rheumatism symptoms

Rheumatic pains
Rheumatic diseases:
much more than a joint disorder


Rheumatism is often considered a disorder
generic and of little importance.
Many people think that they are manifestations
"Normal" at a certain age, which inevitably
arise as the years pass by.
Or that they are a consequence of a use
improper joints, perhaps due
professional activity or sporting practice.

What is that

In fact, the term "rheumatism" includes over one hundred rheumatic diseases extremely diverse in nature, symptoms and complications, which mainly concern the musculoskeletal system (joints, bones, tendons, ligaments, joint capsules, muscles, etc.), but that in many cases can also affect other organs and tissues, such as the heart, blood vessels, lungs, kidneys, skin, intestines, eyes, etc.

In relation to the structures mainly concerned, rheumatism is distinguished in "articular" and "extra-articular" (although, often, rheumatic disease can damage several tissues at different levels of severity), while in relation to the mechanism of onset we recognize "inflammatory" rheumatic forms and "degenerative" rheumatic forms.

In addition, there is an extremely diverse group of rheumatic diseases related to endocrine-metabolic alterations, inherited diseases of connective tissue, neoplasms, neurological and neurovascular diseases, sarcoidosis or some blood diseases.

The most common degenerative joint rheumatism is osteoarthritis, which mainly affects the vertebral column, hands, shoulders, hips, knees and feet. While the main inflammatory rheumatic forms include

Chronic inflammatory arthritis
•  Rheumatoid arthritis
• Psoriatic arthritis
•  Ankylosing spondylitis

connectivitis
• Systemic lupus erythematosus (LES)
• Undifferentiated connectivity
• Scleroderma
• Sjögren syndrome
• Polymyositis-dermatomyositis

Rheumatic polymyalgia

Vasculitis
• Wegener
• Churg-Strauss
• Horton's arteritis
• Behçet

Arthritis from microcrystals
• Gout
• Pseudo-gout (chondro-calcinosis)
• Arthritis resulting from infections

The most common extra-articular rheumatic forms are, instead, represented by:

• Tendinitis
• Periarthritis
• Bursitis
• Myofascial pain syndromes
• Fibromyalgia

To suffer from inflammatory rheumatic diseases are mainly women, affected by these conditions more than men probably for reasons of hormonal nature not better specified. Age, on the other hand, increases the likelihood of being affected by degenerative rheumatic diseases (in particular, arthrosis), but not by inflammatory rheumatic diseases (juvenile idiopathic arthritis, ankylosing spondylitis, Behcet's syndrome, etc.), which may also occur in children and young adults for different reasons depending on the specific disorder considered.
Causes of rheumatic pains

Being an extremely varied group of pathologies, the causes that determine rheumatic diseases are very different in different cases.

The onset of inflammatory forms is, as a rule, linked to an abnormal immune reaction that triggers a local and / or systemic inflammatory process in which the cells of the immune system (in particular, the lymphocytes) attack specific tissues (joints, muscles, tissue). connective etc.) releasing powerful mediators of inflammation (cytokines), which damage the tissues themselves and cause the characteristic symptoms of the disease (variable according to the target organ / structure).


Although intense research has allowed to clarify several details of this immunomediate process, to date, in the vast majority of cases, the initial factors that trigger it are not known. Among the possible causes triggering viral or bacterial infections (in particular from Streptococcus), traumas, stress, exposure to some vaccines or environmental agents of various types, but precise and reliable information about it continue to be missing, except in a few cases.

The probability of developing an inflammatory rheumatic disease is linked to a predisposition on a genetic basis, which can be favored by external factors capable of inducing an alteration of the immune response against substances normally present in the body. However, the fact of having a familiarity with a particular rheumatic disease (parents, siblings, grandparents, uncles uncles) does not mean that it will develop in turn.

In chronic degenerative forms such as osteoarthritis, joint damage essentially derives from the imbalance in cartilage metabolism, which thins and deteriorates, exposing the bone surfaces to greater rubbing and erosion. In the most severe and advanced forms, this phenomenon induces, secondarily, a process of anomalous reactive repair by the articular surfaces, which leads to the formation of bone spurs (osteophytes), which alter the articular structure visibly deforming it.

