What is rheumatism?

Rheuma summarizes more than 100 diseases. Health professionals refer to rheumatic diseases or diseases of the rheumatic spectrum.

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“Rheuma” and “rheumatism” refer to pain conditions in the musculoskeletal system. The musculoskeletal system includes bones, joints, tendons, muscles and connective tissue.

Rheumatism is not an independent diagnosis, but rather summarises a group of diseases that are associated with pain and functional limitations in the musculoskeletal system. Today, Doctors and Therapists Speak of Rheumatic Diseases.

The rheumatic spectrum comprises more than 100 diseases, some of which are very different. These diseases have pain and functional disorders of the musculoskeletal system in common and are therefore summarised in the rheumatic spectrum.

This article uses the rheumatic spectrum to explain what rheumatism is and differentiates between various rheumatic diseases. This is because rheumatic symptoms are not necessarily associated with a rheumatic disease.

A Classification by Cause: The Rheumatic Spectrum

Rheumatic symptoms basically describe pain and functional limitations in the musculoskeletal system. The musculoskeletal system includes bones, joints, tendons, muscles and connective tissue.

Rheumatic symptoms can be associated with rheumatic diseases, but can also have other causes:

  • Muscle tension is a common rheumatic symptom, but is not usually associated with a rheumatic disease.
  • Back pain is a rheumatic symptom that can be associated with rheumatic or other diseases.

Rheumatic diseases can manifest themselves in the bones, joints, tendons, muscles or connective tissue. Accordingly, the clinical pictures can be very different.

In rheumatology, the Rheumatic Spectrum Divides rheumatic diseases according to their origins. The rheumatic spectrum forms four main groups, within which further subdivisions are made.

Rheumatic diseases are currently divided into

  1. Inflammatory rheumatic diseases
  2. Degenerative diseases of the musculoskeletal system
  3. Metabolic disorders with rheumatoid symptoms
  4. Painful, non-inflammatory diseases of soft tissues

In Germany, around 1.5 - 2.1 million people live with a rheumatic disease [1].

Inflammatory rheumatic diseases

Inflammatory rheumatic diseases are often autoimmune diseases in which inflammation occurs in the musculoskeletal system, causing pain. They are often chronic.

As an autoimmune disease, malfunctions of the immune system are the cause of the disease. The immune system recognises the body's own structures as foreign and triggers inflammation in order to fight them.

In rheumatic-inflammatory autoimmune diseases, areas of the musculoskeletal system are primarily affected, such as inflammation of the joints in rheumatoid arthritis. Depending on the disease, however, internal organs, skin, mucous membranes or blood vessels can also be affected.

Common inflammatory rheumatic diseases include

  • Rheumatoid arthritis
  • Psoriatic arthritis / psoriatic arthritis
  • Spondyloarthritis / ankylosing spondylitis / ankylosing spondylitis
  • Vasculitis
  • Polymyalgia rheumatica
  • Sjögren's syndrome
  • Systemic lupus erythematosus (SLE)

Inflammatory rheumatic diseases are characterised by very different causes and clinical pictures.

Degenerative rheumatic diseases

The musculoskeletal system consists of bones, joints, tendons, ligaments, cartilage, muscle and fascia. Joints, bones and surrounding tissue can wear out and deteriorate. In this case, we speak of degenerative diseases of the musculoskeletal system. Degenerative diseases of the musculoskeletal system are diseases caused by wear and tear.

They usually develop over a longer period of time and mainly affect the passive musculoskeletal system. The passive musculoskeletal system includes the skeleton, joints, ligaments, cartilage and intervertebral discs.

Degenerative diseases of the musculoskeletal system can affect all joints of the extremities (e.g. knee, hip, shoulder) as well as the spine, hands and feet.

The most important characteristics of degenerative diseases of the musculoskeletal system include

  • Changes to the cartilage: the joint cartilage, which serves as a sliding layer and shock absorber, becomes thinner and rougher.
  • Wear and tear: The affected joints show signs of wear and tear, which can lead to pain and restrictions in freedom of movement.
  • Age-related development: Degenerative diseases often occur with increasing age. However, they can also develop at a younger age due to incorrect loading, obesity or accidents.

Degenerative diseases can cause inflammatory processes that occur intermittently. However, these inflammations are not the cause of the wear and tear, but a consequence.

