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mity are often so tragically disabling that early diagnosis, prompt
treatment and well directed after-care are vitally important.
It is only too clear that rheumatic diseases constitute a major
medical, social and economic problem for the nation. For example, general practitioners consider that 10% of all their work
is concerned with this group of diseases and official statistics show
that more than 27 million working days per year are lost as a
result of rheumatic disabilities.
Analysis of hospital returns indicate that the average duration
of stay of a patient in all their rheumatological departments is
30.8 days, the highest of any medical speciality. Days of certified
incapacity per person at risk from diseases of the musculoskeletal
system and connective tissue, as given in the latest annual
National Insurance figures, were 1.71 for males and 1.74 for
females representing 9.8% and 9.6% of their respective totals for
all causes.
According to Lawrence's epidemiological survey of rheumatic
disease, the Borough would present some 430 cases of ankylosing
spondylitis and approximately 2,150 rheumatoid arthritics. On a
similar basis there should be 25,000 symptomatic osteoarthritics
and a further possible 6,500 cases of rheumatoid arthritis.
However, "rheumatism" and "arthritis", terms familiar to and
lightly used by the layman, cover more than 150 various inflammatory and degenerative conditions of joints. For instance, in
rubella, an arthropathy closely resembling rheumatoid arthritis
may develop and which remits within 2 or 3 weeks. Again,
on occasions, arthritis can occur in mumps and smallpox but,
fundamentally, rheumatic diseases are considered to be of two
types; that in which the disease is essentially the result of inflammatory conditions such as rheumatoid arthritis and ankylosing
spondylitis and that where degeneration is the main ingredient as
exemplified in osteoarthritis and intervertebral disc disease.
Of all arthritis, rheumatoid, in its severe form, is the most
feared for, with its generalised systematic illness, it taxes the
emotional as well as the physical strength. Victims are aware
that their disease could be prolonged and, because recrudescence
may occur at any time in quiescent joints, they fear the future
perhaps even more than they resent the present. Family complications and threats to economic stability merely serve to
exacerbate the problem. Studies have shown that prognosis is
best in those whose onset is acute and who receive hospital treatment promptly.
The pathogenesis of rheumatoid arthritis and related diseases
remains obscure. Nevertheless, increasing attention given by