For a standard question that nearly every patient has asked me—“Doctor, do I have rheumatism or arthritis? And what is the difference?”—it’s simple to explain, but with progress we have much more to offer. The word “rheumatism” in its broad sense is meant to convey musculoskeletal symptoms or a related disease. This ancient word is very much in use, even subdivided or in subsets, because rheumatism is meant to suggest soft-tissue rheumatism (i.e., a malady that affects structures outside the joint). Its other subsets over the years have seen names such as myositis, fasciitis, bursitis, tendonitis, tenosynovitis, fibrositis, fibromyositis, and the currently in-fashion fibromyalgia. Contemporary rheumatologists mockingly dismiss “soft-tissue rheumatism” as a waste paper–basket diagnosis. Will the rheumatologist of tomorrow do away with some of the current terms—who knows?
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Explore This IssueOctober 2012
A glossary of rheumatic diseases is well recorded.1 Let’s look at a few examples. Some words seem to convey exactly what they are supposed to. For example, ankylosing spondylitis, just perfect; other examples: osteoarthritis, polymyalgia rheumatica, or, if you like, relapsing polychondritis. These terms sum up patients’ symptoms, even the disease. In short, easy to spell and pronounce, and comprehensible to doctors, patients, and healthcare professionals alike.
In contrast, we have systemic lupus erythematosus (SLE). Since the 16th century, the word “lupus” has been derived from a word for wolf, but then we added two words to describe systemic symptoms and rash. As a result, this three-word disease comprises 26 letters of the alphabet, is prone to mistaken spellings, is hard for patients to pronounce, and is, indeed, alarming. Isn’t it time we just used the five-letter, one-word “lupus” and discard the other two words? Diehard rheumatologists in their detailed case reports may certainly use the 26-letter, three-word designation if it pleases them, but let the world formally adopt the word “lupus.” It sounds patient friendly, even if the disease is not. No harm done.
Check out historical documents and you will come across “arthritis deformans” to describe what we understand today as “rheumatoid arthritis.” I believe that the term “arthritis deformans” is apt for this prototype disease. In 1858, Sir Alfred Baring Garrod from England probably thought otherwise, and so he coined “rheumatoid arthritis” (RA). It didn’t seem to carry much weight at that time, and Sir William Osler, in his “Principles and Practice of Medicine” (1909), continued to describe the disease arthritis deformans: “Once established, the disease is rarely curable. Too often it is a slow, but progressive, crippling of the joints, with a disability that makes the disease one of the most terrible of human afflictions.”2