These and other disciplines share the envious circumstance of being well defined and circumscribed. That is not our reality. Where is our focus of interest? Some consider it to be the musculoskeletal system. Possibly, but muscles and joints are not always our prime focus. When evaluating patients for systemic diseases such as vasculitis or systemic lupus erythematosus (SLE), the emphasis may lie far from bone and joints.
To be a rheumatologist is to be a medical jack-of-all-trades and a master or mistress of them all. How did our specialty acquire its name? The term rheuma is derived from the Greek word that describes something that flows. Hippocrates attributed many illnesses, especially those causing muscle achiness to the abnormal flow of body rheums or humors. The influential 1st century botanist and founding author of De Materia Medica, Pedanios Dioscorides, concluded that arthritis was caused by, “a defluxion of rheum or a humour, bilious, sanguineous, melancholic, but usually pituitrous and crude.”2 Since then, rheumatism has served as the all-encompassing explanation for everything that ached. However, rheumatism was facing some competition from another novel term—gout.
Around the time of the fall of the Roman Empire, most medical scribes concurred that all joint pain could be divided into two basic categories—gout and everything else.3 In fact, this simple dichotomy persisted beyond the next millennium. Beginning in the 16th century, a great debate ensued. Were gouty attacks, such as podagra, actually helpful to the patient by providing an “exit pathway” through which the body could discharge potentially lethal humors? This concept was hotly debated for some time. Some authorities believed that treating gouty attacks as opposed to letting them run their natural course was harmful to the patient. Allowing these peccant humours to be released from the body via the big toe or the foot was considered to be in the best interest of the patient’s health.3 Let the rheums flow! Fortunately, this inane approach was finally laid to rest following Carl Wilhelm Scheele’s discovery of urate crystals and Alfred Garrod’s critical insights into the pivotal role of urate in the pathogenesis of gout.
Rheumatism continued to battle gout for preeminence in the nomenclature of musculoskeletal pain disorders. There was room for little else. The situation changed in the early 19th century when Augustin Jacob Landré-Beauvais, a resident physician at the Saltpêtrière asylum in France, described a new form of arthritis afflicting some of his patients. His cohort at the asylum consisted of poor women, previously ignored by other physicians who often chose to treat more affluent male patients suffering from gout. He referred to this polyarthritis, which is now called rheumatoid arthritis (RA), as primary asthenic gout.4
