Rheumatology is a subspecialty of internal medicine, but it also overlaps with the field of orthopedics. Internists or orthopedic surgeons who have completed additional training to become rheumatologists—that is, rheumatology-orthopedic specialists—focus primarily on the diagnosis and non-surgical treatment of patients with inflammatory diseases.
Most often, the musculoskeletal system is affected—that is, all types of joints, the spine, bones, tendons, ligaments, and muscles. These conditions include rheumatoid arthritis—also known as chronic polyarthritis—and psoriatic arthritis, an autoimmune inflammatory joint disease.
The range of responsibilities that rheumatologists have chosen to specialize in extends from prevention and diagnosis to treatment and rehabilitation. The clinical picture is also diverse in this subfield of medicine: in addition to the conditions already mentioned, the spectrum includes ankylosing spondylitis (Morbus Bechterew), various forms of collagenoses—that is, connective tissue disorders—vasculitides, and myositis. There are also hormonal and metabolic joint diseases, chronic bone diseases such as osteoporosis, and chronic “soft-tissue rheumatic” diseases such as fibromyalgia.
A key difference between internal medicine rheumatology and orthopedic rheumatology is that the internal medicine approach focuses primarily on the conservative treatment of rheumatic diseases, whereas orthopedic rheumatology has a strong surgical focus.
Doctors who specialize in rheumatology are called rheumatologists. They may be specialists in internal medicine (internists) or specialists in orthopedics.
Rheumatologists who focus on chronic inflammatory rheumatic diseases are internists and treat their patients conservatively. Orthopedic rheumatology, on the other hand, uses surgical procedures as part of treatment. Their patients suffer from chronic degenerative rheumatic diseases.
All rheumatic diseases have different symptoms, causes, courses, and prognoses, and are treated with specific methods tailored to each condition. They often affect the skeletal muscles and the entire musculoskeletal system. Other conditions within the rheumatic spectrum, in turn, affect the entire human body.
What Is Rheumatism?
Rheumatism (archaic: rheumatism) is the umbrella term for various health disorders that are congenital, genetic, or acquired and are associated with pain in
- joints,
- the back,
- bones,
- tendons,
- muscles, and
- ligaments
are all involved.
Many rheumatic conditions are caused by age-related wear and tear or result from past injuries and accidents the patient has experienced.
Other possible causes include
- inflammatory processes
- an impaired immune system
- metabolic disorders
Current medical research assumes that each rheumatic disease arises from an interaction of various factors that has not yet been fully elucidated.
All rheumatic diseases—which can also affect children and adolescents—significantly impair patients’ quality of life.
Early signs of rheumatism include warm, swollen, or reddened joints @ andifink /AdobeStock
Rheumatic Diseases
Given the wide range of different clinical presentations encompassed by the umbrella term “rheumatism,” the diseases treated in rheumatology are divided into four groups.
Inflammatory rheumatic diseases
These include, for example, rheumatoid arthritis (chronic polyarthritis). This is a form of joint inflammation caused by an autoimmune disorder. In medicine, this term refers to lifelong conditions caused by a dysfunctional immune system: the body’s own immune system produces antibodies against its own healthy cells.
Collagenoses (inflammation of connective tissue), psoriatic arthritis (joint inflammation associated with the skin condition psoriasis), and vasculitides are also classified in rheumatology as chronic inflammatory diseases within the rheumatic spectrum. The latter refers to pathologically altered blood vessels resulting from inflammation.
Degenerative rheumatic diseases of the joints
The best-known example of this is osteoarthritis. It develops as a result of the natural aging process or is caused by chronic overuse of certain joints or surgical intervention.
In osteoarthritis, the hip joints, spine, and knee joints are affected.
Metabolic disorders with rheumatic symptoms
These include, for example,
- osteoporosis,
- bone fragility caused by a calcium deficiency, and
- gout.
It is caused by an increased buildup of uric acid crystals in the joints.
If left untreated, gout leads to changes in the joints and kidneys @ doucefleur /AdobeStock
Rheumatic diseases of the soft tissues (“soft-tissue rheumatism”)
These are caused by inflammatory processes in the body or have other causes. Fibromyalgia, for example, is a non-inflammatory chronic rheumatic condition affecting the tendons and muscles of the musculoskeletal system that is accompanied by pain.
Polymyalgia rheumatica, however, is the result of inflammation within the body.
About the medical author
Sabine Schneider
Editor-in-Chief
Sabine Schneider – medical author: Explore expert articles and medical expertise in the Leading Medicine Guide.
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