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What is Rheumatoid Arthritis?

by Josephine Andrews
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Rheumatoid arthritis (chronic polyarthritis, primary chronic polyarthritis) is an inflammatory joint disease that progresses in phases. Anyone can be affected. Patients suffer from swollen, painful and deformed joints, especially in the fingers and hands. With consistent drug therapy, complications of the disease can be prevented in many cases. Read everything you need to know about rheumatoid arthritis here.

quick overview

  • What is Rheumatoid Arthritis (RA)? A non-contagious, chronic and relapsing inflammation throughout the body.
  • Symptoms : initially non-specific (e.g. exhaustion, slight fever, feeling of heaviness in the muscles), followed by swelling and tearing pains first in small joints (hands, feet), later also in larger ones (e.g. knees), morning stiffness, restricted mobility
  • Causes : RA is an autoimmune disease – the immune system attacks the body’s own tissues. The cause is unclear; hereditary factors and risk factors such as smoking, obesity and infections are discussed.
  • Treatment : Medication, invasive therapy (e.g. artificial joint), physiotherapy (such as massage, thermotherapy, electrotherapy ), ergotherapy and rehabilitation, healthy nutrition, if necessary psychotherapy
  • Prognosis : RA is not curable. With the right, lifelong therapy, however, a rest of the disease (remission) can be achieved. Left untreated, on the other hand, cartilage, bones and connective tissue are increasingly destroyed.

Rheumatoid arthritis: definition

The term “rheumatoid arthritis” means “joint inflammation that belongs to the rheumatic group of diseases”. The disease used to be called (primary) chronic polyarthritis (poly = many, arthritis = joint inflammation).

Rheumatoid arthritis is a systemic (i.e. affecting the whole body) inflammation. It is long-lasting (chronic) and occurs in episodes in many patients. Rheumatic symptoms mainly appear in the small joints of the hands and feet.

Rheumatoid arthritis: who is affected?

Rheumatoid arthritis is the most common inflammatory joint disease in the world. Around 550,000 people are affected in Germany. About two thirds of the patients are female. Although rheumatoid arthritis can occur at any age, most patients are between the ages of 50 and 70 when the disease develops.

The variant “juvenile idiopathic arthritis” (see below) occurs in about 0.1 percent of those under the age of 18, i.e. in about 13,000 children and adolescents. This form of rheumatoid arthritis is one of the most common chronic diseases in minors.

Ten percent of all RA patients have a first-degree relative (such as a parent) who also has rheumatoid arthritis. The probability that identical twins will both get the disease is around 15 to 20 percent.

Rheumatoid arthritis: special forms

There are some special forms of rheumatoid arthritis:

Caplan syndrome: Rheumatoid arthritis in combination with quartz dust lung ( silicosis ). Doctors also speak of silicoarthritis here. Caplan syndrome typically occurs in coal mine workers.

Felty syndrome: Felty syndrome is a severe form of rheumatoid arthritis that primarily affects men. In addition to the joint inflammation, the spleen is swollen and the number of white blood cells ( leukocytes ) and blood platelets (thrombocytes) is reduced.

Late onset rheumatoid arthritis (LORA): Late onset rheumatoid arthritis is a common disease. It only breaks out after the age of 60 and often only affects one or a few large joints. In addition, there are often general symptoms such as fever, reduced performance, weight loss and muscle wasting.

Juvenile Idiopathic Arthritis: Also called Juvenile Rheumatoid Arthritis. The addition “juvenile” shows that this form of rheumatoid arthritis affects young people (children, adolescents). The cause of the disease is usually unclear. It is assumed that a bacterial infection, some of which goes undetected, strongly activates the immune system in those affected. As a result, the body’s own tissue is destroyed (autoimmune reaction).

Systemic arthritis: It is a subtype of juvenile idiopathic arthritis. In addition to joint pain, fever attacks occur here. A patchy skin rash and swelling of the lymph nodes often also develop. The disease also affects other organ systems such as the liver or spleen. This rare disease also occurs in adults, and is then referred to as Still’s disease.

