Rheumatology

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Rheumatology

 

a branch of internal medicine that studies rheumatic diseases. These include such systemic diseases of connective tissue as rheumatic fever, systemic lupus erythematosus, systemic scleroderma, dermatomyositis, and periarteritis nodosa; rheumatoid arthritis and other forms of arthritis; osteoarthrosis; and such inflammations of extra-articular tissues as periarthritis, fibrositis, tendovaginitis, and bursitis. The problems of rheumatology are investigated by clinicians, morphologists, immunologists, biochemists, physiologists, radiologists, and other specialists.

Rheumatology is closely related to nephrology, cardiology, hematology, pulmonology, and other branches of internal medicine and clinical disciplines because systemic diseases of connective tissue may occur in the form of renal, cardiac, cerebral, and other syndromes. In addition, some syndromes studied by rheumatology are associated with blood diseases, tumors, and other pathological processes.

Rheumatic inflammation of the joints was described in ancient times by Hippocrates. In the second century A.D., Galen introduced the term “rheumatism” to designate various diseases of the musculoskeletal system. This generalized concept existed until the 19th century, although descriptions of individual rheumatic diseases appeared in the 17th and 18th centuries. For example, T. Sydenham distinguished rheumatic polyarthritis and chorea. In 1802, the English physician W. Heberden described nodules on fingers in arthrosis and distinguished arthrosis from gout.

In the 1830’s, the founders of modern studies on rheumatic diseases, the French physician J. B. Bouillaud and the Russian physician G. I. Sokol’skii, independently discovered a connection between polyarthritis and heart disease. Rheumatic diseases identified in subsequent years included rheumatoid arthritis (by the English physician A. B. Garrod and the French physician J. M. Charcot), systemic lupus erythematosus (by the Hungarian dermatologist M. K. Kaposi), and scleroderma (by the French physician E. Gintrac). In 1801, M.-F.-X. Bichat introduced the concept of connective tissue with its own specific reactions. R. Virchow and K. von Rokitansky described the pathomorphism of several rheumatic diseases. In 1880, the German pathologist E. Neumann described the fibrinoid changes characteristic of connective-tissue pathology. These advances constituted an important theoretical foundation for the development of rheumatology in the 19th century.

Between 1874 and 1885, S. P. Botkin discovered a relationship between rheumatic fever and infection and described nephritis and rheumatic pleurisy, thereby emphasizing the systemic nature of rheumatic fever. In 1899, G. A. Zakhar’in demonstrated rheumatic fever’s nosological independence and the efficacy of treatment with salicylates. G. M. Malkov noted in 1900 that streptococci and inflammation of the pharyngeal tonsils play a part in the development of rheumatic fever. In 1886, M. A. Chistiakov distinguished three forms of scleroderma: circumscribed, systemic, and mixed.

Streptococcal involvement in the etiology of rheumatic fever was confirmed in the 20th century by the American scientist A. F. Coburn, N. D. Strazhesko, and G. F. Lang. In 1926, A. A. Bogomolets advanced the theory that connective tissue as a physiological system performs specifically defensive functions. The theory of the allergic genesis of rheumatic fever and rheumatic diseases was based on V. T. Talalaev’s studies (1929) demonstrating the phasic nature of morphological changes in the heart’s connective tissue, as well as on the experiments of the German scientist F. Klinge (1933). In the USSR, this theory was developed by N. D. Strazhesko and M. P. Konchalovskii.

In 1942, the American scientist P. Klemperer studied collagen diseases and the role of weakened immunity in their genesis. A. D. Speranskii’s work on the neurotrophic mechanism of the pathological process (1935) emphasized the role of the nervous system in the pathogenesis and sanogenesis of a number of diseases, including rheumatic fever. A. A. Kisel’ developed criteria for diagnosing rheumatic fever in children. In 1950, the American rheumatologist P. S. Hench was the first to use corticosteroids in the treatment of rheumatic diseases.

Advances in rheumatology during the second half of the 20th century have included the successful use of immunological and biochemical methods, which have improved the diagnosis of rheumatic diseases and clarified the mechanisms of their phasic development. Biopsies of synovial membranes, kidneys, and skin facilitate the study of pathological changes in organs during life, and radioisotopic diagnosis of the systemic process has been developed. Virological methods of investigation are used, and research is in progress on nucleic acid metabolism, impairment of humoral and cellular immunity, and immunogenetic deviations. The prognosis of many rheumatic diseases has been improved by immunosuppressive therapy with corticosteroids and cytostatics. This therapy is combined with the phasic principle of therapy in hospitals and polyclinics to ensure long-term use of these drugs. These advances are associated with the names of M. Ziff, L. Shulman, and J. Decker (USA), E. G. By-waters, A. Dickson, and L. E. Glinn (Great Britain), F. Delbarre and S. de Sèze (France), B. Olhagen (Sweden), V. Laine (Finland), Š. Sitaj and A. Šusta (Czechoslovakia), V. Tsonchev and T. Pilosof (Bulgaria), K. Seidel and W. Otto (GDR), J. Pangowska-Wawryńska (Poland), I. Stoia (Rumania), and Z. Berović (Yugoslavia). In the USSR, the work of A. I. Nesterov, E. M. Tareev, and A. I. Strukov on rheumatic diseases was awarded the Lenin Prize (1974).

The advances made in rheumatology caused it to become an independent branch of internal medicine in the 1960’s. Specialized institutes of rheumatology have been established in many countries. These include the Institute of Rheumatic Diseases of the Academy of Medical Sciences of the USSR in Moscow, the Institute of Rheumatic Diseases in Prague, institutes of rheumatology in Warsaw and Belgrade, and the British Association for Rheumatology and Rehabilitation in London. In 1974, the USSR’s network of cardiorheumatological facilities included almost 3,000 consulting rooms in polyclinics, 128 centers, and 11 major dispensaries. Personnel are trained chiefly at the Institute of Rheumatic Diseases and in courses at institutes of postgraduate medicine.

The All-Union Antirheumatic Committee was organized in 1928 by M. P. Konchalovskii and G. M. Danishevskii. In that year it joined the International League Against Rheumatism, founded in 1927. In 1964 the committee became the All-Union Society of Rheumatologists. International congresses of rheumatologists have been held every four years since 1926; the 13th congress was held in Kyoto in 1973.

The journal Rheumatology has been published in Basel since 1967 by the International League Against Rheumatism. The journal Voprosy revmatizma (Problems of Rheumatic Diseases) has been published regularly in the USSR since 1961, with the first issues appearing in 1934.

REFERENCES

Vel’iaminov, N. A. Uchenie o bolezniakh sustavov s klinicheskoi tochki zreniia. Leningrad, 1924.
Bogomolets, A. A. Vvedenie v uchenie o konstitutsiiakh i diatezakh. Moscow, 1926.
Strukov, A. I., and A. G. Beglarian. Patologicheskaia anatomiia i patogenez kollagenovykh boleznei. Moscow, 1963.
Tareev, E. M. Kollagenozy. Moscow, 1965.
Nesterov, A. I., and Ia. A. Sigidin. Klinika kollagenovykh boleznei, 2nd ed. Moscow, 1966.
Astapenko, M. G. and E. G. Pikhlak. Bolezni sustavov. Moscow, 1966.
Gritsman, N. N. Porazhenie serdtsa pri kollagenovykh zabolevaniiakh. Moscow, 1971.

V. A. NASONOVA

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