Disabling, systemic, chronic and worsening the individual’s quality of life: Rheumatic diseases affect five million people in Italy, according to estimates by the Italian Society of Rheumatology (SIR). For them, joint pain, muscle aches and chronic fatigue are the most frequent symptoms to live with and fight against every day. The impact of some rheumatic diseases could be contained by avoiding certain risk factors. However, as a recent SIR survey indicated, not all Italians know these risk factors. Thus, since we do not know the cause of most rheumatic diseases, primary prevention remains difficult and the subject of numerous studies and research. Secondary prevention can be implemented, which is aimed at limiting the damage caused by the disease. We talk about this topic with Professor Bianca Marasini, Senior Consultant in Rheumatology and Clinical Immunology at Humanitas.
Women are most affected
According to the survey of experts, more than half of the respondents, 54%, do not know that for some rheumatic diseases a kind of prevention can be implemented by avoiding some risk factors. Seven out of ten believe that the main causes of these diseases are cold or humidity. Only in one case out of two habits such as addiction to cigarette smoking, sedentary behavior or excess weight are among the risk factors.
Unmodifiable risk factors include age and gender. Some rheumatic diseases, such as osteoporosis and arthrosis, affect older people more; autoimmune rheumatic diseases are more frequent in women; while gout is more frequent, at least until a certain age, in men. There are pathologies such as Lupus Erythematosus Systemic Lupus, scleroderma and some diseases of the thyroid gland in which the different incidence between men and women is very significant (1:7-10); while for other pathologies such as arthrosis, the margin between the two sexes is reduced.
Rheumatic diseases can occur at any age, but age itself can also be considered a risk factor. The so-called acute articular rheumatism is a typical childhood pathology, Lupus Erythematosus Systemic Lupus affects all ages, while arthrosis, osteoporosis, especially rheumatic polymydia are prevalent in old age.
Similar to almost all diseases, genetic predisposition is certainly an important risk factor, but by itself it is not enough”, Professor Marasini recalls. With regard to rheumatic diseases – she continues – at their basis there is an interaction between sexual hormones (many rheumatic diseases mainly affect women), immunity (many rheumatic diseases are characterized by the presence of autoantibodies) and environment (smoking, very important for rheumatoid arthritis and weight, especially osteoarthritis)”.
Today a lot of attention is given to the intestinal environment, the so-called microbioma or our intestinal flora. There are no definitive human studies yet, but studies on experimental models have shown a close link between specific types of microbioma, sexual hormones and autoimmunity.
Joints and inflammation
Only arthritis and arthrosis affect 16% of the Italian population, recalls the Italian Society of Rheumatology. They are among the main causes of disability along with other chronic diseases such as hypertension. The first begins with an inflammation of the synovia, which is the membrane that covers the joints, and causes pain and swelling of the joints. The second one begins by involving the cartilage and then the underlying bone, and also presents pain and often swelling, but with usually different joint locations and characteristics. If not recognized and properly treated at an early stage, both forms can lead to disabilities.
Symptom recognition and early diagnosis are therefore essential to control symptoms and the evolution of rheumatic pathologies with the most appropriate treatment, mainly pharmacological for inflammatory forms, associated with physiotherapy for arthrosic degenerative forms. Attention must be paid to warning signs, which can vary depending on the disease; here are some examples: pain and stiffness of the joints, muscle pain, excessive fatigue, dryness of the eye, changing in the color of the hands.
But what are the first symptoms that must alert individuals and perhaps make people think of a rheumatic disease? “Symptoms can vary greatly and may be subtle at the beginning. Almost always present, but not indispensable, is joint pain and stiffness related to movement, often in the morning. Some rheumatic diseases begin with symptoms in the fingers of the hands in the cold (the so-called Raynaud phenomenon), but let’s remember that the presence of this phenomenon does not always mean “rheumatic disease”; other diseases begin with problems in the eyes, others with skin problems, others with fever and fatigue. Surely it will be the general practitioner, who will refer the patient to the rheumatologist,” concludes Professor Marasini.