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Rheumatism vs. arthritis: same animal?

Knowing the difference may help people in better managing their condition.

By Celine Blancas-Evidente, M.D.

OCTOBER 2013

Cora, 60, recently noticed her joints getting more painful and stiff especially in the mornings. Her fingers ache and she has a hard time preparing food or sending text messages. Her knees are also painful at times, making it harder for her to walk. She has tried gentle massage, compresses, and even supplements supposedly good for the joints. She says it’s probably part of the aging process, but wonders if there’s more relief for her, or if it will get worse over time. She plans to see her doctor about this problem soon.


Arthritis vs. rheumatism

Paul Santos Estrella, M.D., a rheumatologist from St. Luke's Medical Center in Quezon City and Bonifacio Global City, says rheumatism is an old heading for disorders of the body, particularly the connective tissues such as joints, tendons, muscle, ligaments, muscles and bone. Arthritis is a subheading, which refers specifically to inflammation of the joints. He says in the history of rheumatology, "rheum" came from the Greek word meaning "to flow." From this, it was thought that the joint swelling was caused by harmful fluid flowing within our body.

One term is often confused with the other. Dr. Estrella explains that in the Filipino language, rayuma is interchanged with arthritis because of how doctors used older terminology. Nowadays, the term “rheumatism” isn’t used in the medical community except when pertaining to "soft tissue rheumatism" or disorders of the tendons, ligament, fascia and bursa—and usually related to use, misuse, disuse or overuse.


Knowing your joint disorders

Arthritis literally means joint inflammation. It refers to disorders affecting the joints and falls under the broader category of rheumatic diseases. According to the World Health Organization (who.int), rheumatic or musculoskeletal conditions comprise over 150 diseases and syndromes that are usually progressive and associated with pain. In the U.S., more than 46 million people are said to have arthritis or other rheumatic conditions.

Typically, the affected patient will complain of joint stiffness, pain, or swelling. Arthritis can attack neighboring structures such as muscles, liver, lungs, kidneys and heart. It tends to be a long-term disorder. The most common disorders include:

• Rheumatoid arthritis (RA): common in those aged 20 to 40, and affects joints, connective tissues, muscle, tendons and fibrous tissue


• Osteoarthritis: a degenerative joint disease affecting the cartilage, associated with aging, and commonly affects knees, hips, fingers, lower spine


Which type of arthritis is it?

Diagnosis will depend on the patient or individual, emphasizes Dr. Estrella. Information such as age, gender, nature of work, number of joints involved, onset of attack, precipitating and relieving factors, or other co-existing medical conditions are important. For example, a 40-year-old male who recently went binge drinking, complaining of pain and swelling of the left big toe is most likely suffering from gouty arthritis. On the other hand, a 35-year-old female with pain and swelling of the wrist and knuckles may point to rheumatoid arthritis.

Dr. Estrella says further tests will depend on the initial clinical impression. There’s a need to address the root cause of the arthritis and give the specific treatment for that. Early diagnosis is important to prevent irreversible damage to the joints and other soft tissue structures. Once the diagnosis is established, strict compliance with medications and the treatment plan is very important to achieve relief and prevent deformities or loss of function.


Are women more at risk?

Dr. Estrella says for the general term arthritis, women aren’t more susceptible. Gouty arthritis is more common among males, while osteoarthritis has about the same frequency among males and females. However, if it’s in reference to rheumatoid arthritis, yes—females are more susceptible. The susceptibility of females to RA has a long story and recent studies are pointing to the extra chromosomes of females (XX) as opposed to males (XY).

RA is defined as a chronic systemic inflammatory disease of unknown cause. An external trigger—such as cigarette smoking, infection or trauma—may trigger an autoimmune reaction, leading to inflammation in the joints and other parts of the body. Some theories say genetically susceptible individuals are more affected. The onset is gradual—usually beginning with a fever or weakness before progressing to joint inflammation and swelling. No test is specific; instead, a combination of clinical examination, blood tests and X-rays may help.

RA must be differentiated from several other disorders such as infection, connective tissue diseases such as lupus, gout or fibromyalgia. Rheumatoid arthritis is diagnosed specifically using criteria from the American Rheumatism Association, which include the following signs or symptoms:

• morning stiffness at least one hour after initiating movement;

• arthritis of three or more joint areas, including wrists, fingers and toes, elbow, knee, ankle;

• hand-joint involvement;

• symmetric arthritis of the right and left joints;

• rheumatoid nodules over the bony prominences;

• positive result in a laboratory test (serum rheumatoid factor); and

• radiographic changes.


What is the right way to treat or manage these joint diseases? Grab a copy of the October issue of HealthToday to find out.










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