Rheumatoid arthritis: symptoms

Rheumatoid arthritis begins with non-specific symptoms such as

  • exhaustion
  • mild fever
  • feeling of heaviness in the muscles
  • fatigue
  • loss of appetite
  • depression

Many patients then first think of a flu-like infection or a sports injury. Typical rheumatoid arthritis symptoms only appear as the disease progresses. These include swelling and aching, tearing (rheumatic) pain in the small joints of the fingers and feet. As a rule, both hands or feet are affected at the same time ( symmetrical infestation ). A strong handshake in particular causes severe pain in the patient (Gaenslen’s sign).

In addition, the joints feel stiff in the morning. This morning stiffness lasts more than half an hour and is associated with restricted mobility and weakness . For example, those affected suddenly find it difficult to hold a coffee cup.

Rheumatoid arthritis of the hand can also lead to circulatory disorders in individual fingers .

Larger joints towards the center of the body can also be affected later on , for example the elbow, shoulder and knee joints or the upper cervical spine . On the other hand, rheumatoid arthritis is usually not noticeable in the finger joints (distal interphalangeal joints, DIPs) and in the thoracic and lumbar spine .

If you have joint swelling and pain, go to the doctor as soon as possible! If rheumatoid arthritis is recognized in the first six months and treated immediately, the joints are most likely to be protected from destruction.

More Rheumatoid Arthritis Symptoms

Rheumatoid arthritis can also attack other structures in addition to the joints. This can result in:

  • Carpal tunnel syndrome : narrowing of the middle arm nerve (medial nerve) at the wrist due to thickened, inflamed tendon sheaths
  • Sulcus ulnaris syndrome: Irritation of the ulnar nerve (nervus ulnaris) at the elbow
  • Baker’s cyst: Fluid buildup in the back of the knee that can interfere with bending
  • Rheumatoid nodules: nodular structures that form in the subcutaneous fatty tissue along the tendons or at pressure points
  • Sicca Syndrome (Secondary Sjögren’s Syndrome): Dysfunction of the salivary and lacrimal glands

Rheumatoid arthritis: organ manifestations

Rheumatoid arthritis can also affect the internal organs. Possible consequences are:

  • heart valve changes
  • Inflammation of the lungs (pleurisy)
  • Connective tissue remodeling of the liver (liver fibrosis)
  • Inflammation of the kidneys (glomerulonephritis)

Rheumatoid arthritis: causes and risk factors

The exact cause of rheumatoid arthritis is still unknown. However, there are different theories about the development of the disease.

Firstly, genetic factors seem to have an influence. This is supported by the fact that rheumatoid arthritis often runs in families.

In addition, many patients have similarities in the so-called HLA genes. HLA stands for “Human Leukocyte Antigen”. The HLA proteins mark cells as endogenous or foreign. In this way, the immune system knows which cells (foreign cells) should be attacked and which not (body cells). However, certain changes in the HLA genes can mean that this distinction no longer works and the immune system attacks endogenous structures (autoimmune reaction). Experts suspect that this is how rheumatoid arthritis can develop.

Studies have shown that around 70 percent of rheumatoid arthritis patients carry the HLA gene DR4/DRB1. In the healthy population, only about 25 percent of people have this gene variant.

Another possible cause of rheumatoid arthritis are environmental influences in the sense of infections and allergies . Pathogens such as herpes or rubella viruses may be the cause of the disease. If other risk factors are present, smoking and obesity can also contribute to the onset of the disease.

Rheumatoid arthritis: Gradual joint destruction

Joints are surrounded by a joint capsule. The inner layer of the joint capsule is covered with the synovial membrane (also known as the synovial membrane). This synovial lining produces the synovial fluid to lubricate the joint.

The immune system of people with rheumatoid arthritis forms antibodies against their own joint mucosa ( autoantibodies ). It then becomes chronically inflamed and thickens. Now other inflammatory substances are released. These mediators (e.g. TNF-α or interleukin-1) cause the inflammation to flare up again. They ensure that further immune cells migrate and a so-called pannus develops through an increase in connective tissue cells. It overgrows and destroys articular cartilage and can also grow into underlying bone.

In addition to the inflammation of the synovial membrane, joint inflammation (arthritis), bursitis (bursitis) and tendovaginitis (tendonitis) gradually develop. Ultimately, there are malpositions and so-called ankylosis (stiffening of the joints).

Rheumatoid arthritis: treatment

The motto “hit hard and early” applies to rheumatoid arthritis therapy. In this way, the inflammation can be suppressed in many cases and the impending destruction of the joint can be prevented or at least delayed for a long time. Treatment should be started within the first three months after the onset of the first symptoms. Then it is most effective.