The main factors at the origin of these phenomena are represented by aging (associated with a general lower hydration of the cartilage and loss of tissue metabolic efficiency), by the mechanical stress imposed on the joints for long periods due to professional or sporting activity (damage from wear and tear, from accidental traumas, from prolonged overload (overweight, obesity, heavy manual work, etc.), from the presence of congenital or acquired changes in the joint anatomy, as well as from the presence of inflammatory joint diseases (arthritis). Exposure to unfavorable environmental conditions (cold, humidity) is not in itself a cause of osteoarthritis or other rheumatism, but in some cases it can promote its onset and, certainly, worsen its symptoms.

Overload and trauma are also the main causes of localized extra-articular rheumatism, such as bursitis, tendinitis and periarthritis, while the origin of diffused fibromyalgic syndromes is still unknown and, it is believed, multifactorial (with a significant component psycho-emotional).

A rheumatic form typical of children is "rheumatic fever" ("rheumatism in the blood") that can arise as a complication of a bacterial pharyngotonsillitis or other group A Streptococcus infections that are not properly treated. In addition to the typical symptoms of acute joint inflammation, rheumatic fever can cause permanent damage to the heart, especially to heart valves, and / or lead to the development of heart failure. An antibiotic therapy with penicillin, prompt and protracted for several years (generally, until the age of twenty), greatly reduces these risks and is essential for the prevention of possible recurrences.
Exercises for pain

Exercises for every pain

Find out how to prevent and resolve different types of pain with simple exercises
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Symptoms of rheumatic diseases

Always in relation to the extreme variety of rheumatic syndromes and the organs / tissues interested preferentially in the different cases, even the manifestations of the single pathologies can be very different. Focusing on the articular and musculoskeletal aspects, the predominant symptom is pain, which can be more or less intense depending on the severity of the present inflammation and / or the degree of tissue degeneration and accompanied by a more or less marked and persistent functional compromise.

Generally, in the case of rheumatoid arthritis or other inflammatory arthritis, the pain is accompanied by prolonged stiffness upon waking (1-3 hours) which improves throughout the day, swelling, redness and sensation of heat. In the case of arthritis, however, inflammation is present during episodes of exacerbation and the morning stiffness is less in intensity and duration (about 30 minutes).


An intense localized pain that prevents using the affected joint, accompanied or not by a swelling, is also characteristic of bursitis, tendinitis and periarthritis, while in the case of gout (inflammatory arthritis caused by the deposition of micro-crystals of uric acid inside the joints) the appearance of voluminous and reddened swelling and burning pain is characteristic.

Rheumatic diseases that mainly affect the muscles, such as fibromyalgia, are characterized instead by the appearance of localized or widespread musculoskeletal pain, often associated with general tiredness and malaise, as well as a fairly complex set of other symptoms, variable from patient to patient.
To know

Rheumatic diseases are never trivial disorders. In addition to reducing the quality of life immediately, if not diagnosed and treated early in a targeted manner, these diseases inevitably evolve towards more severe forms, leading to a progressive loss of functional autonomy (up to the disability), reduction of working capacity and a series of complications, even severe and associated with a reduction in survival.

Obtaining a specific diagnosis is essential for planning a targeted treatment. Generally, in order to arrive at a correct classification it is necessary to undergo a specialized rheumatological examination (orthopedic in the case of arthrosis), perform a fairly extensive series of laboratory tests aimed at highlighting the presence of systemic inflammation and rheumatic disease markers or auto-specific antibodies (rheumatoid factor, anti-citrulline antibodies, anti-phospholipid antibodies, etc.), as well as some instrumental investigations to verify the state of the joints and the level of impairment of the articular / peri-articular tissues (radiography, ultrasound, magnetic resonance etc.). In some cases, it may also be necessary to perform more invasive investigations, such as a joint biopsy, to more accurately collect and analyze the inflammatory cells within the joint.

Once the diagnosis has been made, an appropriate therapy can be set up, different according to the specific disease present, but always aimed at reducing pain and inflammation (thus improving functionality and quality of life) and, possibly, to slow down evolution of the inflammatory / degenerative process.

