Introduction
to rheumatology
(read
and study the introductory articles in the course manual)
Musculoskeletal
symptoms account for around 20% of consultations to general medical
practitioners. Up to 30% of the population in some surveys claim
to have “arthritis” – and is often the most common
health complaint in these surveys.
In Australia arthritis affects 16.5% of the population; 60.4% are
female; 5% of the population are taking medication for arthritis;
2% of the population are disabled or handicapped with arthritis;
11% of the workforce has arthritis; financial cost (direct and indirect)
is estimated at $9 billion in 2001 (1.4% of GDP); its is ahead of
diabetes and asthma as a ‘disease burden’.
In
the USA, 18.4% of the population have arthritis (21.1% of females
and 15.7% of males); 2.4% of all hospital discharges; financial
costs of $65 billion in 1992 (1.1% of GDP)
Diagnoses
from a rheumatologists office:
Rheumatoid arthritis 31.1%
Degenerative joint disease 21.2%
Uncertain or undetermined 11.3%
Myofascial pain syndrome 4.7%
Bursitis/tendonitis 4.5%
Ankylosing spondylitis 3.7%
Psychogenic rheumatism 3.3%
Systemic lupus erythematous 2.1%
Reiter’s syndrome 1.8%
Low back syndrome 1.4%
Psoriatic arthritis 1.2%
Gout 1.2%
Raynauds disease 1.0%
Costochondritis 0.8%
Polymyalgia rheumatica 0.6%
Sarcoidosis 0.6%
Neuropathy/neuritis 0.6%
Chondromalacia 0.4%
Classification
There are many different classification systems for the
rheumatological diseases as the classification can be based on:
1) Any common clinical and laboratory features of diseases
2) Any similarity of disease mechanisms
3) The anatomic structures involved
4) The organ systems involved
5) Involvement of genetic factors
6) Any specific abnormality or deficiency
Eg
of one classification:
a) Inflammatory arthritis:
- eg Rheumatoid arthritis; Seronegative arthropathies (ankylosing
spondylitis, Reiter’s syndrome, psoriatic arthritis, enteropathic
arthritis)
b) Connective tissue disease:
- eg Systemic lupus erythematosus; scleroderma; progressive systemic
sclerosis; the arteritis’s (eg polyarteritis nodosa); dermatomyositis
and polymyositis; Sjorgren’s syndrome
c)
Crystal deposition disease:
- eg gout; pseudogout
d) Degenerative joint disease:
- eg primary osteoarthritis; secondary osteoarthritis
e) Arthritis associated with infection:
- eg septic arthritis
f) Arthritis associated with systemic disease:
- eg acromegaly; thyroid disease; haemophilia; hypermobility syndrome;
haemochromatosis; neuroarthropathy; hypertrophic pulmonary osteoarthropathy;
sarcoidosis
g) Non-articular rheumatism and localised pain:
- eg bursitis, tenosynovitis, myofascial syndromes; fibromyalgia
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