Rheumatic Disease

Rheumatic Disease any of the diseases of the musculoskeletal system and connective tissues related to rheumatism. It affects people of all ages and sex but their frequency increases with age. Musculoskeletal pain and stiffness are the prominent feature in these diseases. Diagnosis of the diseases are usually established from a detailed history and careful physical examination. Laboratory tests and imaging can help in confirming the clinical diagnosis and in assessing the activity and progression of the disease. Few of the tests available are specific. These diseases are the most common cause of physical impairment in the UK and USA. The Rheumatic diseases are also common in Bangladesh.

Rheumatic fever A systemic, febrile disease, common to children and young adults, usually marked by fever and swollen joints. Rheumatic fever is the most common cause of heart diseases in children and young adult. The prevalence of the disease has progressively declined to a very low level in developed countries but the incidence is as high as 140/100,000 in developing countries. In Bangladesh the prevalence of the disease was found to be 4 per 1000 children. Rheumatic fever is a systemic illness, followed by - haemolytic group A streptococcal infection of the throat and encountered in less than 1% of episodes of streptococcal pharyngitis. However no history of sorethroat can be obtained in about 30-50% cases of rheumatic fever patients. Characteristically it tends to recur and although the name rheumatic emphasizes the joints but the involvement of the heart makes it important. It is said that 'rheumatic fever leaks the joints but bites the heart'.

Rheumatic fever most commonly occurs between the age of 5 and 15 years. It is rare under the age of 4 and becomes progressively less common after the age of 15. The disease is more common among the people of low socio-economic group. Overcrowding, damp environment, poor nutrition and sanitation may play an important role in causing rheumatic fever. All these environmental factors contribute to streptococcal infection and affect immunity.

A number of immunologic theories postulated over the years indicate that rheumatic fever is the result of a hyperimmune reaction either to bacterial allergy or to autoimmunity. Microscopic evidence of acute rheumatic fever is widespread but affects particularly the tissues lined by endothelium. The pathological hall mark of rheumatic carditis are McCallum patch and the Aschoff's nodule. The lesions of rheumatic fever are most obvious in relation to heart valves and pericardium.

Rheumatic fever consists of a number of clinical manifestations, the most common of which is fleeting arthritis of big joints, and carditis, the inflammation of the layers of the walls of the heart. Fever is usually present. The physical signs of carditis are mostly found on auscultation as heart murmurs or sometimes as pericardial friction rub. There is no certain way of establishing the presence of rheumatic fever, but the combination of certain clinical features and laboratory finding is highly suggestive.

The aim of the treatment of rheumatic fever is directed towards limiting cardiac damage, relieving symptoms and eliminating the streptococcal infection. Absolute bed rest, adequate dose of aspirin, and long acting penicillin should be given in acute rheumatic fever. Rest must be continued until the indices for continuing disease activity have settled. Sometimes corticosteriod to be used if there is no response to aspirin or there is carditis.

Most important part in the treatment is to prevent the recurrence of the disease by giving regular prophylaxis against streptococcal infection preferably by injectable form of long acting penicillin. It is a preventable disease and the primary preventive measures may decrease the morbidity and mortality.

Rheumatism A general term for acute and chronic condition characterized by inflammation, degeneration or metabolic derangement of the connective tissue structures of the body, specially the joints and related structures including muscles, tendons, and fibrous tissues. It is associated with pain, soreness and stiffness or limitation of motion of these parts. Rheumatism confined to the joints is termed as arthritis. Various types of arthritis and rheumatism are often classified as follows: Acute arthritis (Rheumatic fever); Chronic arthritis (Rheumatoid arthritis, gout); Traumatic arthritis; Inflammatory arthrits (Rheumatic fever); Infective rheumatism (Gonococcal arthritis); Muscular rheumatism (Fibromyo-sitis, myositis, myalgia, torticollis); Palindromic rheumatism (A condition in which there is intermittent joint pain with tenderness, heat and swelling that lasts from few hours to as long as a week. The knee is most often involved but the disease does not necessarily return to the same joints. Between attacks there is no evidence of the disease. The cause is unknown.); and Psychogenic rheumatism (Rheumatism associated with emotional stress).

Although some form of rheumatism is common to a wide range of population of either sex of Bangladesh, the disorder is more prevalent to the elderly people above 40 years. [AKM Mohibullah]

See also arthritis.