There are various medications used to treat rheumatoid arthritis. In addition, supportive measures such as physiotherapy, heat therapy, relaxation therapy or alternative healing methods are also available. However, the need for drug therapy is undisputed.

Careful therapy planning

Rheumatoid arthritis progresses individually in each patient. Your doctor will therefore tailor the therapy to your needs as best he can. However, this is only possible if you and your doctor speak openly with each other and you make the therapy decisions together. The following questions could be important to you and should therefore be discussed with your rheumatologist:

  • What result can be expected from the treatment?
  • What side effects and complications can occur?
  • How long is the treatment expected to last?
  • Can I go about my normal lifestyle during treatment?
  • Are the medications compatible with the medications I am already taking (e.g. for high blood pressure, etc.)?

If you don’t understand something when you talk to your doctor, ask. A few days to think about it or a second opinion can also be useful if you are unsure. Rheumatoid arthritis therapy is a comprehensive and long-term measure that should be optimally planned.

Six weeks after the start of treatment, the tolerability and correct dosage of your medication should be checked in a first check -up appointment. Another three months later, disease activity should have improved by half. After six months, thanks to the medication, an almost complete freedom from inflammation and symptoms (remission) should be achieved. If this is not the case for you, your rheumatologist should adjust the therapy.

Rheumatoid arthritis: therapy with drugs

There are several medicines for rheumatoid arthritis. A distinction is made between so-called basic therapeutics (“disease-modifying antirheumatic drugs”, DMARD), glucocorticoids and non-steroidal anti-inflammatory drugs (NSAIDs):

  • DMARDs are disease-modifying drugs – they modulate the excessive immune response and can thus slow down or even stop the progression of the disease. The symptoms then recede and the joints are protected from further destruction as far as possible.
  • Glucocorticoids (“cortisone”) are anti-inflammatory hormones and are also naturally formed in the adrenal cortex . Administered as medication for rheumatoid arthritis, they are particularly effective and can help against joint damage caused by the disease.
  • NSAIDs (e.g. diclofenac, ibuprofen , naproxen , indomethacin) relieve pain in an acute attack and are sometimes also anti-inflammatory.

start of therapy

At the beginning of the disease, the most important representative of the conventional synthetic DMARD (csDMARD) is given: methotrexate (MTX). This active ingredient has been the most intensively studied to date.

Methotrexate must not be given to some patients – due to concomitant diseases, drug interactions or intolerance. Then the therapy of the rheumatoid arthritis can also be started with the active ingredients leflunomide or sulfasalazine . These substances also belong to the csDMARDs and are similarly effective as MTX.

Since it takes several weeks for the csDMARDs to develop their full effect, the doctor will also prescribe anti-inflammatory glucocorticoids (cortisone) at the beginning of the therapy. Your doctor can also inject the glucocorticoids directly into particularly severely affected joints.

Due to their severe side effects, however, glucocorticoids are not suitable as long-term basic therapy. Your rheumatologist therefore lowers the starting dose (10 to 30 mg prednisolone per day) significantly within eight weeks. Ideally, after three to six months you can do without glucocorticoids altogether.

Tip: Take cortisone tablets early in the morning. At this time, the body itself also produces the anti-inflammatory hormone. By taking it in the morning, you follow your body’s natural production rhythm.

Initially, you can suppress pain and morning stiffness with NSAIDs . But even these drugs are not suitable for long-term use due to their side effects. Therefore, if you respond well to DMARD treatment, you can stop taking NSAIDs.

Further therapy

If no effect can be seen twelve weeks after the start of treatment, you must decide on a new treatment strategy together with your doctor. If your rheumatoid arthritis is mild and prospects for control are good, other conventional DMARDs are used with MTX—either the triple combination of sulfasalazine and hydroxychloroquine (antimalarial) or the dual combination of leflunomide.

If the (adapted) drug therapy has not successfully curbed the rheumatoid arthritis even after six months, you will receive biological DMARDs – also called biologica (biologicals) – or targeted synthetic DMARDs (“targeted synthetic Disease Modifying Anti-Rheumatic Drug”, abbreviated tsDMARD ). These are combined with MTX if possible. You will also receive such medication if your illness is taking a more severe course and there is still no sufficient improvement after three months or the treatment goal has not yet been reached after six months.

