Rheumatism: what kind of disease is it and how does it differ from others

Rheumatism is a word used in everyday speech for almost any back or joint pain, but in medicine it refers to a specific process: systemic inflammation of connective tissue with predominant damage to the linings of the heart. Let us break down the mechanism to explain why the same disease turns out to be both cardiac and articular.

Rheumatism: what kind of disease is it and where the name came from

In medical literature the term "rheumatism" has been displaced by the international "acute rheumatic fever" — partly because of inconsistent understanding. Outside the Russian-language tradition, "rheumatism" describes lesions of the periarticular soft tissues, while in everyday vocabulary almost all diseases of the musculoskeletal system live under this word. Hence the confusion: in everyday speech "rheumatism" means worn-out joints, whereas the actual condition is a state following streptococcal infection that targets primarily the heart.

Acute rheumatic fever and the autoimmune mechanism

The mechanism is post-infectious. The causative agent is β-hemolytic group A streptococcus (S. pyogenes), and the trigger is usually tonsillitis or scarlet fever. Imagine that the immune system is a border checkpoint that recognizes an intruder by the shape of their uniform. Streptococcus has antigenic substances that match the tissues of the heart — that very "shape". The immune system learns from the bacterium and then recognizes the "uniform" on the valves and myocardium and attacks its own tissues. Rheumatism is autoimmune: the immune system, responding to streptococcal infection, damages healthy tissues. Why the breakdown occurs in not everyone is unknown; a genetic predisposition is likely. Symptoms appear 1–5 weeks after tonsillitis.

Types and stages of rheumatism

Clinically, rheumatism is divided into five syndromes — according to which tissue has become inflamed.

• Rheumatic carditis — inflammation of the heart involving its linings, primarily the myocardium.
• Rheumatic polyarthritis — damage to large joints, often symmetrical.
• Rheumatic chorea ("St. Vitus' dance") — changes in the small vessels of the brain, more often in children and girls.
• Skin form — annular erythema, subcutaneous nodules.
• Rheumatic pleuritis — chest pain on inspiration, shortness of breath, pleural friction rub.

By activity, minimal (latent), moderate (subacute) and maximal (acute, continuously relapsing) degrees are distinguished, and in the absence of signs of inflammation — the inactive phase. The active period lasts 3–6 months; relapses are provoked by infections and exposure to cold.

Cardiac rheumatism and joint involvement

Cardiac rheumatism is the core of the disease. Inflammation involves all the linings, but primarily the myocardium: weakness, sweating, pain in the heart area, temperature above 38 °C, tachycardia, muffled heart sounds. The articular form looks different: large joints — knees, elbows, ankles, symmetry, migrating pain, fever 38–39 °C, nosebleeds. The articular form runs a benign course, and joint deformity does not remain.

How rheumatism is diagnosed

It mainly affects children aged 5–15; heart damage may manifest years later. Diagnosis is based on examination and criteria: major — arthritis of several large joints, inflammation of the heart, subcutaneous nodules, chorea, rash; minor — fever, elevated ESR, joint pain, ECG changes. The diagnosis is probable with two major criteria or one major and two minor together with signs of a past streptococcal infection. Among the investigations used are an antistreptolysin test (ASO), a complete blood count, ESR, and ECG. What to prescribe and how to manage is decided by the doctor.

Complications and when a doctor is needed

Complications concern primarily the heart: valve damage with insufficiency or narrowing, heart failure, endocarditis, pericarditis, rhythm disturbances, as well as chorea. Most people recover in about 3 months, but the disease can return: the younger the age, the higher the likelihood of a repeat attack, and 5 years after the last episode the risk is noticeably lower.

The reason to see a doctor is a history of rheumatism and a new tonsillitis, suspicion of a return of the disease, as well as a recent streptococcal throat infection after which fever rose, joints became painful or chest pain appeared. Early treatment of streptococcal tonsillitis reduces the risk of rheumatism.

Rheumatism itself is not a reason to call an ambulance; 103 or 112 — if severe chest pain or marked shortness of breath appears.

The text is for reference: it explains the mechanics but does not replace a doctor's consultation — the heart and joints are best entrusted to someone who knows how to listen to them.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer