Connective tissue disorders and the vasculitides

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.

Sir William Osler 1898

The connective tissue disorders and the vasculitides are groups of diseases 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.

It is convenient to consider a working classification of joint pain (Table 28.1) 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 crystalopathy of the tendons around the shoulder joint. Vasculitis is, in fact, a condition common to the connective tissue disorders and to the socalled vasculitides.

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