>>>Biologicals are biotechnologically produced proteins that intervene in the body’s immunological processes. They intercept inflammatory messenger substances in the blood. They include:

  • TNF-α inhibitors (adalimumab, etanercept, infliximab , certolizumab, golimumab)
  • T cell activation inhibitors (Abatacept)
  • Interleukin-6 receptor antibodies (tocilizumab, sarilumab)
  • B-cell antibodies (rituximab)
  • Interleukin-1 competitor (anakinra)

If the patent protection for one of these original biologics has expired, similar biotechnologically manufactured drugs (so-called biosimilars ) can also be given. According to the medical guidelines for rheumatoid arthritis, these can be used in the same way as the original biologicals.

>>>Targeted synthetic DMARDs are the newest subset of staple drugs in rheumatoid arthritis. In contrast to biologics, they are not produced biotechnologically, but synthetically like conventional DMARDs.

The active ingredients specifically inhibit a specific molecule within the cells and thereby interrupt a pro-inflammatory signaling pathway that is jointly responsible for the development of rheumatoid arthritis. From this group of active ingredients, the Janus kinase (JAK) inhibitors baricitinib, tofacitinib and upadacitinib have been approved for the treatment of rheumatoid arthritis.

Which active ingredients help best varies from patient to patient. Once the right medication has been found, the dose is gradually reduced once the flare-up has subsided. The aim is to determine the so-called maintenance dose – the dose that is high enough to keep the rheumatoid arthritis in check, but at the same time so low that the side effects are still acceptable.

therapy control

From the time of diagnosis, your rheumatoid arthritis should be examined and documented by your rheumatologist every three months with regard to disease activity and course. For this, the doctor uses various scoring systems such as:

  • Disease Activity Score of 28 Joints (DAS28)
  • Clinical Disease Activity Index (CDAI)
  • Simplified Disease Activity Index (SDAI)

With the help of these systems, the number of painful and swollen joints, your condition and, if applicable, your inflammation values ​​can be used to assess how well you are responding to the therapy or whether it might need to be adjusted.

Rheumatoid arthritis: side effects of the drugs

All the active ingredients mentioned can have side effects. These depend on the dose and also vary from patient to patient – some people suffer more from them than others. In the following table you will find MS medication with the type of administration (usually orally, i.e. as a tablet) and the most important side effects

active ingredient type of application Important side effects
Methotrexate (MTX) orally Blood count changes, kidney and liver damage, gastrointestinal complaints, headache, skin rash
TNF-alpha inhibitors IV or injection under the skin Infections, administration site pain, infusion reactions, abdominal pain, nausea, vomiting, headache, decreased white blood cell count, increased blood lipid levels
Interleukin-6 inhibitors (tocilizumab, sarilumab) intravenously (infusion, injection) or injection under the skin Upper respiratory tract infections (with cough, stuffy nose, sore throat and headache), infusion reactions (with fever, chills, fatigue)
B-cell antibodies (rituximab) Infusion (combined with MTX) Infections, allergic reactions, changes in blood pressure, nausea, rash, itching, fever, runny or stuffy nose and sneezing, tremors, increased heart rate and tiredness, headache, laboratory test results, infusion reactions (with fever, chills, fatigue)
Interleukin-1 competitor (anakinra) Inject under the skin Headache, reactions at the injection site, increased cholesterol level
JAK inhibitors orally Upper respiratory tract infection, headache, diarrhea
NSAIDs orally Gastrointestinal complaints (such as nausea, vomiting, diarrhea, gastrointestinal bleeding), kidney dysfunction, fluid retention in the legs, central nervous disorders (such as hearing or vision problems, ringing in the ears, dizziness, headache, tiredness)
glucocorticoids mostly orally including osteoporosis , increased risk of infection, high blood pressure, mental or neurological disorders, growth disorders in children

During pregnancy, rheumatoid arthritis may only be treated with ciclosporin, azathioprine and sulfsalazine in order not to endanger the unborn child. In addition, MTX and leflunomide should be discontinued months before a planned pregnancy.

