Types of Rheumatic Disease

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Introduction

Historically, "rheumatism" was a term used to describe a range of painful conditions affecting muscles, tendons, joints, and bones. Nowadays, we prefer the more precise term "rheumatic disease." Rheumatic disease RD is a comprehensive term encompassing arthritis and various other conditions, it encompasses over 200 different conditions, musculoskeletal system be the most affected system it is sometimes named musculoskeletal diseases, some of it's condition involving the immune system when mistakenly attacking the body's own tissues, which can lead to autoimmunity.

It is divided into:

• Autoimmune disease.
• Autoinflammatory disease.
• Degenerative/ metabolic disorders.

General Classification Criteria of Rheumatic Diseases

There is still no accurate solo diagnostic procedures to diagnose or confirm Rheumatic Diseases, the Classification criteria will help to distinguish between similar diseases and confirm or exclude a specific disease based on specific factors. These criteria are guidelines, not the only way to diagnose. Diagnosis of rheumatic disease can be challenging, it relies on clinical assessment, gathering a complete patient history and carefully evaluating the musculoskeletal system is very important, hence match the findings during clinical examination with lab, X-ray, and sometimes tissue samples to confirm the diagnosis.

Diagnostic Criteria for RA.

Rheumatoid arthritis In 1987, the American College of Rheumatology (ACR) introduced the initial classification criteria for RA, which required meeting 4 out of 7 criteria for over 6 weeks. Subsequently, a new classification criteria set was developed jointly by ACR/ EULAR in 2010. This updated criteria take in consideration the prognostic markers while maintaining high specificity and sensitivity. This allows for early patient identification and timely treatment with disease-modifying antirheumatic drugs DMARDs or inclusion in clinical trials for new therapies, enhancing care for those with early arthritis and enabling personalized treatment strategies.

SLE classification criteria

Systemic Lupus Erythematosus Classification Criteria

In 2012, International Collaborating Clinics (SLICC) improved the 1997 criteria for categorizing lupus patients. These criteria help in research but aren't perfect for diagnosing patients. The new criteria are more sensitive (better at finding lupus cases) but less specific (may include some false positives). To be classified with lupus, a person must meet at least 4 out of 17 criteria, including one clinical and one immunologic sign. If a biopsy confirms lupus in the kidneys and there are positive autoantibodies, that's enough for classification.

Spondyloarthritis

Spondyloarthritis (SpA) includes diseases like ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis, enteropathic-related spondylitis. There are different criteria for diagnosing SpA, mainly used in research, but the latest from Assessment of SpondyloArthritis international Society suggests MRI is better for detecting early disease in the spine and sacroiliac area. They also defined inflammatory back pain and criteria for diagnosing axial and peripheral spondyloarthritis in early phases. ASAS introduced non-radiographic axial spondyloarthritis, which is similar to the radiographic form but lacks findings on plain X-rays and shows less ossification and inflammation on MRIs.

• Axial spondyloarthritis.jpg

  Axial spondyloarthritis

• Peripheral spondyloarthritis.jpg

  Peripheral spondyloarthritis

Autoimmune	Autoinflammatory	Degenerative/ metabolic disorders
Systemic lupus erythematosus Rheumatoid arthritis Psoriatic Arthritis Ankylosing Spondylitis Systemic sclerosis (Scleroderma) Idiopathic inflammatory myopathies Antiphospholipid syndrome Sjogren’s syndrome Primary vasculitis Dermatomyositis	Familial Mediterranean fever Mevalonate kinase deficiencies Muckle-Wells syndrome Familial cold urticaria NOMID syndrome NLRP12-associated syndrome/NLRP12-associated periodic fever syndrome PAPA syndrome Chronic recurrent multifocal osteomyelitis Adult-onset Still disease	OsteoarthritisOsteoporosis Parathyroid disorders Paget’s disease Calcium and phosphorus disorders (Hypercalcemia/ Hypocalcemia/ Hyperphosphatemia/ Hypophosphatemia) Vitamin D deficiency/osteomalacia Renal osteodystrophy Gout Hemochromatosis Ochronosis

Rheumatoid Arthritis and Osteoarthritis

Rheumatoid Arthritis	Osteoarthritis
Autoimmune inflammatory arthritis, more aggressive course. A family history of RA or specific genetic markers like HLA-DRB1 can increase the risk. Smoking, age usually develops between (40-60), females are predisposing factors. Symmetrical joint involved, narrowing in joint space, soft tissue swelling, erosion, and joint deformities are common findings Pain, swelling, and Morning stiffness lasting > 1 hour that improves with use. Systemic symptoms (fever, fatigue, weight loss), and extraarticular manifestations are common.	Degenerative joint disorder/Mechanical—wear and tear that destroys articular cartilage. Age, obesity, joint trauma are risk factors Narrowing in joint space (asymmetric), osteophytes, noninflammatory synovial fluid, and no joint deformities are common findings Pain will aggravate during weight-bearing on joint after activities e.g.: at the end of the day) and improve with rest. No systemic symptoms were involved.