What Is Nonarticular Rheumatism?
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Nonarticular Rheumatism: A Complete Picture

Published on Nov 03, 2022 and last reviewed on Nov 11, 2022   -  6 min read


Nonarticular rheumatism refers to the painful musculoskeletal conditions of the body which do not involve the joints. Read the article to know more.


Nonarticular rheumatism or regional rheumatism refers to myalgias (muscle pain) and arthralgias (joint stiffness) that are not associated with any joint deformity or disorder. Such pain may arise from generalized conditions like polymyalgia rheumatica (inflammation of shoulders and hips) and fibrositis (fibrous tissue inflammation) or from regional conditions like tendonitis (tendon inflammation), epicondylitis (tennis elbow caused by overloaded elbow tendons), fasciitis (inflammation of the soles), tenosynovitis (inflammation of the synovial membrane covering the tendons), and bursitis (inflammation of bursa sacs).

Who Is Susceptible to Nonarticular Rheumatism?

Nonarticular rheumatic conditions are found in 4000 individuals per 10,000 of the population giving a one-in-four prevalence. The racial and gender demographic is equal. The condition is most common in ages 45 to 64 years, with less than 0.2 % of patients under the age of 14.

How to Categorize Nonarticular Rheumatism?

The condition can be categorized into five broad categories:

  1. Tendonitis and bursitis like tennis elbow and trochanteric bursitis.

  2. Structural disorders like pain from flat feet and hypermobility syndrome (a genetic disorder causing increased articulation of joints).

  3. Neurovascular entrapment like carpal tunnel (pain and numbness in hand caused by median nerve compression) and thoracic outlet syndrome (neurovascular components get compressed in the thoracic region).

  4. Regional myofascial pain syndrome (muscle pain associated with muscle inflammation and triggered by pressure on sensitive points) with similar trigger points to fibromyalgia (widespread musculoskeletal pain) but in a localized region like TMJ (temporomandibular joint) syndrome.

  5. Generalized pain syndrome like fibromyalgia and multiple bursitis-tendonitis syndrome.

What Are Some of the Common Nonarticular Rheumatic Conditions?

  • Hand-wrist: Thumb abductor or extensor tenosynovitis (inflammation of the tendon that affects muscle movement).

  • Elbow: Tennis elbow, olecranon bursitis (painful elbow swelling).

  • Shoulder: Rotator cuff tendinitis (inflammation of connective tissues of the shoulder joint), bicipital tenosynovitis (inflammation of the tendon and sheath of the biceps muscle).

  • Hip: Trochanteric bursitis (bursa inflammation of the hip), ischial bursitis (inflammation of the ischial bursa-buttock region).

  • Knee: Prepatellar bursitis (bursa inflammation in the front of the knee cap), anserine bursitis (bursa inflammation between the shinbone and hamstring muscle tendons).

  • Ankle-foot: Achilles tendinitis (inflammation of tendon between the calf muscle and heel), plantar fasciitis (inflammation of ligament connecting heel to toes).

What Causes Nonarticular Rheumatism?

The exact etiology has not been studied, but a possible link between certain predisposing factors can precipitate non-articular rheumatism.

  • Severe flu-like syndrome.

  • Autoimmune diseases like rheumatoid arthritis and systemic lupus erythematosus.

  • Infections like Lyme disease, hepatitis C, and HIV (human immunodeficiency virus).

  • Trauma.

  • Chronic disturbed sleep or insomnia.

  • Family history of fibromyalgia.

  • Female sex.

  • Psychological stress and depression.

  • Emotional trauma.

Some etiological factors may contribute to certain conditions that may precipitate nonarticular rheumatism:

  • Repetitive motion and localized trauma may result in regional and local bursitis and tendonitis.

  • Fluoroquinolone consumption may cause tendonitis.

  • Pregnancy, endocrine disorders, systemic amyloidosis leading to carpal tunnel syndrome.

  • Genetic disorders like Ehler-Danlos syndrome, Marfan syndrome, and pseudoxanthoma elasticum cause hypermobility syndrome.

What Is the Pathophysiology of Nonarticular Rheumatism?

Tendonitis presents as localized pain, inflammation, dysfunction, and degeneration of the tendons primarily due to overuse, infections, systemic rheumatic conditions, calcium apatite or pyrophosphate deposition, and Fluoroquinolone consumption. The inflammation can cause the digits to lock and a snapping sensation when released.

Bursitis presents with similar signs in the synovial fluid sacs present over the bone. Overuse, infection, systemic rheumatism, and salt deposition can precipitate bursitis. Gout causes olecranon bursitis (inflammation of the bursa at the tip of the elbow) and prepatellar bursitis (bursa inflammation in the front of the knee cap).