Rheumatoid arthritis: invasive therapy

Rheumatic arthritis can also be treated with invasive therapy, i.e. with measures that involve an intervention in the body. This includes:

  • Joint puncture : If there is an effusion in the affected joint, it can be punctured to drain the fluid and relieve the discomfort.
  • Radiosynoviorthesis (RSO) : In this case, radioactive substances are introduced into severely inflamed joints. In this way, freedom from pain in individual joints can be achieved after a few months.
  • Synovectomy : This operation removes the lining of the joint (synovium), which contributes significantly to the symptoms of rheumatoid arthritis.
  • Joint replacement : If a joint has been destroyed by rheumatoid arthritis, it can sometimes be replaced with a prosthesis.

With all invasive methods, the strictest observance of hygiene regulations must be ensured, since joints can easily become infected.

Rheumatoid arthritis: physical therapy

Rheumatoid arthritis should not only be treated with medication, but also with physiotherapy. This can:

  • improve joint mobility
  • strengthen or relax muscles
  • prevent misalignments
  • reduce pain

Physiotherapy includes various methods and techniques:

Special hand movements of manual therapy ( manual therapy ) can release joint blockages and restore mobility. Massages help against muscle tension.

Thermotherapy is also suitable for supporting rheumatoid arthritis :

  • Cold applications help in phases of acute inflammation to relieve pain and inhibit inflammation.
  • Heat applications can be useful in phases of remission (temporary relief of symptoms) to stimulate the metabolism and promote blood circulation. This can relieve tension.

If you have a cardiovascular disease (such as high blood pressure, heart failure), you should refrain from thermotherapy.

Direct currents and alternating currents in the context of electrotherapy are also suitable for the supportive treatment of rheumatoid arthritis. They have different effects at different frequencies:

  • Low-frequency therapy has pain-relieving and blood circulation-promoting properties.
  • Medium frequency therapy strengthens the muscles.
  • High-frequency therapy is a heat treatment with a deep effect.

If you have a pacemaker and/or metal implants (such as a joint replacement), electrical treatments are not allowed at all or only with restrictions.

Rheumatoid arthritis: occupational therapy and rehabilitation

If rheumatoid arthritis takes a severe course, you have to adapt your lifestyle to the disease. As part of occupational therapy and rehabilitation, you can train in everyday activities (at home, at work and in your free time) in order to maintain (occupational therapy) or restore (rehabilitation) your independence. For example, opening drinks bottles with as little stress as possible, handling cutlery, getting up and getting dressed can be trained.

Rheumatoid arthritis: alternative medicine

Patients also like to use alternative medicine such as homeopathy or traditional Chinese medicine (TCM) in addition to drug treatment. Naturopathy is also popular: there are several plants that can alleviate the symptoms of rheumatoid arthritis. These include, among other things:

Always discuss alternative therapies with your rheumatologist. These methods can only supplement and support the drug treatment of rheumatoid arthritis, but cannot replace it.

Rheumatoid Arthritis: Psychological Support

Psychological support can reduce pain, stress and disability in everyday life and improve your quality of life. Your psychotherapist can recommend relaxation techniques for this, such as progressive muscle relaxation according to Jacobson or autogenic training . In order to be able to deal with the symptoms better, he will also provide you with pain, illness and stress management programs if necessary.

Rheumatoid arthritis: remedies

In order to cope better with the disease in everyday life, there are various aids, the costs of which are often covered by health insurance in the case of rheumatoid arthritis:

Orthopedic shoes and insoles : Metatarsal, ball of foot or toe rollers provide support and ensure that pressure is better distributed. Heel wedges support the shortened foot at the back. Custom-made shoes adapt to the changed shape of the foot. Soft insoles or walking soles provide pleasant cushioning.

Jointed and non-articulated splints: Supporting splints or bandages maintain joint mobility and relieve excessive pressure. There are also movable rails that secure the direction and extent of movement of the joints via hinges. Immobilizing splints are also available, which immobilize a joint overnight or in the event of acute pain.

Walking aids : Depending on the degree of walking disability, a simple walking stick with or without a special handle, a crutch or an underarm crutch will help. When walking, they provide the necessary security. A so-called rollator can also be helpful if you have a particularly pronounced walking disability. This is a walker with brakes, a seat board and a small storage space, which allows longer distances or independent shopping.

Special aids : Raised toilet seats, grab rails, shower wheelchairs and bath tub lifts make it easier to carry out thorough personal hygiene without outside help, even with severe mobility impairments – an important prerequisite for a good quality of life.

Rheumatoid arthritis: what can you do yourself?

