How Rheumatism Got its Name

Fast forward another 50 years to Alfred Garrod, who ingeniously fused gout and rheumatism together to create a new moniker, rheumatic gout, to replace Landré-Beauvais’ label for RA. Realizing that rheumatic gout was a distinct disease, Alfred Garrod’s son, Archibald, caused a stir some 40 years later, when he extricated this disorder from the clutches of gout. He did not stray far, selecting another rheum variant, rheumatoid arthritis. Since this disease has kept its name constant for well over a century, it has assured the long-term survival of the term rheum in our lexicon.

Like a virus embedded in our DNA, rheum continues to pass from one generation to the next. Has the definition of all things rheum gotten any clearer? After all, what is the meaning of rheumatology? Of course, readers of this publication understand the breadth of a rheumatologist’s practice, but have you ever tried to explain your métier to a stranger at a cocktail party?

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A history of arthritis and rheumatism
From Blumberg B S. History of arthritis and rheumatism. Arthritis Rheum. 1960;3:421-422.

In The Company of Wolves

It wasn’t just RA and gout that sowed such confusion. What about the red wolf? The characteristic facial rash of SLE is considered to have first been described by a monk named Herbenus, who lived in Tours, France, more than 1,000 years ago. He chose lupus, or wolf in Latin. After studying many images of wolves on Google, I doubt that I would have chosen this canine. Centuries later, other authors described the facial rash of lupus as having a butterfly appearance, though its Latin translation, papilio, never caught on as a medical term. There were a number of challengers to the name lupus, including the interesting Latin descriptor, noli mi tangere, or touch me not. This phrase has its derivation in the New Testament where it describes what Jesus said to Mary Magdalene when she approached him following his resurrection.⁵

The prolific Hungarian dermatologist Moritz Kaposi is credited with making some sense of all these diverse lupus-related skin lesions. He subdivided the cutaneous features of lupus into discoid and systemic forms. He also introduced the concept of lupus as being a systemic disease with a potentially fatal outcome. Though William Osler is heaped with praise for his work in defining SLE, his contributions may be overstated. For example, over a decade, he published a series of seminal papers describing 29 cases of various skin disorders that he referred to as the erythema group of diseases. These included a variety of lesions that were not typical for lupus, such as purpura and angioneurotic edema.⁶ In fact, among the series there were only two definite cases of SLE. Yet this fact has not prevented Sir William from being showered with accolades for his writings on cutaneous lupus. Based on his dismissive approach to managing patients with osteoarthritis and his paltry collection of cutaneous lupus cases, Osler’s contributions to rheumatology may have been exaggerated.

Star Wars Meets Rheumatology

What if rheumatologists had an about-face and followed the baseball metaphor of calling diseases the way they see them? In 1985, Dan McCarty, MD, professor emeritus at the Medical College of Wisconsin in Milwaukee and a past president of the ACR, described a series of 10 older patients who developed the sudden onset of symmetrical polyarthritis involving their hands and feet.⁷ He noted that their seronegative synovitis was also associated with marked, pitting edema of the hands and feet. Over time, the clinical and laboratory signs of inflammation along with their extremity edema gradually resolved. Being a modern man, Dr. McCarty shunned the Classics and the animal world when he named this condition, remitting seronegative symmetrical synovitis with pitting edema. Finally, rheumatologists could describe an illness whose name said it all. Perhaps Dr. McCarty was influenced by the blockbuster movie of that era, Star Wars, when he promoted the use of the mnemonic RS3PE to describe this form of arthritis.