My joints hurt: is it rheumatism?

Rheumatic pain or rheumatism is one of the main reasons for medical consultation. The pain, which is localised in any joint including the spine, often affects the individual’s quality of life and may lead to low productivity or absenteeism. Specific illnesses responsible for rheumatic pain may not be easy to diagnose: many conditions, from mild to life threatening, can induce rheumatic pain syndrome. It is however important to make an early diagnosis to prevent or minimise possible severe complications. 

The joint is the area of junction between bones that allows bone motion. The joint consists of the cartilage, a flexible tissue, which covers the surface of the bone, and the synovial membrane that produces the synovial fluid to lubricate the joint. Ligaments and tendons are attached to the joint to support and limit the joint movement. 

Whatever its underlying cause, rheumatic pain presents common characteristics linked to a chronic inflammation process within the joint: the pain is present in one or several joints, increases in intensity when the joint is moved or compressed during examination, associated with stiffness of the joint especially after a period of immobility (morning stiffness), and diminished after minor exercise or repeated gentle movements. The affected joint is often warm and swollen. Sometimes the pain get worse according to climatic variations such as increased humidity or cold and may improve in warmer temperatures.

Other symptoms or signs related to the specific cause may be present, in particular fever, fatigue, rash and internal organ involvement. 

The most common cause is osteoarthritis, an extremely frequent disorder affecting adults and the elderly due to the progressive wearing down of the cartilage. The joint pain is coupled with difficulties in joint movement and loss of flexibility, making some daily tasks difficult to perform. Also called wear-and-tear arthritis, it mainly affects the hands, lower back, neck, knees and hips. 

Rheumatoid arthritis is another frequent illness responsible for chronic rheumatic pain. It is induced by a persistent inflammation of the joint due to the presence of antibodies - secreted by the body’s defence mechanism – on the synovial membrane. Rheumatoid arthritis is an autoimmune disorder in which some antibodies wrongly attack normal tissue structures. Continual inflammation may eventually destroy the cartilage and the adjacent bone leading to marked joint deformities. Rheumatoid arthritis is more common among women aged 40 to 60 years, and often affects the same joints on both sides of the body, initially occurring in the small joints of the hands and feet. Minor forms of the disease may last a few months or years while the more severe ones may last a lifetime. 

Systemic Lupus Erythematosus or lupus is another autoimmune disease and one with a higher likelihood of internal organ damage. The disease often leads to various joint pains with swelling and stiffness. Untreated, the chronic inflammation may affect the kidneys, lungs, heart and blood vessels. Like rheumatoid arthritis, blood tests are needed to reveal the intensity of the inflammation and the abnormal antibodies. 

Ankylosing Spondylitis is another chronic disease where the joint inflammation is mainly found in the lower spine. It commonly affects males and its onset starts from the teenage years to early adulthood. The progressive stiffness of the spine due to the fusing of some vertebrae can lead to hunched forward posture, persistent back pain and marked reduction in spine flexibility. Early diagnosis is required to prevent spine deformities and possible internal organ involvement. 

Individuals with rheumatic pain are usually referred to a rheumatologist for proper diagnosis and treatment. Besides anti-inflammatory medicines and specific drugs for each illness, the practice of healthy habits with moderate and regular exercise and a balanced diet is recommended to alleviate most of the pain and associated symptoms. 

 

Dr Gerard Lalande is managing director of CEO-Health, which provides medical |referrals for expatriates and customised executive medical check-ups in |Thailand. He can be contacted at [email protected].