Rheumatism: a non-specific term for medical problems affecting the joints and connective tissue. The study of, and therapeutic interventions in, such disorders is called rheumatology.
The term "rheumatism" is still used in colloquial speech and historical contexts, but is no longer frequently used in medical or technical literature; there is no longer any recognized disorder simply called "rheumatism." Some countries use the word Rheumatism to describe fibromyalgia syndrome. The traditional term covers such a range of different problems that to ascribe symptoms to "rheumatism" is not to say very much. Nevertheless, sources dealing with rheumatism tend to focus on arthritis. However, "non-articular rheumatism", also known as "regional pain syndrome" or "soft tissue rheumatism" can cause significant discomfort and difficulty.
Types
The major rheumatic disorders currently recognised include:
Rheumatic heart disease (a long-term complication of Rheumatic fever)
Temporal arteritis and Polymyalgia rheumatica
Although these disorders probably have little in common in terms of their epidemiology, they do share two characteristics: they cause chronic (though often intermittent) pain, and they are difficult to treat. They are also, collectively, very common.
"Rheumatism" and weather.
There has long been said to be a link between "rheumatic" pain and the weather. There appears to be no firm evidence in favour or against; a 1995 questionnaire given to 557 people by A. Naser and others at the Brigham and Women's Hospital's Pain Management Center concludes that "changes in barometric pressure are the main link between weather and pain. Low pressure is generally associated with cold, wet weather and an increase in pain. Clear, dry conditions signal high pressure and a decrease in pain".
Some conditions that were once given the general label of rheumatism or called rheumatic diseases include, rheumatoid arthritis, osteoarthritis, lupus, fibromyalgia, and tendonitis. Frequently autoimmune disorders, since they remained unnamed but caused pain as well as affecting other organs, were classed as rheumatism. Illnesses like lupus were particularly susceptible to being called rheumatism. Later understanding of the actions of these illnesses show that the problem is not dysfunction of the joints, but rather immune systems that can attack joints, muscles and organs.
Rheumatic diseases have been recognized since early times. Hippocrates referred to joint conditions in 18 of his aphorisms. The term ‘rheuma’ dates back to the 1st century ad, its meaning resembling the Hippocratic Catarrhos. Both terms refer to substances which flow, and are derived from the term phlegm, which was one of the four primary humors. Rheumatic diseases, including chondrocalcinosis and gout, were found in Egyptian mummies. Intervertebral disc calcification was common in mummified specimens, and osteoarthritis has been found in archeological specimens. The first clinical description of rheumatoid arthritis is credited to Landre-Beauvais (1880). He described a series of women with a disease he considered to be a variant of gout. Examination of Flemish paintings between 1400 and 1700 show a few people with rheumatoid arthritis, demonstrated by swelling of the interphalangeal joints.
Gout is a medical condition that usually presents with recurrent attacks of acute inflammatory arthritis (red, tender, hot, swollen joint). It is caused by elevated levels of uric acid in the blood. The uric acid crystallizes and deposits in joints, tendons, and surrounding tissues. Gout affects 1% of Western populations at some point in their lives.
Treatment with non-steroidal anti-inflammatory drug (NSAIDs), steroids, or colchicine improves symptoms. Once the acute attack has subsided, levels of uric acid are usually lowered via lifestyle changes and long-term prevention with allopurinol.
Historically, it was known as "the disease of kings" or "rich man's disease".
The glorification of gout in 16th-to 18th-century literature
Martina Scholtens, MD
John Ruedy Immunodeficiency Clinic, St. Paul's Hospital and Bridge Community Health Clinic, Vancouver Coastal Health, Vancouver, BC
Literary references to gout are a prime example of the insight into popular perceptions of disease that historical writings offer. While praise of podagra is currently in short supply, the merits of gout have been extolled over the centuries by physicians and laypersons. In the past, gout was regarded as a badge of nobility, a talisman against other afflictions and an aphrodisiac, and these beliefs were preserved in 16th-to 18th-century literature.
A mark of nobility
Gout as a disease of the nobility was referred to and explained in a popular fable involving Mr. Gout and the spider. This story has been traced to the ninth century, and the first English version of it was recorded in a medical handbook by the Puritan Richard Hawes in 1634.
