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Understanding rheumatic and musculoskeletal diseases (RMDs) is an understandably tall order for the lay public, what with the huge number of conditions and the complex—and often little understood—processes involved.
Now, a working group of the European League Against Rheumatism (EULAR) and the ACR has set out to try to correct this problem with a definition of RMDs in easy-to-understand language. The definition is part of a paper, recently published in Arthritis & Rheumatology and simultaneously in the Annals of Rheumatic Diseases, that also provides a clear and concise synopsis of several important points regarding RMDs that the group feels are important for the public and policymakers to grasp: the diversity of RMDs, their varied pathophysiological pathways, the major burden they pose to individuals and society, and workforce issues regarding care of patients with RMDs.1,2
“In general, it is difficult to understand what rheumatic diseases are,” says Desiree van der Heijde, MD, PhD, the paper’s lead author and professor of rheumatology at Leiden University Medical Center in The Netherlands. “It is a heterogeneous group of diseases with different causes, varying outcomes and affecting people at all ages. It is important to understand what rheumatic diseases are [because] they are prevalent and lead to a major burden for both patients and society.”
The group included leaders from EULAR and the ACR, with practicing and academic rheumatologists, a patient representative and a rheumatology health professional.
“The goal of this effort was to create a succinct general statement describing RMDs in adults and children in language that can be used in conversations with the general population with and without RMDs; media; healthcare providers; policymakers at local, national and international levels; health insurance companies; charities; employers; and other stakeholders,” the group wrote.
The group crafted this definition:
Rheumatic and musculoskeletal diseases (RMDs) are a diverse group of diseases that commonly affect the joints, but can affect any organ of the body. There are more than 200 different RMDs, affecting both children and adults. They are usually caused by problems of the immune system, inflammation, infections, or gradual deterioration of joints, muscles, and bones. Many of these diseases are long term and worsen over time. They are typically painful and limit function. In severe cases, RMDs can result in significant disability, having a major impact on both quality of life and life expectancy.
Dr. van der Heijde says that although the language and information in the paper will be helpful for communicating with a wide array of people, the most urgent need for improvement is “most likely” in communicating with policymakers.
Here are other important communication points regarding RMDs, according to the group:
Diversity
Data suggest more than 200 RMDs exist—some very common and some rare. Symptomatic osteoarthritis affects 15% of people worldwide, according to a conservative United Nations estimate, and by 2050, 130 million will be affected, with 40 million severely disabled by it. Rheumatoid arthritis affects about one in 100 people around the world, with women twice as likely to be diagnosed. Other RMDs, such as systemic lupus erythematosus (SLE) are less common, but still cause significant morbidity and mortality.
In the U.S., the overall lifetime risk for developing an inflammatory RMD—including RA, gout and lupus—has been calculated as one in 12 for women and one in 20 for men.3
RMDs frequently affect joints, but also affect internal organs and the skin, and many of them occur in children, even though RMDs are commonly thought of as a disease of aging.
Pathophysiologic Pathways Vary
Many RMDs come about because of dysregulation and activation of immune mechanisms, leading to inflammation and tissue damage. But others stem from acute or chronic damage to musculoskeletal structures, such as bone and cartilage.
According to Dr. van der Heijde and her colleagues, other diseases with a primary cause that is metabolic, endocrine, neurologic or infectious can bring on secondary dysfunction of musculoskeletal tissue—for example, changes in tendon structure and other soft tissues caused by prolonged hyperglycemia in diabetes.
A Major Burden
Many RMDs start in childhood or early adulthood, so Dr. van der Heijde and her colleagues wrote, “patients suffer with their disease for decades. … Moreover, most RMDs worsen over time with increasing impact on both the physical and psychological conditions of the patient.”
A 17-country collaboration in Europe found musculoskeletal problems are the most common cause of severe long-term pain and disability in the European Union, with significant healthcare costs, and are a major cause of loss of work productivity.4
A recent U.S. study found that arthritis affects about 37% of the adult population—about 29% of men and 55% of women between 18 and 65.5 As the population ages, Dr. van der Heijde and her colleagues note, the prevalence of RMDs is only increasing.
In a report on global burden of disease, the World Health Organization listed osteoarthritis as the eighth-leading cause of impact on disability-adjusted life years (DALY), essentially the loss of one year of healthy life.6
For many RMDs, Dr. van der Heijde and her colleagues wrote, “it is important to recognize the disease early to have the best option to start treatment early and prevent or limit long-term consequences.”
‘It is important to understand what rheumatic diseases are [because] they are prevalent & lead to a major burden for both patients & society.’ —Desiree van der Heijde, MD, PhD
Workforce Issues
Dr. van der Heijde and her colleagues note that a range of practitioners—including general physicians, community pharmacists and medical specialists—manage musculoskeletal problems. Rheumatologists are the specialists that possess the broadest, most specific training for the diagnosis and management of RMDs.
The number of practicing rheumatologists varies greatly by region in the U.S., they wrote. There can be more than two rheumatologists per 100,000 people in highly populated areas, but in more rural regions, it can drop to as low as 1.5 rheumatologists per 1 million people. The numbers are falling, and shortages are expected to worsen, to 0.5 to 1.0 rheumatologist per 100,000 people in a large majority of the U.S. expected by 2025.
They say they hope the guidance serves a dual purpose: helping communicate the need for more research, given that effective treatments are unavailable for so many disorders, and helping patients have ready access to treatments made available with recent advances.
“We hope the description of RMDs provided in this report will enable improved communication about and advocacy for these conditions and the patients who suffer from them,” wrote Dr. van der Heijde and her colleagues.
Thomas R. Collins is a freelance writer living in South Florida.
References
- van der Heijde D, Daikh DI, Betterdidge N, et al. Common language description of the term rheumatic and musculoskeletal diseases (RMDs) for use in communication with the lay public, healthcare providers, and other stakeholders endorsed by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR). Arthritis Rheumatol. 2018 Jun;70(6):826–831.
- van der Heijde D, Daikh DI, Betteridge N, et al. Common language description of the term rheumatic and musculoskeletal diseases (RMDs) for use in communication with the lay public, healthcare providers and other stakeholders endorsed by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR). Ann Rheum Dis. 2018 Jun;77(6):829–832.
- Crowson CS, Matteson EL, Myasoedova E, et al. The lifetime risk of adult-onset rheumatoid arthritis and other inflammatory autoimmune rheumatic diseases. Arthritis Rheum. 2011 Mar;63(3):633–639.
- Musculoskeletal health in Europe report v5.0. EUMUSC.net. (n.d.).
- Jafarzadeh SR, Felson DT. Updated estimates suggest a much higher prevalence of arthritis in United States adults than previous ones. Arthritis Rheumatol. 2018 Feb;70(2):185–192.
- Mathers C, Stevens G, Mascarenhas M. Global health risks: Mortality and burden of disease attributable to selected major risks. Geneva: World Health Organization/WHO Press; 2009.