides and other autoimmune diseases that are less frequently found in the population.
Again the hallmark of rheumatological disease tends to be joint stiffness lasting for more than half an hour of morning for 3 months or more.
Generally speaking if the criteria of joint stiffness lasting for more than half an hour in the morning for several months is met and the blood tests are negative including checking for items such as Lyme disease-rheumatological consultation should be sought.
There are 2 schools of thought on a condition called fibromyalgia. One school believes that it is the illness or a disease process that can exist as a solitary item. This author believes that fibromyalgia is part of the symptom complex and not a disease in it’s own right.
As an example, fibromyalgia may be considered to be having a fever as part of the complex for the disease would be considered to be pneumonia. In this context fibromyalgia should be considered as any condition that can disrupt sleep-most common being pain from any cause or source, causing worsening of aches and pains in a defined fashion.
Cyclically pain interferes with sleeping and the following day insomnia makes pain worse… and so goes the cycle. As can be surmised from the above statement that…
Chronic pain alone can lead to fibromyalgia and it becomes imperative the cause of chronic pain be found and treated to treat the symptom of fibromyalgia.
There are other conditions associated with rheumatism. These include Sjögren syndrome where there is involvement of mucous membranes, there is dryness of mucous membranes of the eyes mouth and the genitalia particularly in women.
Raynaud’s syndrome where blood vessels (particularly the arterial blood vessels in the periphery of the extremities) develop spasm and can cause pain and in extreme cases gangrene and amputations.
Rheumatological diseases are associated with autoimmune disease such as Ulcerative colitis and Crohn’s disease. Treatment of Ulcerative colitis and Crohn’s disease brings about generalized relief of inflammation of joints as well as of the alimentary canal.
Similarly, the treatment of psoriasis leads to relief of symptoms of inflammation affecting the joints once psoriasis is treated adequately.
For more information visit website www.arthritis.org or Arthritis Foundation.