Common degenerative diseases of the musculoskeletal system are

  • Arthroses
  • Spondylosis (osteoarthritis of the vertebral joints)
  • Osteochondrosis

The treatment of degenerative diseases of the musculoskeletal system such as osteoarthritis, spondylosis and osteochondrosis aims to alleviate pain and maintain mobility. Various therapeutic approaches such as physiotherapy, occupational therapy, osteopathy and pain-relieving medication can be used for this purpose. In advanced cases, surgical interventions may also be necessary.

Soft tissue rheumatism

Soft tissue rheumatism or soft tissue rheumatism are painful rheumatic diseases that affect the "soft" structures of the musculoskeletal system. The affected tissues include

  • Muscles
  • Tendons and tendon sheaths
  • ligaments
  • bursae
  • fatty tissue
  • Fasciae (connective tissue)
  • nerves
  • Vessels

In contrast to other rheumatic diseases, soft tissue rheumatism does not affect the bones, joints and articular cartilage.

Soft tissue rheumatism is not a diagnosis in its own right, but is used as an umbrella term for various clinical pictures.

Rheumatic diseases of the soft tissues that cause local symptoms include

  • Localised, bulging or nodular muscle hardening (myogelosis)
  • Degenerative tendon diseases (tendopathies),
  • Inflammation of the muscle tendons and muscle tendon sheaths (tendovaginitis),
  • irritation or inflammation of the bursa (bursitis)

Fibromyalgia, a chronic pain disorder, is also classified soft tissue rheumatism. The disease can cause pain throughout the body, usually occurring near joints or the spine.

Metabolic disorders with rheumatic complaints

Metabolic disorders with rheumatic complaints are diseases in which metabolic disorders lead to pain and inflammation of the musculoskeletal system.

Restrictions in freedom of movement and pain are therefore a consequence of metabolic disorders. Common clinical pictures include, among others.

Gout & pseudogout

In the case of gout, a metabolic disorder leads to deposits in the joints that trigger inflammation. More specifically, a disorder in uric acid or purine metabolism leads to the formation of urate crystals, which are deposited in joints and cause inflammation.

In pseudogout (chondrocalcinosis), calcium oxalate crystals are deposited in the joints and are visible in imaging procedures. This is also referred to as calcification of the joints, which can cause symptoms.


Osteoporosis is a disease of the bone metabolism. It reduces the density, quality and strength of the bones. It leads to increased bone fragility. Osteoporosis is also known as bone loss.

While osteoporosis is often asymptomatic in the early stages, bone pain and back pain can occur as the disease progresses.

Hormonal and endocrine joint diseases

Hormonal dysfunctions can also trigger complaints in the musculoskeletal system. An underactive thyroid gland (hypothyroidism) can lead to joint and muscle pain as well as general stiffness. An overactive thyroid (hyperthyroidism) can cause osteopenia and osteoporosis.

Metabolic disorders can cause pain, inflammation or functional limitations in joints, bones or muscles that resemble 'classic' rheumatic diseases.

Treatment depends on the underlying metabolic disorder and the specific symptoms.

Not all rheumatism is the same. Rheumatism or rheumatism is a non-specific term for functional limitations and pain of the musculoskeletal system.

Corresponding symptoms such as muscle tension can be harmless. If pain and functional limitations occur regularly or permanently, these symptoms can indicate serious rheumatic diseases.

More than 100 rheumatic diseases are known to date. Rheumatoid arthritis is the most common of these diseases. The rheumatic form group structures rheumatic diseases according to their cause.

[1] Albrecht, K., Binder, S., Minden, K. et al. Systematic review to estimate the prevalence of inflammatory rheumatic diseases in Germany. Z Rheumatol 82, 727-738 (2023). https://doi.org/10.1007/s00393-022-01305-2

[2] Junge-Hülsing, G. (1975). Rheumatic forms. In: Hauss, W.H., Oberwittler, W. (eds) Geriatrics in practice. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-66000-9_11

[3] Yellow list. rheumatic diseases. Retrieved on 24/06/2024 at https://www.gelbe-liste.de/rheumatologie/rheumatische-erkrankungen

[4] DocCheck. rheumatic diseases. Retrieved on 24/06/2024 at https://flexikon.doccheck.com/de/Erkrankungen_des_rheumatischen_Formenkreises

[5] Rheumatism guide. Retrieved on 24/06/2024 at https://www.ratgeber-rheuma.de/