Structural disorders like scoliosis, lateral patellar subluxation, and flat feet can sometimes cause pain. Arthralgia is seen in hypermobility syndrome due to increased joint laxity.

Neurovascular entrapment in cases like spinal stenosis, thoracic outlet syndrome, carpal tunnel, or tarsal tunnel syndrome can give rise to painful conditions. Other reasons for pain might be due to bone enlargement from osteophytes, muscular tension, and inflammation. Pain is usually associated with paresthesia.

Regional myofascial pain syndrome, like TMJ syndrome, may trigger pain from mechanical trauma due to muscle spasms from overuse or strain.

Multiple bursitis and tendonitis syndrome results in anatomically confined areas of pain and dysfunction. The fatigue, in this case, is much lower and responds to local therapies due to a lack of muscle tenderness.

Fibromyalgia is caused by a painless stimulus perceived as painful and hyperalgesia (extreme pain response), where normal painful stimuli are amplified multifold. Physiologically, CSF fluid levels of substance P are elevated with elevated levels of serotonin and cortisol. The pain can also exist in connection to various autoimmune diseases, severe flu-like syndromes, infections, or trauma. Lack of sleep or insomnia, hormonal disturbances, and abnormalities of cerebral blood flow in the thalamus and quartet nucleus are some of the other likely causes of abnormal pain perception in the CNS.

What Tests Are Indicated for Nonarticular Rheumatism?

The laboratory tests to be ordered are similar to any systemic disease. Some of the tests may reveal the reports within the normal range as well.

Subject to the presence of any predisposing condition or in the presence of other rheumatic diseases, certain tests have to be ordered.

  • Antinuclear antibody (ANA) for systemic autoimmune disease.

  • Rheumatoid factor (RF) for rheumatoid arthritis or other immune complex diseases.

  • Creatine kinase (CK) for myositis.

  • HIV serology.

  • Lyme serology for Lyme disease

  • Prolactin for panhypopituitarism.

  • Urinalysis for renal disease.

  • Hepatitis C antibody.

Play in radiographic studies may reveal calcification of the tendons, which may or may not correlate with the clinical findings. MRIs are often not indicated but can be used to diagnose rotator cuff disruption at the shoulder and to differentiate tendonitis from intra-articular synovitis. MRIs are ordered only when the clinical history and physical findings demand such a test.

Findings like muscle weakness may prompt electromyography and nerve conduction velocity studies which can diagnose compression neuropathies.

How to Treat Nonarticular Rheumatism?

Patients with non-articular rheumatism can benefit from a multimodal treatment approach. The treatment protocol should include the following:

  • Sedative antidepressants at night.

  • Activating antidepressants in the morning.

  • Aerobic exercise and physical therapy.

  • Heat or ice pack.

  • Meditation.

  • Subcutaneous steroid injections.

  • Electromyography biofeedback.

  • Psychotherapy.

  • Cognitive behavior therapy.

  • Stress management.

  • Transcutaneous electrical nerve stimulation (TENS).

There has been limited success with a few of the advanced new-generation treatment disorders like eye movement desensitization and reprocessing or EMDR, and it has been useful in patients with post-traumatic stress disorder (PTSD). The success can be replicated with nonarticular rheumatism due to similar pathophysiology to that of PTSD.

Transcranial direct current stimulation has emerged as a potential treatment, but more research and development need to be conducted.

Other treatment methods might include acupuncture which might give relief through a placebo, and prescribing acetyl l-carnitine, muscle relaxant, malic acid, and magnesium medications.

The patient should be advised for:

  • Rest.

  • Immobilization.

  • Ice or heat pack.

  • Non-steroidal anti-inflammatory drugs.

  • Physical therapy.

  • Antibiotics (in case of infection).

  • Chronic pain treatment.

  • Tennis elbow strap for lateral epicondylitis.

  • Paddings for bursa and Achilles tendon involvement.

  • Lidocaine and steroid injections.

  • Bursa aspiration.

  • Assessment of habits like posture and untoward motions

  • Alteration of sleeping position.

  • Breast reduction in females.

  • Night wrist splints.

  • Postural therapies.

  • Proper foot support in arthritis can help reduce the pain.


Non-articular rheumatism is a disease with various complicated origins but is often self-limiting. The basic science behind the condition is largely not understood and requires more clinical studies to reach a definite conclusion regarding the mechanism and treatment protocol. The only treatment that can relieve the patient of the discomfort is to identify the underlying cause, observe the irregularities and implement proper pharmacological and non-pharmacological methods to relieve the pain and prevent any recurrence. The condition tends to be regional, transient, and easily treatable; significant pain and disability can be avoided by early recognition and appropriate therapy.

