Rheumatic disorders

What are rheumatic disorders?

Rheumatic disorders (or rheumatic diseases) is an umbrella term for a large group of over 200 different conditions that affect your joints, muscles, bones, tendons and ligaments. Many, though not all, happen when your immune system doesn't work properly and causes inflammation.

What are the symptoms of rheumatic disorders?

Symptoms vary depending on the specific condition, but commonly include:

• joint pain, tenderness and swelling
• stiffness, especially in the morning or after sitting still for a while
• reduced range of movement in the affected joint
• fatigue
• muscle pain or weakness
• skin changes, such as rashes
• a low-grade fever that can persist.

Your joints may feel better after light activity but worse after strenuous exercise, and some people notice their symptoms flare up in cold or damp weather.

What are the causes of rheumatic disorders and who is at risk?

Many rheumatic disorders happen when your immune system mistakenly attacks your own tissues, though doctors don't fully understand why this happens. Others result from wear and tear on your joints, infections, or problems with how your body processes certain substances.

You may be more at risk of developing a rheumatic disorder if you:

• have a family history of a rheumatic condition, or carry certain genes linked to it
• are overweight
• smoke
• have had certain infections
• have been exposed to certain pollutants or chemicals.

Some conditions are also more common in one sex than the other. For example, rheumatoid arthritis and lupus are more common in women, while ankylosing spondylitis is more common in men.

Are there different types of rheumatic disorders?

There are more than 200 different rheumatic conditions. Some of the more common ones include:

• rheumatoid arthritis: an autoimmune disease causing joint inflammation, most often starting in the hands, wrists or feet.
• osteoarthritis: wear and tear of the cartilage that cushions your joints, most often affecting the knees, hips, hands and spine.
• psoriatic arthritis: joint inflammation associated with the skin condition psoriasis.
• ankylosing spondylitis: inflammation affecting the joints of your lower back and spine.
• gout: a build-up of uric acid crystals in a joint, often the big toe, causing sudden, intense pain.
• systemic lupus erythematosus (lupus): an autoimmune condition that can affect the joints, skin and other organs.
• sjögren's syndrome: an autoimmune condition mainly affecting the glands that produce tears and saliva.
• scleroderma: a condition causing patches of hard, tight skin, which can sometimes also affect internal organs.
• polymyalgia rheumatica: causes muscle pain and stiffness, mainly in the shoulders, hips and neck, usually in older adults.
• fibromyalgia: widespread pain and tenderness, along with fatigue and difficulty concentrating.

How are rheumatic disorders diagnosed?

Your GP will ask about your symptoms and medical history and examine your joints and muscles. If they suspect a rheumatic condition, they'll usually refer you to a rheumatologist, who may arrange:

• blood tests, to look for signs of inflammation or specific antibodies linked to certain conditions
• imaging tests, such as an X-ray, ultrasound or MRI scan, to look for joint damage or inflammation
• a sample of fluid taken from an affected joint, to check for infection, uric acid crystals, or other markers.

How are rheumatic disorders treated?

Non-surgical treatment

Treatment depends on your specific diagnosis, but the main aims are usually to reduce pain and inflammation, and to slow the condition down. Options can include:

• painkillers, such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs)
• disease-modifying anti-rheumatic drugs (DMARDs) or immunosuppressants, which calm an overactive immune system
• corticosteroids, for more severe inflammation
• biologic therapies, for severe conditions that aren't controlled by other treatments
• physiotherapy and regular exercise, to maintain movement, muscle strength and mobility.

If you're prescribed some of these medications, you'll need regular blood tests so your rheumatology team can monitor how well they're working and check for side effects.

Surgical treatment

Surgery may be considered if a joint has become severely damaged and other treatments haven't controlled your symptoms, for example to repair or replace the joint. Your specialist will discuss whether this is a suitable option for your specific condition.

When should I see a doctor?

See your GP if you have joint or muscle pain that doesn't settle quickly, especially alongside stiffness, swelling, fatigue or skin changes. It's also worth mentioning any of the following, as they can be signs of a rheumatic condition:

• persistent fever or unexplained weight loss
• ongoing tiredness or weakness
• a new rash or skin changes
• sudden changes to your vision, or eye redness and pain.

Getting an early diagnosis is important, as many rheumatic conditions respond best to treatment when it's started early.