Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android


In its more aggravated forms diffuse scleroderma is one of the most terrible of all human ills. Like Tithonus to ‘wither slowly’ and like him to be ‘beaten down and marred and wasted’, until one is literally a mummy, encased in an ever shrinking, slow contracting skin of steel, is a fate not pictured in any tragedy.


The inflammatory connective tissue diseases and the related vasculitides are groups of disorders that are difficult to classify because their causation is generally unknown. They all cause joint and soft tissue inflammation and multiple other possible manifestations that create diagnostic difficulties.


These are disorders in which the body’s immune system damages its own specific organs or systems. The connective tissue diseases are a classic subgroup of autoimmune disease. Rheumatoid arthritis is the most common autoimmune disease. Organ-specific autoimmune diseases include diabetes type 1, Hashimoto thyroiditis, pernicious anaemia, IgA glomerulonephritis, Graves disease, autoimmune hepatitis and myasthenia gravis.

It is convenient to consider a working classification of joint pain (see TABLE 21.1) that includes apparent joint pain (arthralgia), as some of the inflammatory disorders cause problems in the soft tissues around joints (e.g. giant cell arteritis and hydroxyapatite crystallopathy of the tendons around the shoulder joint).

Table 21.1A classification of rheumatological pain

Vasculitis is, in fact, a condition common to the connective tissue disorders and to the so-called vasculitides (see TABLE 21.2).

Table 21.2List of connective tissue disorders and systemic vasculitides

A major concern to all is that the diagnosis of these conditions is elusive and often ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.