Rheumatic Pain - Symptoms, Risk Factors, Diagnosis, and Treatment

Introduction:

Rheumatic diseases are a type of autoimmune or inflammatory disease in which the immune system of the body starts attacking the body's healthy tissues, such as joints, muscles, bones, and organs. Various diseases fall under the category of rheumatic diseases, such as various forms of arthritis and spondyloarthropathies (inflammatory spinal conditions), which are usually painful, chronic, and progressive. Pain is often the primary symptom of rheumatic disease. It usually occurs due to the interplay of inflammation, tissue damage, and neurogenic responses.

What Is Pain?

Pain is an unpleasant feeling in the body that may be due to a prick, sting, burn, or ache. It is a method through which the body signals that something may be wrong in the body. The pain can be sharp or dull, ranging from annoying to debilitating. The pain can be acute, develop suddenly, or it may be chronic and last for several months or years. People respond to pain differently, some have a high pain tolerance and some have a low one.

What Are Rheumatic Diseases?

Rheumatic diseases affect the joints, tendons, ligaments, bones, and body muscles. There are numerous rheumatic diseases, and arthritis is the most common term for conditions that affect the joints. They are also termed musculoskeletal diseases in the United States only, and around 54 million adults and more than 300,000 children are affected by these conditions. Rheumatic diseases can cause inflammation, tissue degeneration, and autoimmune dysfunction, in which the immune system mistakenly attacks the healthy tissues of the body. The term rheumatism can also be used to describe rheumatoid arthritis.

What Are the Different Types of Rheumatic Diseases?

There are various types of rheumatic diseases which can be classified as follows:

Degenerative Joint Diseases:

• Osteoarthritis.

Connective Tissue Diseases:

• Rheumatoid arthritis (chronic inflammatory disease of joints).

• Systemic lupus erythematosus (an inflammatory disease in which the immune system attacks its own cells).

• Systemic sclerosis (a rare disease causing tightening and hardening of the skin).

• Polymyositis (a condition causing muscle weakness).

• Sjogren's syndrome (immune disorder causing dry eyes and dry mouth).

Spondyloarthropathies:

• Ankylosing spondylitis (a type of arthritis affecting the spine and large joints).

• Reiter's syndrome (inflammatory arthritis triggered by other infections in the body).

• Psoriatic arthritis (type of arthritis occurring in people with skin conditions).

Crystalline-induced Arthropathies:

• Gout (characterized by severe pain, redness, and tenderness in joints).

• Chondrocalcinosis (pseudogout is a painful condition caused by calcium pyrophosphate crystal deposits in the joints).

Infectious Arthritis:

• Bacterial.

• Fungal.

• Viral.

• Acute rheumatic fever.

Unknown Etiological Origin: Juvenile arthritis of unknown etiology.

Systemic Disease Origin: Arthritis associated with other systemic diseases.

What Is Rheumatic Pain?

Rheumatic pain is caused by various rheumatic diseases. The rheumatic pain is usually localized to the affected region only, such as one region of the body, for example, one shoulder, or to a single structure at multiple sites. The affected area can be found by directly asking the patient where it hurts, and further evaluation must be done.

What Factors Can Aggravate Rheumatic Pain?

The following factors can aggravate rheumatic pain, which includes -

• The gentle motion of the affected part can also increase the discomfort or pain, but it can be controlled by ceasing the movement.

• Vigorous exercises can worsen the pain both during or after the activity.

• Long periods of immobility, especially during sleep, can result in symptoms like stiffness.

What Are the Symptoms of Rheumatic Diseases?

Rheumatic symptoms or rheumatism can be characterized by some of the following points which include:

• Pain or discomfort is usually found in one or more joints.

• Pain on movement of the affected area.

• Soreness (while touching) the affected region.

• Stiffness usually after a period of mobility.

• Improvement in symptoms after mild exercise may worsen after vigorous exercise.

• Worsening of symptoms due to climatic changes such as changes in atmospheric pressure or rising humidity.

• Improvement in symptoms by applying heat to the affected area.

All these seven factors may or may not be present in all rheumatic diseases, but the first four are usually common in these conditions.

Other than that, some of the following symptoms are most commonly seen in these conditions which include:

• Joint pain.

• Swelling of a joint or joints.

• Chronic pain in joints.

• Warmth or redness in the joint area.

• Joint stiffness.

• Restricted movement in an affected joint or joints.

• Fatigue.

Additionally, some rheumatic diseases are characterized by specific symptoms, such as the appearance of skin rashes in lupus along with joint pain and inflammation.

What Are the Etiological and Risk Factors of Rheumatic Diseases?

There are multiple factors responsible for rheumatic diseases depending upon the type of rheumatic disease, which include -

• Genes and family history.

• Environmental triggers.

• Lifestyle choices.

• Infection.

• Trauma.

• Metabolic problems.

• Wear and tear or stress on joints.

How to Clinically Assess Rheumatic Pain?

To clinically assess rheumatic pain, a thorough examination of the patient which includes the location, severity, nature, or radiation of the pain, the response of the pain to the medicine, aggravating or relieving factors, and the impact of pain on the quality of life is undertaken.

Moreover, various scales can be used to assess the level of pain. Doctors use different types of measuring scales to measure pain, which include:

• Numerical Rating Scales - In this scale, the pain is measured from 0 to 10, where 0 means no pain and 10 means severe or unimaginable pain. This is useful to measure the change in pain levels in response to a treatment or deteriorating condition.

• Verbal Descriptor Scale - This scale helps measure the pain levels in children, older adults, and patients with autism and dyslexia (learning disorder). Instead of using numbers to measure pain, the doctor asks questions to narrow down the type of pain.

• Faces Scale - The doctor will show a scale with a range of expressive faces, from distressed to happy, to know the pain level. This is commonly used with children and can also be used in the case of autistic people.

• Brief Pain Inventory - This is a detailed written questionnaire that helps in measuring the effect of pain on the mood, sleep patterns, and relationship of the patient. The pain timeline can also be charted to know the pattern of pain.

• McGill Pain Questionnaire (MPQ) - This questionnaire encourages people to choose words from 20-word groups to understand how the pain feels.

How to Manage Rheumatic Pain?

The ideal treatment of rheumatic pain involves pharmacological and nonpharmacological therapies while considering various psychosocial factors. Medications that help with pain include:

• Analgesics (painkillers) such as Acetaminophen.

• Topical analgesics.

• NSAIDs (Nonsteroidal anti-inflammatory drugs), including Ibuprofen and naproxen sodium.

Medications used for the treatment of rheumatic diseases include:

• Corticosteroids.

• Janus kinase inhibitors drugs (DMARD subclass) target Janus kinase pathways that are involved in the immune response of the body.

• Disease-modifying anti-rheumatic drugs (DMARDs) help slow the progression of rheumatic diseases by stimulating immune system reactions and inflammatory processes.

In addition to medicines, some of the following treatments can be prescribed for rheumatic diseases which include:

• Physical therapy.

• Occupational therapy.

• Hot and cold therapy.

• Splints, braces, and other assistive devices.

• Surgery.

Conclusion:

Pain is one of the most critical factors in rheumatic conditions. Therefore, identifying the underlying cause and providing necessary treatment to control the pain is always important. Before opting for pharmacological and surgical procedures, interventional pain management techniques such as physical therapy or cold and hot therapy are important in managing rheumatic pain.