Understanding the difference between rheumatism and arthritis

'Rheumatism' is a traditional and non-specific term used in the East and West to refer to a variety of conditions affecting the bones, joints, skin, heart, kidneys, lungs. This term is rapidly falling out of favour in the West today because modern medical science has discovered that most of these conditions have different aetiologies (causes) requiring very different treatments.

You can say that it's a word mainly used in Chinese (& traditional) societies; it's also used by a minority of Westerners into homeopathic and alternative medicine. The only common characteristics among these conditions are: 1) they cause long-term chronic pain, and 2) they are very difficult to treat.

'Arthritis' is a broad term refers to inflammation of the joints, but doesn't say anything about the cause. Includes conditions like osteoarthritis, rheumatoid arthritis, psoriatic arthritis, infective arthritis, gouty arthritis, etc.

Generally, I'd divide arthritis into 2 big groups:

1) Osteoarthritis (OA)
This is primarily a 'wear and tear' condition affecting older people. Arises from overuse (e.g. marathon runners), previous injuries (football players), overweight, heredity. A lot of older Asian women get osteoarthritis of the knees while the Americans and Europeans get it in the hips. The pain is more mechanical than inflammatory. So you get pain in the later part of the day after a lot of walking and climbing stairs.

Because it's mainly a mechanical problem, treatment with painkillers is only a temporary solution. Long-term lifestyle changes are more important - reduce weight, mobility and muscle-strengthening exercises, reduce all kinds of weight-bearing activities (walking, jumping, running, carrying heavy objects). In severe cases, surgery may be warranted.

2) Inflammatory ('Rheumatic') Arthritis
This group comprises the various types of arthritis which are mainly inflammatory , not mechanical, in nature. They usually result from an auto-immune condition, which causes the body's immune system to go haywire and attack the joints and other parts of the body. E.g. rheumatoid arthritis (RA), SLE (skin, kidneys, joints, brain), psoriasis (skin, joints), ankylosing spondylitis (back, heart), gout (joints, skin, kidneys), rheumatic heart disease/fever (joints, heart, skin). All these conditions require different forms of treatment.

I'll talk a bit about rheumatoid arthritis as it is the most common condition in this group. Unlike osteoarthritis, rheumatoid arthritis can occur at any age and is usually hereditary (we now have a test for the rheumatoid arthritis factor in the blood). Pain is usually in the early morning, worse when it's cold, and gets better with activity and use. That means a rheumatoid arthritis sufferer suffers from morning stiffness and pain, but gets better in the afternoon when it's warmer and when he has moved around a bit.

Treatment for rheumatoid arthritis, unlike osteoarthritis, is mainly through drugs - painkillers, anti-inflammatory drugs like steroids, cytotoxic drugs like sulfasalazine and MTX. With the vast arsenals of drugs available today, rheumatoid arthritis can be controlled very well and the sufferer can actually lead a very active life. Many osteoarthritis sufferers on the other hand may eventually require surgery since we don't have very effective drugs for osteoarthritis at this moment.

This article is contributed by Leong Y.H., M.D. Dr Leong is a western trained medical doctor with a keen interest in Oriental medical methods. You may republish this article provided you give credit to the author and a link back to this website.