The term 'arthritis' embraces a wider group of diseases more correctly referred to as rheumatic and musculoskeletal diseases (RMDs). These are diseases that cause abnormalities in the joints and surrounding tissues such as the tendons, muscles and bones. In some instances, internal organs may also be affected. This group of diseases include more than 100 conditions, but the best-known ones are osteoarthritis, gout, rheumatoid arthritis, ankylosing spondylitis and connective tissue diseases such as systemic lupus erythematosus.
The commonest symptoms of RMD are pain and sometimes swelling of the joints and surrounding tissues. In osteoarthritis (OA), the commonest form of arthritis, the pain is more 'mechanical', meaning that the symptoms are made worse by activity.
In rheumatoid arthritis (RA), the pain is more inflammatory, meaning that the pain is relieved by activity. Patients with RA typically have prolonged morning stiffness and feel better as the day progresses. Lower backache is a common reason for patients to present to a doctor and in these cases osteoarthritis and ankylosing spondylitis should be considered. In connective tissue diseases, such as systemic lupus erythematosus (SLE), a skin rash may be present and internal organs may be affected.
Obesity - an increasing global health challenge - is a major risk factor for the development of OA and gout. Genetic predisposition, female gender and smoking are significant risk factors for developing RA and SLE.
The general practitioner is the first to be consulted, but when there is diagnostic uncertainty or management is very difficult, the patient should be referred to a rheumatologist. It should be stressed that the treatment of RMDs requires a team effort and important role players are the allied health professionals such as the occupational therapist, physiotherapist, dietitian, social worker and psychologist.
Although RMDs are generally not curable, the treatment may result in significant improvement in the patient's condition. In OA, the drug treatment is largely symptomatic, but in RA and gout, treatment may result in treating the underlying disease. Surgery has a small role, particularly in OA where joint replacement may be necessary.