The tale tells of Monsieur Gout and his travelling companion, the spider. Mr. Gout lodged with a poor man, and the spider with a rich man. When they reviewed their accommodations the next day, both had complaints.
“‚Mine,' said the Gout, ‚was the worst as ever I had, for I had no sooner touched the poor man's legs, thinking there to take my rest, but up he gets, and to thrashing he goes, so that I had no rest the whole night.'
‚And I,' said the spider, ‚had no sooner begun to build my house in the rich man's chamber, but the maid came with a broom, and tore down all my work.”
They then agreed to change places and were so pleased with their respective new homes that they each decided to put up permanent residence, for the spider's webs were not disturbed by the poor man, and “the Gout he was entertained with a soft cushion, with down pillows, with dainty caudles, and delicate broths. In brief, he did like it so well, that ever since he takes up his lodging with rich men.”
This fable purports to explain gout's apparent predilection for the upper class. Gout was referred to as morbus dominorum et dominus morborum, lord of disease and disease of lords, because of its respectable antiquity and its association with intemperance afforded only by the wealthy. Gout was personified as one of the Greek deities, Podagra, born of Dionysus (Bacchus), the god of wine, and Aphrodite (Venus), the goddess of love. The idea that gout resulted from service to these gods and was a consequence of overindulgence in sex, food and wine was recorded by ancient Roman authors and persisted into the Christian era.
A good-luck piece
Another popular idea of 16th-to 18th-century Europe was that gout was a remedy rather than a disease. Jonathan Swift (1667–1745), the Irish author and satirist, articulates this concept in his poem for his acquaintance Rebecca Dingley entitled “Bec's Birthday” (1726).
As, if the gout should seize the head,
Doctors pronounce the patient dead;
But, if they can, by all their arts,
Eject it to th'extreamest parts,
They give the sick man joy, and praise
The gout that will prolong his days:
Rebecca thus I gladly greet,
Who drives her cares to hands and feet.
Gout was understood to be incompatible with most other afflictions, in keeping with the age-old idea that diseases were mutually exclusive. As such, gout was regarded as a cure, a vaccine, an insurance policy against worse illness. In his letters, the English writer Horace Walpole claimed, “It prevents other illness and prolongs life. Could I cure the gout, should not I have a fever, a palsy or an apoplexy?" He went on, “I believe the gout a remedy and not a disease, and being so no wonder there is no medicine for it, nor do I desire to be fully cured of a remedy.”
Gout was sought by some who did not have it. In the 18th century, patients suffering from consumption or melancholy were sent by their physicians to the waters at Bath in the hope of acquiring gout and so ousting their other sickness.
Podagra as an aphrodisiac
Gout was also touted as having aphrodisiac properties. The earliest reference to gout as an aphrodisiac is the Podagra Encomium of 1562 by Hieronymus Cardanus of Pavia (1501–1576). A physician and mathematician, Cardanus explained in his encomium, a formal yet facetious expression of praise, that: “For with Venus and Bacchus and the feasts of voluptuaries an abiding covenant serves as check, and such a cause of happiness is she [the gout] that those who are restrained by her are compelled to lead lives that, except for the pain itself are happy. For she does not render them sterile but restores them to Venus with increased prowess.”
T.G. Benedek reviews several reasons that were postulated for this sexual performance–enhancing character of gout. In his 1588 essay, “Of Cripples,” Michel de Montaigne, the French Renaissance writer, explains that when the legs are crippled (by any cause) and “do not receive the food that is their due … the genital parts … are fuller, better nourished, and more vigorous. or else that, since this defect prevents exercise, those who are tainted by it dissipate their strength less and come more entire to the sports of Venus."
In 1693, Gerhardus Feltmann, a 17th-century Dutch jurist, suggested that the sexual prowess of a person suffering with gout was due to the incubating effect of bed rest on the reproductive organs: “For when a patient who is suffering from gout is forced to lie on his back, anyone who knows that the channels of the sperm trace their source to the kidneys can easily and at his leisure comprehend that the loins and kidneys are hot and inflamed.”
Historical conceptions of gout may be entertaining and the current metabolic definition of the disease considered a scientific advancement, however, if I were to diagnose gout in a patient today, I would prefer to temper the announcement with the reassurance that the condition guaranteed increased social status, a reduction of cancer risk, and an end to Viagra refills.
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