What is rheumatism?
The term 'rheumatism' encompasses various painful illnesses of the musculoskeletal system. Problems may be encountered in the joints, ligaments, tendons, bones or muscles or in other soft tissue structures. The illnesses underlying these problems can vary widely in nature. Rheumatism is thus an umbrella term for several illnesses.
The onset of most rheumatic illnesses occurs in adulthood. Some forms of rheumatism are however typical of children.
Joint problems are very frequently experienced by children. Approximately 5-10% of schoolchildren complain of pain in their joints at some point, without any illness being discovered as the cause of the symptoms. So-called 'growing pains', which mostly affect the knee joints, are mainly experienced by young children and can sometimes be quite severe. However, they disappear weeks, months or sometimes even years later and have no permanent consequences. Genuine joint diseases, on the other hand, are seen much more rarely in children than in adults. The signs of wear and degradation seen in older people are thus absent. Inflammatory illnesses of the joints and tendon inserts and painful illnesses of the musculoskeletal system predominantly affect children.
Which rheumatic illnesses can affect children?
There are two groups: the acute and the chronic form of arthritis. The key difference is that in the acute form, the joint structure remains intact, whereas with chronic inflammation, there is a danger of joint damage that can result in the joint being destroyed.
Acute rheumatic illnesses are more frequently seen than the chronic form. They are typically triggered by infections. Rheumatic illnesses are not direct joint infections ('septic arthritis') but are a reactive or post-infection joint inflammation arising two to three weeks after infection owing to an excessive reaction from the immune system. These infections can be viruses, e.g. the rubella virus, or bacteria, particularly streptococcus (rheumatic fever, post-streptococcal arthritis) but also Yersinia or salmonella, which trigger gastrointestinal infections. In the broader sense, this also includes Lyme's arthritis, which is transmitted by ticks and caused by borrelia (=a bacterium), although in terms of its onset this is between infectious and post-infectious arthritis (Lyme is the town in the USA where this joint disease was described for the first time). Acute rheumatic joint inflammations frequently last for a matter of days or a few weeks. Occasionally, however, they can last for several months or even 1-2 years and can flare up multiple times. In contrast to many other acute illnesses, acute rheumatic joint inflammations can remain present for extended periods of time and are therefore easily confused with chronic forms of the disease. The acute forms of rheumatism are approximately ten times more common than the chronic progressions.
Although chronic rheumatic joint inflammations can also sometimes be triggered by infections, they usually begin without any discernible external cause. Occasionally, the first signs of illness develop so subtly that in retrospect it is impossible to pinpoint the exact moment at which the condition began. It has been known for children to have the illness for weeks, months or even years without being aware of it.
The chronic inflammation process occurs slowly in most childhood progressions, so damage to joints does not occur until months or years after onset and can often be prevented if therapy is administered in good time.
In addition to the two groups of acute and chronic arthritis, numerous other rheumatic illnesses occur in children, such as collagenoses – inflammatory illnesses of connective tissues – or differences in appearance caused by inflammation of the blood vessels, known as vasculitis. These illnesses affect not only the joints; most of them affect the skin as well and it is not uncommon for muscles and internal organs to be affected. Soft tissue rheumatic illnesses, frequently involving considerable pain in the joints, muscles and tendon insertions, can also manifest when the patient is still a child. Further information on clinical pictures can be found here.
How does rheumatism occur?
Results from existing research have shown that several factors, both 'internal' (originating from the affected person him/herself) and 'external' (environment, viruses, bacteria) have to unite before a rheumatic illness is triggered. The current theory is that a predisposition to rheumatism is an inherited trait. This stems from the observation that rheumatism frequently runs in families. In addition, genetic traits such as HLA-B27 have been discovered that are present in increased levels in patients with certain forms of rheumatism. Predisposition explains only part of how rheumatism occurs, however. Many people are just as likely to contract the illness but never do so. There must therefore also be external factors that act as triggers. Infections with different bacteria or viruses are the typical triggers for acute rheumatic illnesses. A faulty reaction by the body's defences or immune system means that not only are the pathogens attacked, but an immune reaction also occurs in the joints, tendon insertions or internal organs that leads to inflammation. The body thus directs its defensive forces against its own tissue. These autoimmune processes are also involved in the development of chronic rheumatic illnesses. Infections can also act as triggers in this regard. Sometimes accidents or overwork can also contribute to rheumatism occurring. In addition, it has been observed on numerous occasions that situations of emotional stress contribute to the development of rheumatic illnesses. A great deal of care is needed when determining cause and effect, however. If the illness has broken out, most parents will try to find reasons for it, but these reasons are frequently incorrect. Chronic illness most often begins in the absence of any discernible external influences.
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