Battling different kinds of pain

Arthritis and rheumatism, is there a difference? People are often confused- and they do overlap. 'Arthritis' means disease of or damage to the joints. 'Rheumatism' is a more general term used to describe any pain in or around your bones, muscles and joints. The term 'rheumatic disease' is used to refer to all types of arthritis and rheumatism.

There are about 200 different types of rheumatic disease. They fall into four main groups:

In these disorders the joint lining becomes inflamed. This can damage the surface of the joint and underlying bone. Rheumatoid arthritis is an example, but there are many other forms of inflammatory arthritis, including: gout, reactive arthritis, arthritis associated with colitis or psoriasis, and rarer disorders that can affect many parts of the body - the connective tissue diseases. An example is systemic lupus erythematosus (SLE).

This is a common condition where the cartilage becomes thinner and damaged and extra bone forms at the edges of the joint. It can result from abnormal stress on the joints, or from many different forms of injury or joint disease. However, many cases develop without any obvious reason. The hips, knees, and hands are most likely to be affected, but osteoarthritis can occur in any joint.

Pain can arise from irritation of tissues around joints, such as ligaments and tendons. Minor injury or overuse can result in localised pain which often lasts only for a short period. Tennis elbow and housemaid's knee are examples. In addition, more generalised pain can develop in the muscles or joints without arthritis. For example, as in 'fibrositis' or fibromyalgia.

This common problem can arise from muscles, discs, ligaments, bones and joints. Often it is not possible to find the exact cause of the pain. Certain forms of inflammatory arthritis, such as ankylosing spondylitis, can affect the spine, and osteoarthritis can also affect the back, where it is usually referred to as 'spondylosis'. Osteoporosis of the spine can show up initially as back pain.

Arthritis and rheumatism are a common, worldwide problem. They affect people regardless of age, sex, race, class or country.

There is no single, simple answer to this question, and there are many different forms of arthritis to be considered. We understand the causes of some diseases, such as gout, and can treat them effectively. Research has gone a long way towards unravelling the causes of most of the common forms of arthritis, but there is still much to be done.

Most rheumatic diseases are due to several factors acting together. Firstly, some people are naturally more likely to suffer from certain disorders (that is genetic risk - see below). Secondly, a variety of environmental factors can trigger the condition in those who are susceptible to it. Thirdly, in some cases the condition progresses because the body cannot clear the initial reaction to the 'trigger'. Fourthly, for many conditions there is a major element of chance.

Arthritis is not infectious. Furthermore, most types are not passed on directly from one generation to another. However, some forms of arthritis may run in families. The way our body is made (based on the genes passed on from your parents) makes you more or less susceptible to the disease in question. Researchers are helping us to understand the precise nature of the genetic side of arthritis. We believe this could lead eventually to our being able to prevent some forms of arthritis.

Arthritis can start suddenly without any obvious cause, and at any age. In some conditions something in the environment - or exposure to a combination of factors - appears to be responsible. A mild infection, for example, may trigger some types of arthritis.

Occasionally an allergic reaction can cause short-lived arthritis. Certain foods may appear to make arthritis worse. However, diet and allergies are unlikely to cause long - term arthritis. Most of the main forms of arthritis occur all over the world, in people with completely different diets and ways of living.The weather can affect symptoms, but it does not cause rheumatism or arthritis. If you have arthritis you may feel better in warm, settled weather, but arthritis also occurs in countries with a warm dry climate.

Arthritis does not always get worse. Many forms of rheumatism, such as most of the soft tissue disorders and many attacks of back pain, are short-lived, and go away on their own. Some of the inflammatory forms of arthritis, such as reactive arthritis, can also go away. Others, including gout, can often be controlled by traetment.

However, several of the major types of arthritis, including rheumatoid arthritis and osteoarthritis, are chronic (persistent) disorders, which are unlikely to go away once they have become established. These conditions also tend to vary - 'flare-ups' (where the symptoms are much worse) are interrupted by 'remissions' in which the pain and other symptoms are much less severe.

Arthritis can affect different people in different ways. Some cases are more severe than others. Different joints can be involved. This makes it difficult for rheumatologists to predict a clear outcome for any one patient. However, most people with arthritis do not become badly disabled, and it is only a minority who will end up in need of a wheelchair. Effective treatment will help reduce the risk of a bad result, even in the most severe of cases.

Everyone gets aches and pains in their muscles and joints from time to time, particularly if they take part in unusual or excessive physical activities. So, how can the beginning of arthritis be distinguished from normal pain and stiffness ?

Persistent pain and stiffness in or around joints which has no obvious cause could be due to arthritis. Most muscle pain settles within a few days, but if it persists, particularly if it occurs when you are resting or there is also a lot of stiffness and difficulty moving the joint, you should consult your rheumatologist for advice. Other symptoms of rheumatic disease can include tiredness, a general feeling of being unwell, loss of weight, mild fevers or night sweats, and skin rashes.

A joint that is developing arthritis is quite likely to swell up. When your rheumatologist examines you, he or she may also find a variety of other signs, such as restricted joint movement, or difficulty in doing a particular movement or task. Because some forms of arthritis can affect other parts of the body as well (causing a rash, or mouth ulcers for example) there may be other signs to help your rheumatologist to make a diagnosis.

Tests sometimes help but may not be helpful in the early stages of arthritis. Some blood tests may simply show evidence of inflammation in the joints, whereas there are others which are more specific to certain diseases, such as rheumatoid factor in rheumatoid arthritis. X-rays, and other ways of showing the inside of the joints,can also help.