What is soft-tissue rheumatism?

Rheumatic diseases are often accompanied by pain and functional limitations of the musculoskeletal system. Depending on the rheumatic disease, symptoms can occur in different parts of the musculoskeletal system.

The musculoskeletal system includes all the structures that ensure that we can stand upright and move around: Bones, joints, muscles, tendons, ligaments and connective tissue.

Soft tissue rheumatism or soft tissue rheumatism describes diseases that are associated with rheumatic complaints in soft tissue. Soft tissue includes

• the muscles,
• tendons,
• tendon sheaths,
• bursae,
• ligaments,
• connective and fatty tissue and
• nerves and blood vessels.

In contrast to other rheumatic diseases, soft tissue rheumatism often does not affect bones, joints or cartilage.

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Common symptoms of soft tissue rheumatism

Rheumatic diseases, which are categorised as soft tissue rheumatism in the rheumaticspectrum, can be accompanied by very different symptoms.

Common symptoms include

• Persistent or permanent pain in muscles, tendons, tendon attachments and other soft tissues
• Painful swelling
• Restricted mobility
• Tiredness and exhaustion (fatigue)

Depending on the disease, symptomatic pain can occur locally (e.g. tennis elbow) or affect the whole body (e.g. fibromyalgia).

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Which diseases belong to soft tissue rheumatism?

In the rheumatic spectrum, diseases that affect the soft tissues are categorised as soft tissue rheumatism. Soft tissue rheumatism or soft tissue rheumatism is not itself a diagnosis.

The following diseases are categorised as soft tissue rheumatism.

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Tendovaginitis (inflammation of the tendon sheath)

Inflammation of the muscle tendons and tendon sheaths can lead to redness, swelling and pain, which can limit the ability to function.

Tendovaginitis is curable. They are treated conservatively by resting and immobilising the affected area. To avoid chronification, it is important to follow the therapy.

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Localised muscle hardening (myogelosis)

Overexertion and incorrect strain can lead to muscle hardening the size of a pea or a marble. These often occur in the calves, back or neck. Myogelosis is associated with pain when pressure is exerted on the affected muscle sections.

Localised muscle stiffness is treated with massages and manual therapy to release it. Lasting improvements can also be achieved with personalised physiotherapy.

Pain-relieving medication (analgesics such as ibuprofen or pain ointments such as diclofenac) and, if necessary, medication to relax the muscles (muscle relaxants) can be used for acute treatment.

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Bursal irritation or inflammation of the bursa (bursitis)

Bursitis or bursitis is an inflammation of the bursa, which often occurs in the elbow or knee joint. Bursitis is often triggered by injuries or trauma, infections or chronic incorrect loading. However, bursitis can also occur in connection with inflammatory rheumatic diseases such as rheumatoid arthritis.

Bursitis often develops slowly. At the beginning, there is often slight pain on movement and a rubbing sensation in the irritated or inflamed area.

Further strain can lead to more severe pain. Local symptoms such as swelling, hyperthermia and effusions may also occur.

Bursitis (antiseptic) is usually initially treated by resting and immobilising the affected joint in order to reduce the strain. Non-steroidal anti-inflammatory drugs such as diclofenac as well as heat and cold treatments can also provide relief.

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Enthesiopathies

Enthesiopathy is a group of painful diseases of tendon attachment points close to the joint.

Enthesiopathy is also known as insertional tendinopathy. Enthesiopathies include

• Achilles tendinitis (achillodynia)
• Inflammation of the tendon plate of the sole of the foot (plantar fasciitis)
• Irritation of the patellar tendon, jumper's knee (patellar tendinitis)

The affected muscle insertion hurts with pressure, stretching and movement. The pain is intensified when forceful movements with muscle involvement are performed. This is also referred to as exertional pain.

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Fibromyalgia

Fibromyalgia, also known as fibromyalgia syndrome (FMS), is a chronic pain syndrome. In fibromyalgia, pain is often not localised, but can occur throughout the entire body. Fibromyalgia is also known as muscle-fibre pain.

The pain that occurs with fibromyalgia is often accompanied by various symptoms. These include sleep disorders, tiredness and physical and mental exhaustion (fatigue).

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Colloquially, fibromyalgia is often incorrectly referred to as soft tissue rheumatism. However, fibromyalgia is an independent diagnosis that is assigned to soft tissue rheumatism in the rheumatic spectrum.

The causes and mechanisms of fibromyalgia in the body are currently (2024) the subject of further scientific debate.

Fibromyalgia is also sometimes categorised as a chronic pain disorder.