Classification and Health Impact of the Rheumatic Diseases

When you are frustrated with me because of things I cannot do, just think how frustrated I must be because I am not able.

–One or more of the 91 million people in the United States with a musculoskeletal disorder

Key Points

Approximately 33% of the US population has arthritis and/or back pain.
One out of every five office visits to a primary care provider and 10% of all surgeries are for a musculoskeletal problem.
Arthritis/back pain is the leading cause of chronic disability, second leading cause of acute disability, and most common reason for social security disability payments.

1 What is rheumatology?

A medical science devoted to the study of rheumatic and musculoskeletal disorders (RMDs). RMDs are diverse and include autoimmune disorders, inflammatory arthritides, noninflammatory arthritides, diffuse and local soft tissue disorders, injuries, and osteoporosis.

2 What are the roots of rheumatology?

First century AD—The term “rheuma” first appears in the literature. Rheuma refers to “a substance that flows” and probably was derived from phlegm, an ancient primary humor, which was believed to originate from the brain and flow to various parts of the body causing ailments.
1642—The word rheumatism is introduced into the literature by the French physician Dr. G. Baillou who emphasized that arthritis could be a systemic disorder.
1928—The American Committee for the Control of Rheumatism is established in the United States of America by Dr. R. Pemberton. It was renamed as the American Association for the Study and Control of Rheumatic Disease (1934), then American Rheumatism Association (ARA; 1937), and finally American College of Rheumatology (1988).
1940s—The terms rheumatology and rheumatologist are first coined by Drs. Hollander and Comroe, respectively.

3 How many rheumatic/musculoskeletal disorders are there?

There are over 200 rheumatic/musculoskeletal disorders ( https://www.uems.eu/areas-of-expertise/postgraduate-training ).

4 How have these rheumatic/musculoskeletal disorders been classified over the years?

1904—Dr. Goldthwaite, an orthopedic surgeon, makes the first attempt to classify the arthritides in to five categories: gout, infectious arthritis, hypertrophic arthritis (probably osteoarthritis), atrophic arthritis (probably rheumatoid arthritis), and chronic villous arthritis (probably traumatic arthritis).
1964—ARA classification.
1983—The ARA classification is revised based on the ninth edition of the International Classification of Disease (ICD 9).
2015—ICD 10 Diagnosis Codes are published. Chapter 13 (M00-M99) contains 6929 diagnosis codes related to diseases of the musculoskeletal system and connective tissue. Notably, there are other ICD 10 chapters that include diagnostic codes for other arthritides (e.g. psoriatic arthritis [L40.5], others]. ICD 11 is being developed.

5 The ICD 10 diagnostic codes and classification systems are overwhelming. Is there a simpler outline to remember?

Most of the rheumatic diseases can be grouped into 10 major categories:

1.
Systemic connective tissue diseases.
2.
Vasculitides and related disorders.
3.
Seronegative spondyloarthropathies.
4.
Arthritis associated with infectious agents.
5.
Rheumatic disorders associated with metabolic, endocrine, and hematologic disease.
6.
Bone and cartilage disorders.
7.
Hereditary, congenital, and inborn errors of metabolism associated with rheumatic syndromes.
8.
Nonarticular and regional musculoskeletal disorders.
9.
Neoplasms and tumor-like lesions.
10.
Miscellaneous rheumatic disorders.

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