Soft Tissue Rheumatism
Rheumatic diseases do not only affect the joints causing arthritis but can also affect tissues and structures around a joint, such as the tendons, ligaments, bursae and muscles. The inflammation of these tissues or structures causes bursitis (inflammation of small sac found between the bone and muscle-tendon) and tendinitis (inflammation of thick fibrous cords that attach muscles to bone) and are associated with pain and swelling.
Because these structures are near joints, pain in these areas may be mistaken for arthritis. The difference is that arthritis means inflammation in the joint itself, not in the structures around the joint. Soft-tissue rheumatic syndromes may affect the areas around the shoulders, elbows, wrists, fingers, hips, back, knees, ankles and feet.
Pain is the main symptom of these conditions. Because the structures affected are located near the joint, moving the joint can be extremely painful and may be difficult. The pain is more prominent at night. Some conditions may cause redness, warmth or swelling in the affected area. Most of these conditions occur suddenly, may last for days, weeks or longer, and then go away. They can, however, occur again in the same place.
Who Gets Soft Tissue Rheumatism?
Bursitis and tendinitis affect men and women of all age groups.
The Diagnosis of Soft Tissue Rheumatism
Diagnosis is based on medical history and physical examination. There are no blood test or Xray abnormalities. MRI and ultrasound may be useful in the detection of bursitis and tendonitis. Aspiration of a swollen bursa may be performed to exclude infection or gout. Blood tests are generally not necessary to diagnose tendonitis or bursitis. Underlying diseases that may present with symptoms of soft tissue rheumatism like rheumatoid arthritis and diabetes must be excluded.
Non-steroidal anti-inflammatory medications are needed to reduce inflammation and pain in some patients. Corticosteroid injections into the affected area are frequently helpful if symptoms persist.
Treatment focuses on reducing pain and inflammation, as well as on preserving mobility and preventing disability and recurrence.
The treatment for many soft tissue conditions is similar but may be modified for each particular condition. These include a combination of rest, splints, heat and cold application, medications, physical therapy or occupational therapy.
Because many soft tissue conditions are caused by overuse, the best treatment is prevention. It is important to avoid or modify the activities that cause the problem. Underlying conditions such as leg length differences, improper posture or poor technique in sports or work must be corrected.
What is the outlook?
Soft tissue syndromes like tendinitis and bursitis are very common in people who are otherwise healthy. Many of the syndromes go away on their own over time. Be aware of potential overuse or injury in your daily activities and change your lifestyle to prevent problems. Otherwise, problems may persist or occur repeatedly.