In rheumatisms with a more or less accentuated inflammatory component and in the degenerative joint forms associated with moderate-severe pain, the main classes of drugs used to reduce the symptoms are local or systemic non-steroidal anti-inflammatory drugs (NSAIDs), opioid and non-opiate analgesics. - double and corticosteroids, to be taken by mouth or injected directly into the joint structure involved in inflammation. In some cases, the addition of an antidepressant may help to improve painful symptoms (in particular, in the case of fibromyalgia).

The choice between the different pharmacological options must be made by the doctor on the basis of a careful risk-benefit analysis, which also takes into account age, any concomitant diseases and the general characteristics of the individual patient.

In addition to the symptomatic therapies, rheumatic diseases must be managed with "background" drugs, able to modify the course of the disease through modulation of the immune response. In the case of inflammatory arthritis (rheumatoid arthritis), the reference drug in this sense, to be taken on a long-term basis, is methotrexate. Other drugs that can be used are cyclophosphamide, azathioprine and mycophenolate. In all cases, these are effective therapies, but also associated with a number of non-negligible side effects, which must be managed by experienced rheumatologists in order to offer maximum benefits in the face of minimum risks.


For some years, to keep under control symptoms and evolution of many more severe inflammatory rheumatic diseases and / or that do not adequately respond to traditional therapies we have also available "biological drugs", so defined because they are not small synthetic molecules, but of complex protein structures produced with molecular biology techniques (in general, monoclonal antibodies). These are effective and safe drugs, but not free from side effects (in particular, of an infectious type), which can be used alone or in combination with traditional background medications (above all, methotrexate). Their use must always be managed and monitored by rheumatologists from specialist centers who have gained sufficient experience in their clinical use.

With regard to natural remedies, often propagandized as able to improve the symptoms of rheumatism or even to "repair" the cartilage deteriorated by arthritis or arthrosis, it should be noted that, to date, there is no valid scientific evidence to support their use in clinical practice. To obtain appreciable benefits, therefore, better refer to the pharmacological remedies offered by traditional medicine.

Except in the stages of acute pain and inflammation, those suffering from rheumatic diseases should try to use the joints as much as possible, without overloading them, and regularly exercise. The movement is, in fact, an important component of the therapeutic program as it allows to maintain a better articular mobility, to protect the elasticity of the supporting tissues and to strengthen the tendons, muscles and ligaments on which stability and movement of the joint depend. . To avoid errors and to derive maximum benefits from exercise, it is advisable to contact experienced physiotherapists and participate in targeted rehabilitation programs, ideally to be repeated cyclically.

Depending on the individual preferences, the specific problem present and the physical characteristics, the training sessions can be carried out "on the ground" (in the gym) or in the water (in heated pools). During the rehabilitation, moreover, the physiotherapist will be able to teach simple exercises to be performed at home every day to maintain the results achieved and favor greater joint functionality and autonomy in everyday life.

In addition to targeted exercises, every form of moderate movement compatible with individual potential should be encouraged (walking, cycling, swimming, etc.), also important for keeping body weight under control, easing stress and reducing cardiovascular risk, typically increased in he suffers from rheumatic diseases due to persistent systemic inflammation.

On the nutrition front, in general, for those suffering from rheumatic diseases there are no specific indications, except to follow a healthy diet based on fresh food and mainly composed of fruit and vegetables (better if raw or undercooked), cereals , fish, legumes, lean dairy products (for the indispensable supply of calcium) and small quantities of meat (preferably white) and vegetable fats (extra virgin olive oil). Some more restrictions in the choice of food is required for those suffering from gout: in this case, foods rich in purines, such as meat and extracts, brain and offal, anchovies, herrings, mussels and sardines (but also asparagus, spinach) should be avoided , cauliflowers, legumes and mushrooms), since they increase uric acid levels in the blood and its deposit in the joints, favoring acute attacks.

In addition to quality, attention must be paid to the quantity of foods ingested and the relative caloric intake, with a view to keeping body weight under control and not imposing excessive load on the joints already compromised (in particular, those of the spine, hip, knee and foot). In this regard, it should also be remembered that conditions of high overweight and obesity, as well as excessive consumption of foods of animal origin and / or very fat and processed, increase the level of general inflammation of the organism, worsening rheumatic diseases.