Rheumatology

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Musculoskeletal system

The musculoskeletal system ensures that the body remains in a defined form but still can move in a purposeful manner.  It consists of the skeleton, muscles, tendons and ligaments.

The skeleton is comprised of over 200 differently shaped bones (tubular bones and flat bones). The contraction and relaxation of the muscles determines which movements the body makes. To convert the force developed by the muscles into a movement of the bones, both must be connected with one another. This connection is produced by the tendons, which are partially protected by the tendon sheaths from friction. The ligaments produce the connections between bones. They help to stabilize the joint. Bursae are located at places where muscles slide directly over the bones and protect muscles and bones from pressure and friction.

Rheumatism is the generic term for diseases that occur in the musculoskeletal system. They are usually associated with pain and frequently with restrictions of movement. The rheumatic diseases are subdivided into the following main group

  • Inflammatory rheumatic diseases
    Inflammatory joint diseases can be triggered, for example, by viruses, bacteria, metabolic byproducts or antibodies. A frequent form is the so-called rheumatoid arthritis (chronic polyarthritis/joint inflammation). Typical symptoms are morning pains in the joints of the fingers (morning stiffness).
  • Degenerative joint and spinal column diseases
    Underlying the degenerative joint diseases is wear and tear on the joint cartilage. Unlike the inflammatory diseases, the degenerative joint diseases do not involve systemic diseases. One refers here to a joint arthrosis and to a degenerative change in the spinal column.
  • Soft tissue rheumatism
    Soft tissue rheumatism is a generic term for various rheumatic diseases of “soft” structures, e.g. the subcutaneous fatty tissue, the capsule-ligament apparatus, the tendons, the tendon sheaths, the bursae or the musculature.
  • Metabolic diseases with rheumatic ailments
    Gout, for example, represents a known metabolic disease that is expressed through rheumatic ailments. The uric acid elevation in the blood leads to joint inflammation. The joint at the base of the big toe is frequently affected.
  • Backache and lower back pain
    Acute or chronic pain occurring intermittently is called lumbago (pain in the lumbar vertebrae). If the pain radiates into the leg as well, one refers to it as sciatica. A suddenly occurring, stabbing pain in the lower back triggered by specific movements is also referred to as “lumbago”.

Sports injuries also affect the musculoskeletal system. These result from too much stress placed on the musculoskeletal system or the direct effect of force or blunt injuries (blow or impact). They include strains, compression injuries, contusions or bruising, which also can lead to inflammation, swelling and pain.

Physical therapy
Massages and physiotherapy are methods of great significance for the treatment of diseases of the musculoskeletal system.

Medicinal therapy
There are a number of specific medications for the treatment of rheumatic diseases and sports injuries.

The non-steroidal antirheumatics (NSAR/NSAID) have proven most effective in practice for the symptomatic treatment of the associated inflammation, pain and swelling. Unfortunately these substances are only poorly tolerated by many patients during long-term internal use (oral intake) due to their relatively frequent side-effects (predominantly in the gastrointestinal tract).

External (topical) therapy represents a well-tolerated and effective alternative to the internal use of these active ingredients. The same active ingredients (e.g. salicylic acid derivatives, Dicolfenac or Indometacin) are available as an ointment/ cream, patch or spray and can be applied directly to the affected areas. The active ingredient penetrates the skin and acts locally without the whole body being involved.

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