Rheumatic diseases include a number of diseases of the musculoskeletal system. There are several hundred types of rheumatic diseases, the most common diagnosis is RA, i.e. rheumatoid arthritis. Symptoms depend on the place taken (rheumatic changes in the knees, feet, spine), mainly pain and stiffness in the joints. Treatment of rheumatic pain involves a combination of pharmacotherapy and rehabilitation supplemented with home exercises.

What is rheumatic disease?

Rheumatic diseases are a generalized disease of connective tissue. The lesions may include internal organs (most often the kidneys, pleura, pericardium), but most of all they causejoint deformitiesandmuscle atrophy. The specificity of rheumatic diseases is the accumulation of large amounts of enzymes in the affected joints, which damage the surface of the articular cartilage, which leads to the gradual destruction of it and bones.

Inrheumatism, the changes also affect soft tissues, first they touch the synovium inside the joint, then the synovial bursae, tendons and ligaments, causing their inflammation and, consequently, deformation of the joints, limiting their mobility and sometimes complete stiffness.Rheumatic diseasesare characterized by a chronic course with periods of exacerbation of lesions (relapses) and their silencing (remission).

The causes of rheumatic disease and types of diseases

Rheumatic diseases are the most common cause of pathological changes in the musculoskeletal system. They most often affect people between 25 and 50 years of age, more often women, although there are also cases of developingrheumatic disease at a young age. They include a number of diseases of the musculoskeletal system. They are inflammatory, multi-systemic changes, they can affect internal organs, but most often they include changes in bones, soft tissues and joints.

A common feature of all rheumatic diseases is joint pain, chronic inflammation andlimited joint mobility. Most often these are progressive changes that build slowly and cause secondary overload changes in the locomotor system, limitation of physical fitness and cardiovascular and respiratory efficiency.The cause of rheumatic diseaseis unknown.The catalog of types of remumatic diseasesis very broad. The most common conditions of this type are:

• rheumatoid arthritis(RA, rheumatism),
• ankylosing spondylitis (AS),
• juvenile idiopathic arthritis,
• psoriatic arthritis,
• systemic lupus.

The cause of rheumatic diseasesis not fully understood. It is assumed that the most common isthe autoimmune reaction of the body, i.e. a situation in which the body destroys its own cells during an incorrect reaction of the immune system. Other causes may be: inflammations of unknown origin, static-dynamic overload of the musculoskeletal system, and abnormal shape or length of bones congenital or acquired during life.

Diagnosis of Rheumatoid Arthritis

There are criteria that suggest thatjoint lesionsare rheumatic in nature. Characteristic for RA is:

• hand arthritis,
• symmetrical arthritis (both hands, both feet),
• the presence of rheumatoid nodulesunder the skin ,
• development of morning joint stiffness lasting at least an hour.

During the visit to the doctor, it is recommended to examine all joints, even those not affected by the inflammation process, and perform imaging tests. If a rheumatic disease is suspected, it is necessary to performlaboratory tests(blood count, general urine test, synovial fluid), including rheumatoid factor (RF) , which occurs in 85% of patients. In RA patients, C-reactive protein (CRP), which will be elevated in inflammation, and ESR, in which the rate of sinking of blood cells will be faster.

What are the symptoms of rheumatic disease?

Rheumatic disease is defined as a systemic disease because it primarily affects the joints and the locomotor system, but pathological changes can also affect other organs and systems of the body.The following may occur in the motion system :

• rheumatic changes in the joints of the hands– interphalangeal, metacarpophalangeal and wrist joints are affected; characteristic are: elbow deviation of the hands, subluxation of the phalanges and changes in their appearance, subcutaneous, painlessrheumatoid noduleson the straight surfaces of joints and in places exposed to pressure due to inflammation of small blood vessels, ganglions – cavities surrounded by epithelium filled with fluid or jelly, carpal tunnel syndrome, i.e. pressure on the median nerve with symptoms of numbness in the fingers and night pains;
• rheumatic changes in the feet– there may be swelling in the ankle area, leg pain when walking, rheumatoid nodules form, tendon rupture, subluxation of the joints and deformation of the toes may occur;
• changes in the elbow joints – rheumatic pain,limitation of extension movement, and rheumatoid nodules appear , and a flexion contracture develops gradually in the joint;
• rheumatic changes in the knees—the first symptom of knee rheumatism may be atrophy of the quadriceps muscle of the thigh. There is joint swelling, flexion contractures, and the bulging of the outer part of the joint, which increases with the pressure of the kneecap. A common complication is a popliteal ( Baker ‘s ) cyst resulting from excessive production of synovial fluid in the course of the inflammatory process and its leakage outside the joint cavity;
• rheumatic changes in the hip joints-there are pains in the groin area, which increase when walking and limit their mobility,
• Rheumatic changes in the spine: changes most often concern the cervical section. There is a restriction of mobility, pain during movements, and damage to the intervertebral disc;
• changes in the temporomandibular joints (difficulty opening the mouth), which restricts talking and eating.

Extra-articular rheumatic changesoccur most frequently in patients with diagnosedrheumatoid factorin the blood and may affect the eyes, pericardium, kidneys and cause haematological changes, mainly anemia.

