Rheumatism is a popular term for chronic pain conditions, but is an indefinite vague term for a variety of disorders marked by inflammation, degeneration or metabolic derangement of connective tissue structures (especially joints and related structures), with pain, stiffness or limitation of motion. It includes many disorders, such as arthritis, osteoarthritis, bursitis and sciatica.
The term “rheumatism” is still used in colloquial speech and historical contexts, but is no longer frequently used in medical or technical literature; there is no longer any recognized disorder simply called “rheumatism.” The traditional term covers such a wide range of different problems that to ascribe symptoms to “rheumatism” is not to say very much. Some countries use the word “rheumatism” to describe “fibromyalgia syndrome”.
There has long been said to be a link between “rheumatic” pain and the weather. There appears to be no firm evidence in favour or against; a 1995 questionnaire given to 557 people by A Naser and others at the Brigham and Women’s Hospital’s Pain Management Center concludes that “changes in barometric pressure are the main link between weather and pain. Low pressure is generally associated with cold, wet weather and an increase in pain. Clear, dry conditions signal high pressure and a decrease in pain”.
Causes of Rheumatism
Locally, a condition is defined as rheumatism when a patient complains of chronic joint or spine (back, neck and shoulder) pain. This is when doctors attempt to make an assessment and when investigations do not yield results (normal findings of the bony structures). All investigations can be frustratingly normal but, yet, the pain in the joints and spine continues. This chronic pain can go on for months or years when the original injury to that part of the body has already recovered or healed. Physical examination may be normal or, at best, some vague signs of non-specific swelling not relating to trauma. Very often, the pain can wax and wane, although, in some cases, it may be persistently present everyday as a baseline pain, with pain flares ever so often. Many of these patients would remark that a rainy weather is imminent, whenever their joints or spine get a pain flare. They are almost like a barometer gauge that tends to be fairly accurate. At the end of the day, the patient is faced with this pain on a daily basis with no respite in sight. Most of the painkillers may not be effective in controlling this condition. Even for those that are useful, many patients are fearful of using them, worried about the side effects from long-term use.
Incidentally, “rheumatism” coincides with a Chinese TCM term of “wind wetness”. In the TCM context, when a patient is stricken with “wind wetness”, there is dampness in the blood circulation of the body, resulting in stagnant blood flow, causing generalized body aches in the muscles. The wetness has been purported to be caused by late-night showers or baths, touching water excessively during post-natal period and catching a chill that never went away. This wetness will stay in the body and present itself as muscle and joint aches or bodily pain during wet, rainy weather or being in an air-conditioned environment. To heal the “wind wetness”, one must keep warm to expel the dampness during all situations, especially during confinement post-delivery, or avoid showering in the night. There is no equivalent treatment of such in modern medicine.
In the context of western medicine, “non-joint rheumatism”, also known as “regional pain syndrome” or “soft tissue rheumatism”, can be difficult to diagnose and/or treat. It causes significant discomfort and difficulty. More often than not, this diagnosis is made when the pain condition does not fall into any of the other diagnoses, ie, a diagnosis of exclusion (after excluding all other conditions).
Non-articular rheumatic pain syndromes can be classified into 5 general categories, as follows: (1) tendonitis and bursitis, such as the common lateral epicondylitis (tennis elbow) and trochanteric bursitis; (2) structural disorders, such as pain syndromes resulting from flatfoot and the hypermobility syndrome; (3) neurovascular entrapment, such as carpal tunnel syndrome and thoracic outlet syndrome; (4) regional myofascial pain syndromes, with trigger points similar to those of fibromyalgia but in a localized distribution, such as the temporomandibular joint syndrome; and (5) generalized pain syndromes, such as fibromyalgia (FMS) and multiple bursitis-tendonitis syndrome. The more generalized and chronic the syndrome, the more difficult it is to treat. There are a lot of overlap with the other syndromes (MPS, CFS).
A vast number of traditional herbal remedies were recommended for “rheumatism”. Modern medicine, both conventional and complementary, recognize that the different rheumatic disorders have different causes (and several of them have multiple causes) and require different kinds of treatment.
Nevertheless, initial therapy of the major rheumatological diseases is with analgesics, such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), members of which are ibuprofen, synflex and diclofenac. Often, stronger analgesics are required.
Usually, a lot of patients with a variant of rheumatism will not respond well to standard painkillers and analgesia. They may require treatment along the lines of fibromyalgia. The use of very specialized medications, such as anti-convulsants, anti-depressants and muscle relaxants, has a unique role to play in treating this type of pain.
- Some rheumatism patients will need the same treatment as for FMS, although the emphasis is to keep warm and dry (with the slant towards rheumatic pain and wet weather).
- Standard NSAIDs and painkillers can be useful. But it can recur again repeatedly.
- Exercise is helpful for non-articular rheumatism. This is usually very hard to convince the patient. Exercise involves moving the muscles and joints and this, in itself, can increase the pain experienced. However, once the patient perseveres at it, the benefits will show, and the pain will improve and subside.