Frequently Asked Questions


How Does Rheumatic Pain Feel Like?

Rheumatic pain is usually felt at the joints. The joints feel tender and warm to the touch and are swollen, sore, and stiff. The pain and other characteristics are worse in the mornings and after inactivity. The condition may also bring about fever, fatigue, and loss of appetite.


What Do Articular and Nonarticular Mean?

Articular and nonarticular terminologies are associated with several features of a bone or joint. Articular refers to forming joints with another movable segment of another bone, while nonarticular refers to the attachment of connective tissue other than bone, like muscles, tendons, and ligaments.


What Is the Consequence of the Absence of Articular Cartilage?

Articular cartilage is responsible for the smooth and painless movement of the joints; the absence of articular cartilage would lead to bone-to-bone attachment at the joints, making the movements painful. Additionally, the surfaces would rapidly wear away. Articular cartilage is self-lubricating and gives the lowest coefficient of friction.


What Can Be Done to Tackle Articular Pain?

Some of the ways to deal with articular pain are:
- Acupuncture.
- Warm pads.
- Warm paraffin wax.
- Massage.
- Exercise.
- Acetaminophen or Ibuprofen.
- Topical analgesic ointments.


Can Walking Help With Rheumatism?

Mild and low-impact exercises like swimming, water aerobics, and walking work like rheumatism medicines. Walking can ease rheumatoid arthritis pain and strengthen the muscles across the joint, improving joint support.


Which Is the Best Medicine for Rheumatism?

DMARDs (disease-modifying anti-rheumatic drugs) and biological treatments form the two prongs of rheumatism treatment. Methotrexate is the first and best choice for rheumatologic treatment. Other DMARDs include Leflunomide, Hydroxychloroquine, and Sulfasalazine. Biological agents include Adalimumab, Etanercept, and Infliximab.


What Tests Can Be Done to Check for Rheumatism?

The tests for an absolute diagnosis of rheumatism include blood tests for ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), CBC (complete blood count), rheumatoid factor, anti-CCP antibodies, and imaging studies of the affected joints (X-rays, and magnetic resonance imaging).


Are Soft Tissue Rheumatism Same as Fibromyalgia?

Soft tissue rheumatism is a condition that causes pain, swelling, and inflammation around a joint without any particular origin. These conditions include tendinitis, tenosynovitis, bursitis, capsulitis, enthesitis, myofascial pain syndrome, and fibromyalgia. Whereas fibromyalgia refers to widespread musculoskeletal pain combined with fatigue, mood, memory, sleep disturbances, body stiffness, headaches, and migraines.


Which Conditions Are Considered Regional Rheumatic Conditions?

Regional rheumatoid conditions are also known as nonarticular rheumatism. These refer to musculoskeletal disorders that affect regions around the joint but do not originate there. Regional rheumatic conditions include tendinitis, tenosynovitis, bursitis, capsulitis, enthesitis, myofascial pain syndrome, and fibromyalgia. 


What Does Autoimmune Rheumatic Disorders Mean?

Autoimmune rheumatic disorders affect the joints, bones, muscles, and connective tissue. The basic etiology is due to the aberrant behavior of the immune system when it fails to differentiate between indigenous and foreign tissues. The immune system attacks the articular components and causes rheumatic diseases.


How Is Rheumatoid Arthritis Classified?

In adults, rheumatoid arthritis is classified as:
- Seropositive Rheumatoid Arthritis: This type has positive anti-CCP antibodies in the serum and is considered more progressive and severe than the other types.
- Seronegative Rheumatoid Arthritis: No anti-CCP or anti-Rh antibodies are found. This is less severe and affects multiple joints symmetrically.


How to Know if the Arthritis is of Osteoid or Rheumatoid Type?

Osteoid or osteoarthritis is caused by mechanical wear and tear of the joint, whereas rheumatoid arthritis is an autoimmune condition. The easiest way to clinically differentiate the two is because osteoarthritis usually occurs in an isolated joint, and rheumatic arthritis occurs in multiple joints symmetrically, along with fever, anemia, fatigue, and loss of appetite. Additionally, blood reports may test positive for anti-CCP and anti-Rh antibodies in patients with seropositive rheumatoid arthritis.


What Is the Current Terminology for Rheumatism?

Rheumatism is a loose layman's term, and the condition is ideally described as rheumatoid arthritis as it includes all disorders of the muscles, joints, tendons, cartilage, bones, and tendons associated with autoimmune etiology and systemic manifestations.

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Last reviewed at:
11 Nov 2022  -  6 min read




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