Pathology and the nine ages of rheumatism. Advances in knowledge of the connective tissue diseases

Contemporary societies, in many of which it is more apt to talk of nine rather than of seven Shakespearean ages, are prone to chronic, disabling disorders that are 'life-shortening' rather than 'life-threatening'. These conditions, triggered by environmental agents but set against a background of inherited susceptibility, were 'rheumatism'; they are now the systemic connective tissue diseases. Although the agents causing the most important of these abnormalities-rheumatoid arthritis (RA), osteoarthrosis (OA), and systemic lupus erythematosus (SLE)-are not yet known, there have been substantial advances in their molecular and cellular pathology, and in their genetics and pharmacodynamics. The present account, in which some of the most frequent connective tissue diseases are brought together by decade, draws attention to selected aspects of this new knowledge.