With rheumatoid arthritis, you don’t have to rely solely on others for your well-being and management. You can also become active yourself:

patient education

In patient training, you will get to know your illness better. You will also learn how to better manage the disease, the associated pain and the resulting stress. The better informed you are, the easier it is for you to make decisions about treatment together with your doctor. The German Society for Rheumatology has developed such patient training in cooperation with the German Rheumatism League.

support groups

Rheumatoid arthritis is easier to manage together. Therefore, if possible, you should join a self-help group for rheumatism sufferers. The exchange with other affected people can be very valuable and helpful! .

exercise and smoking cessation

Painful joints often spoil the desire to exercise in rheumatoid arthritis. You should still do sport regularly: Endurance sport helps you to feel better and keep your body fit. This way you can prevent painful muscle tension.

In addition, you should not smoke (anymore). Avoiding nicotine can have a positive effect on the course of rheumatoid arthritis.

nutrition

Diet is also an important issue in rheumatoid arthritis. It should not focus on animal foods but on plant foods. The reason: Meat, sausage, eggs & Co. contain arachidonic acid – a fatty acid that the body uses as a building block for pain and inflammatory substances (prostaglandins).

There is no arachidonic acid in plant-based foods such as fruit, vegetables and nuts – but there are plenty of vitamins, minerals and other substances that are good for the sick body.

You can find out more about this and why fish, despite its animal origin, is important for people with rheumatoid arthritis in the article ” Nutrition in Rheumatism “.

Rheumatoid arthritis: investigations and diagnosis

Most rheumatoid arthritis patients see their family doctor first. The unspecific symptoms at the beginning of the disease are often misinterpreted as a harmless flu-like infection. If there is a known family history of rheumatoid arthritis, your GP will refer you to a rheumatologist. With a lot of experience and great expertise, he can make the right diagnosis and initiate the necessary therapy.

History and physical examination

In order to diagnose rheumatoid arthritis, the doctor first asks you in detail about your medical history (anamnesis). Possible questions are:

  • Does anyone in your family suffer from rheumatism?
  • When are the symptoms worst?
  • Which joints are affected?
  • Have you noticed any other symptoms besides joint pain?

The interview is followed by a physical examination. For example, the doctor will take a close look at your finger joints and wrists and check their mobility.

blood test

A blood test is also important for the diagnosis. As with other inflammations in the body, there are also noticeable changes in blood values ​​in rheumatoid arthritis:

  • increased CRP (C-reactive protein)
  • greatly accelerated ESR ( sedimentation rate )
  • decreased Hb ( hemoglobin = red blood pigment)
  • increased ceruloplasmin
  • increased α2 and γ bands in electrophoresis

In addition, rheumatism patients often develop anemia.

Laboratory values ​​that can indicate rheumatoid arthritis (RA) are rheumatoid factor , anti-CCP antibodies and other autoantibodies:

  • Rheumatoid factor : The term refers to antibodies against so-called Fc fragments of antibodies of the IgG class. They can be detected in most RA patients. Then there is a so-called seropositive rheumatoid arthritis. If the rheumatoid factor is missing despite the presence of RA, it is a matter of seronegative rheumatoid arthritis.
  • Anti-CCP antibodies : They are directed against cyclic citrullinated peptide: Citrulline is a protein building block (amino acid) that is found in large quantities in the coagulation substance fibrin, but only rarely in the rest of the body. Fibrin is released not only during blood clotting , but also during inflammation in joints. According to the theory, where citrulline antibodies dock, there must also be an inflammation. Anti-CCP antibodies are often detectable in the blood early on and in many patients with rheumatoid arthritis.
  • Other autoantibodies such as ANA (antinuclear antibodies) can be detected in a few RA patients.

Rheumatoid arthritis: imaging techniques

Imaging methods help to diagnose and determine the stage of the disease.