Rheumatic disease – drugs for rheumatic pain

Non-steroidal anti-inflammatory drugs (NSAIDs)are helpful in reducingrheumatic pain. They can be administered orally or topically in the form of ointments, gel or patches. Non-steroidal anti-inflammatory drugs have an analgesic and anti-inflammatory effect, but are associated with the possibility of side effects, especially with long-term use. It is recommended to use drugs made from natural healing minerals (sulphide water, peloid), which also have a similar effect, but do not show side effects and can be used during physical therapy treatments.

If the pain is not severe and limited to a small area, the use of painkillers or patchesis usually sufficient .

However, if thepain in rheumatismis more generalized and stronger, oral medications or rectal medications (suppositories) must be used.

Some NSAIDs are available over the counter (e.g. ibuprofen, diclofenac, and even meloxicam). These drugs, in the recommended doses, should not be harmful, but they should not be used for a long time. When the pain is severe and lasts more than a few days, it is worth visiting a doctor to arrange further treatment.

Massage can also be used to reducepain in rheumatic diseases .Its purpose is also to normalizemuscle tone.

Rheumatic joint disease – rehabilitation

The continuity of this process is important in the entirerehabilitation process in rheumatic disease .The patient should be treated during rehabilitation stays lasting 2–4 weeks in rehabilitation centers (hospitals, clinics) at least twice a year.Sanatorium treatmentis also recommended in rheumatic diseases. It is worth looking for centers where spa treatment is offered with the use of natural resources of our environment. Patients with rheumatic diseases are treated there with sulphide waters and peloid. The remaining period is dedicated to rehabilitation at home, as the level of functionality and independence depends mainly on the conscientiousness and regularity of the patient.

Rehabilitation should include:

• physical therapy that relieves pain and inflammation; From various physical treatments, the best results in rheumatic changes are achieved by using cryotherapy, ultrasounds, laser therapy, magnetic fields, and iontophoresis;
• kinesitherapy, i.e., performing various therapeutic exercises that include exercises for the joints that improve their mobility, strengthening their muscles, and general conditioning exercises that improve the patient’s efficiency;
• manual therapy, which includes mobilization or manipulation techniques that can unblock the diseased joint and restore its physiological biomechanics; after the use of an appropriate technique, pain is reduced, the inflammatory process is resolved and the mobility of the joint improves; in the caseof joints with rheumatic changes, it is recommended to perform manual therapy with particular caution.

In the acute period, it is important to avoid overloading, rest and use auxiliary devices, e.g. crutches, canes, bands and devices stabilizing the diseased joints while walking or performing various activities,

Rheumatic joint disease – exercises

Exercises in rheumatic diseaseshould be carried out with particular caution due to chronic inflammation, the possibility of exacerbation of the disease process, reduced strength of soft tissues and the possibility of their damage. Exercises should be selected individually depending on the advancement of the disease process, the type of changes and pain tolerance. They should not tire the patient too much and must depend on the current state of the disease. Ideally, the physiotherapist should show the patient a set of exercises that should be performed regularly and systematically at home.

In the period of exacerbation of symptoms, i.e. during the relapse period, it is recommended to relieve the affected section of the musculoskeletal system and perform only exercises that maintain physical fitness. The best exercises in this period will be relieving, relaxing and stretching exercises.

When the symptoms subside and the patient’s condition improves, we speak of a period of remission. During this period, it is recommended to maximize the patient’s rehabilitation aimed at increasing the range of motion and muscle strength in the affected joint. Active exercises are recommended, taking into account all movements in a given joint with their maximum, physiological range, and active resistance exercises – performed with the use of a weight in order to increase muscle strength.

However, in people suffering fromrheumatoid arthritis,exercisesshould not be performed immediately after getting out of bed due to morning stiffness present in this disease. In this case, physical effort may aggravate the symptoms. In addition, not every patient is willing to exercise, as pain is felt during exercise.

Nevertheless, movement has a beneficial effect on cartilage nourishment, bone calcification, increasing muscle strength and maintaining the normal range of motion in the joints. Additionally, it has a positive effect on the respiratory and circulatory systems.

How to prevent rheumatic diseases?

As in any disease,preventionis extremely important inrheumatic diseases .First of all, you should take care of your body weight.Overweightandobesepeople put too much strain on their joints, which is definitely not good for them.

An important element of prophylaxis is proper nutrition. For example, in people withjoint problems, the dietshould include eatingfish, which are a source of omega-3 fatty acids. These acids have a positive effect on the work of the heart, brain and, most importantly in this group of patients – joints. Omega-3 acid has an anti-inflammatory effect. However, it is important not to over-take acid as it can be harmful.Omega-3 and omega-6 fatty acidsshould be consumed in the right proportions.

It is advisable to eat vegetables and fruits containingvitamin C(it has a beneficial effect on the joints) and bioflavonoids, which cleanse the body of free radicals that initiate and maintain inflammation in the body. Spices recommended for people with rheumatism are primarily:

• turmeric_
• ginger_
• cloves.