X-rays of hands and feet make it easy to recognize changes in the joints that result from rheumatoid arthritis, especially in the advanced stage, for example:

  • Narrowing of the joint space
  • cartilage loss
  • ossification
  • Joint dislocations (dislocations)

Other imaging tests that can help diagnose rheumatoid arthritis include:

  • Ultrasound (sonography): Display of joint effusions and thickening of the tendons
  • Scintigraphy (nuclear medical examination): Depiction of an increased metabolism in the inflamed area
  • Nuclear spin tomography (magnetic resonance imaging, MRI): Depiction of early changes at the onset of the disease

Rheumatoid arthritis: differentiation from similar diseases

There are many diseases associated with joint problems. It is therefore important when making a diagnosis to differentiate between rheumatoid arthritis and these diseases. These include, among other things:

Rheumatoid arthritis: disease course and prognosis

Rheumatoid arthritis progresses in phases. This means that highly inflammatory, painful conditions alternate with symptom-free phases. At the beginning of the disease, there are often more flare-ups. Overall, rheumatoid arthritis progresses in stages , divided according to the predominant symptoms:

  • Stage 1: Intermittent occurrence of joint swelling and pain, morning stiffness and general symptoms.
  • Stage 2: Progressive decrease in joint mobility, muscle and bone atrophy, involvement of the connective tissue (capsules, tendon sheaths, bursa).
  • Stage 3: Beginning destruction of articular cartilage and bone. Gradual damage to the connective tissue (loosening of the ligaments and joint capsule), resulting in instability and misalignment of the joints. Increasingly restricted mobility. Spread of the disease to other regions (cervical spine, large joints, temporomandibular joints).
  • Stage 4: Incipient stiffening of the joints, gross deformations; extensive disability and immobility. The patients are dependent on outside help in everyday life.

The exact course of the disease can vary from patient to patient.

Rheumatoid arthritis: prognosis

Rheumatoid arthritis has no cure and it is difficult to predict how it will progress in any individual. However, a rough prognosis can be made based on various factors :

  • If the rheumatoid factor is present in the blood, the CCP antibodies are particularly high and the patient is a smoker, a severe course can be assumed.
  • Severe courses can also be seen in young patients in whom more than 20 joints are affected. Because the rheumatoid arthritis often manifests itself outside of the joints (extra-articularly) in them, their life expectancy is reduced compared to the healthy population.

In addition, the symptoms of rheumatoid arthritis often improve during pregnancy.

In any case, it is important to treat rheumatoid arthritis as early and correctly as possible. Then the disease can be stopped (remission) . To do this, it is necessary for the patients to take their medication for the rest of their lives and to be continuously cared for by their rheumatologist – even during phases when the disease is dormant. In this way, a renewed flare-up of rheumatoid arthritis can be recognized and treated at an early stage.

Consequences of insufficient or missing treatment

If rheumatoid arthritis is not treated adequately and correctly, cartilage, bones and connective tissue are increasingly destroyed. This results in typical deformities of the fingers and feet:

  • Ulnar deviation of the fingers (the fingers point towards the little finger)
  • Buttonhole deformity (flexion deformity in the middle finger joint, hyperextension in the finger end and metatarsophalangeal joint)
  • Swan-neck deformity (flexion deformity in the end and metatarsophalangeal joints, hyperextension in the middle joints of the fingers)
  • 90/90 deformity of the thumb (flexion deformity in the metatarsophalangeal joint, hyperextension in the distal joint)
  • Hallux valgus, hammer toes, or side-pointing toes

In addition, many patients develop bone loss (osteoporosis) in the course of the disease. Those affected should then ensure that they have an adequate supply of calcium and vitamin D : Calcium is found in dairy products, broccoli or leeks, for example, and vitamin D is mainly found in fish. In addition, the body can also produce vitamin D itself with the help of sunlight. If necessary, the doctor will also prescribe a preparation with calcium and/or vitamin D.

Rheumatoid Arthritis & COVID-19

Drug treatment of rheumatoid arthritis suppresses inflammation and therefore also the overactive immune system that attacks your own body. It is now unclear whether this also increases the risk of becoming more seriously ill with the new infectious disease COVID-19. Researchers are therefore currently in the process of collating international cases of rheumatism patients with COVID-19 in registers and observing and comparing the courses.

Results so far are reassuring, as most patients recover from COVID-19, even on rheumatism medication. In the “EULAR and Global Rheumatology Alliance COVID-19” register, 600 COVID-19 diseases in patients with rheumatic diseases from 40 countries have already been analyzed from March 24, 2020 to April 20, 2020: The intake of conventional DMARDs, biologicals, non-steroidals Anti-inflammatory drugs and TNF-alpha inhibitors did not increase the likelihood of needing hospital treatment. Only treatment with a moderate to high dose of cortisone (more than 10 mg prednisone per day) was associated with a higher likelihood of hospitalization.

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