Diseases

Chronic polyarthritis


One of the most common inflammatory rheumatic diseases is chronic polyarthritis. The relapsing disease affects women particularly often and, if not treated, results in severe joint deformities, which can lead to considerable physical disabilities. Experts estimate that up to two percent of the population (1.6 million people) are affected in this country.

Definition

Chronic polyarthritis is an inflammatory rheumatic disease of the inner synovium (stratum synoviale) and other connective tissue structures, the trigger of which is a misguided response of the immune system (autoimmune disease). A so-called rheumatoid factor can often be detected in the blood, which defines a “seropositive chronic polyarthritis” (ICD10 code: M05) according to the international classification of diseases. However, the disease also occurs as "Other chronic polyarthritis" (ICD10 code: M06) without a rheumatoid factor. Synonyms for the symptoms are rheumatoid arthritis, primarily chronic polyarthritis or progressive chronic polyarthritis. Rheumatoid arthritis was first described to the public around 1800 by the French surgeon Dr. Augustin Jacob Landré-Beauvais (1772-1840).

Symptoms

Joint pain, which first appears in the middle and basic joints of the fingers and appears symmetrically on both hands, is often the first, clearly noticeable sign of chronic polyarthritis. They are caused by inflammation, which also causes swelling and overheating, as well as a feeling of stiffness in the affected joints. In some patients, this inflammation first occurs in the large joints, such as the knee or ankle joints. Morning stiffness, combined with unspecific general symptoms such as increased fatigue and reduced performance, weight loss or increased basic temperature, are sometimes early signs of chronic polyarthritis.

In any case, such an inflammatory phase in the joints is to be assessed as the first disease flare, the intensity of which can vary greatly from individual to individual. The time interval until another inflammation phase can vary, but from now on those affected must always count on a further relapse. A few patients are spared the recurrence of the symptoms, but the majority are confronted with numerous other episodes of the disease in the course of their lives.

With repeated occurrence, the inflammation of the joints results in an increasing loss of cartilage and bone mass over time, which leads to massive impairments of the joint function. The joints deform more and more in the course of the disease until they finally stiffen completely. The surrounding ligaments and vision are also affected by the joint deformity and because many sufferers avoid movement due to the pain, the muscles begin to shrink relatively quickly. The deformations of the joints in the course of chronic polyarthritis can cause the pain to persist between the inflammatory phases and the patient to suffer permanently. So-called rheumatoid nodules often form on the joints, which can be felt as thickening in the tissue.

Sometimes chronic polyarthritis also affects other systems of the human organism outside the musculoskeletal system. While this is rare, it can lead to life-threatening complications such as pleurisy, vascular inflammation, pericarditis and other serious diseases.

Disease mechanism and possible causes

While the mechanism of chronic polyarthritis is relatively well researched today, it has not yet been possible to determine a clear cause of the disease. Various possible triggers are under discussion here. Regarding the mechanism, it is known that in the inflammatory phases an overgrowth of the inner skin of the joint and an increased release of synovial fluid lead to a breakdown of the cartilage and bone mass. A disturbance in the immune system is the trigger for this process. How the immune system's reaction is misdirected remains unclear. Genetic predispositions, smoking and a problem of white blood cells or B lymphocytes are discussed as risk factors. Viruses and bacteria are also considered as triggers or influencing forces.

For unknown reasons, women are affected much more often than men, and although the disease can theoretically occur at any age, most people first experience the symptoms between the ages of 20 and 30.

Diagnosis

The diagnosis of chronic polyarthritis is usually made on the basis of a criteria catalog, from which four points must be fulfilled. However, the comparison first requires a thorough medical history with a detailed description of the complaints that occur. The criteria used for the diagnosis include:

  • Joint pain and swelling in the central and basic joints of the fingers, the wrists or the large joints,
  • symmetrical appearance of joint inflammation on both halves of the body,
  • morning stiffness in the joint for more than 60 minutes,
  • noticeable rheumatoid knots,
  • recognizable, typical changes in the joints during imaging examinations (X-ray, skeletal scintigraphy etc.),
  • Rheumatoid factor or antibodies in the blood against certain proteins (so-called CCP) can be detected in the blood.

If four of these criteria are met, a reliable diagnosis is usually assumed among medical professionals.

Furthermore, the symptoms can be classified according to their severity, with the spectrum ranging from simple joint swelling without affecting the joint structure to the most severe degenerative changes with deformities and stiffening.

Treatment

So-called non-steroidal anti-inflammatory drugs (NSAIDs) are usually used to combat the symptoms during an acute episode. They have an anti-inflammatory effect and are said to relieve pain. If the NSAIDs do not have the desired effect, cortisone can also be used to reduce inflammation of the joints. However, this treatment only serves to alleviate acute symptoms. In addition, basic medication is provided to reduce the occurrence of renewed episodes in terms of intensity and frequency.

Basic drug treatment is often carried out with methotrexate, but various other active ingredients can also be used. Here rheumatologists make an appropriate selection based on the individual symptoms. The effect of this basic medication only takes weeks or months to come, but it has been proven that it can help to significantly reduce joint deformities and sometimes to avoid them altogether. Among the therapeutic options, the so-called biologicals, antibodies directed against inflammatory cytokines, such as adalimumab and rituximab, should also be mentioned.

Last but not least, there is also the option of taking surgical measures against the disease and its consequences. In this way, the growths of the inner skin of the joint can be surgically removed or deformed joints can be corrected. Artificial replacement of the joints with a prosthesis is also possible. However, these measures ultimately only serve to relieve symptoms - they cannot cure them.

Accompanying movement or physiotherapy after the inflammation phases have subsided should prevent possible movement restrictions in the joints and at the same time strengthen the often weakened muscles. For more pronounced forms, occupational therapy is appropriate to make life easier for those affected. Therapeutic support is sometimes helpful in coping with the psychological stress associated with the disease. Because the diagnosis of "chronic polyarthritis" brings massive cuts in old days and in the long term the risk of disability, which many affected people find it difficult to deal with.

Naturopathy

In addition to the manual therapies that can be used to combat long-term impairment of joint function, naturopathy also offers good approaches to alleviating acute symptoms during a disease episode. Here, especially cold applications such as cold wraps or bathing in ice water are widely used naturopathic measures. Heat treatments such as fango packs or warm hay sacks can be applied between the crises.

Various medicinal plants in naturopathy are also said to have a positive effect against the symptoms of chronic polyarthritis. The traditional remedies for joint problems include full baths with nettle addition, external applications with St. John's wort oil, thyme oil and comfrey tincture, as well as tea based on yarrow or Odermennig. The consumption of fresh dandelion stems is also said to have a positive effect on inflammatory rheumatic complaints. Furthermore, herbal remedies from the root of the devil's claw are increasingly used for the treatment of chronic polyarthritis due to their anti-inflammatory effects.

Other naturopathic procedures that may be used include acupuncture, hydrotherapy, homeopathy and Schüssler salt therapy. A total of a variety of naturopathic treatment approaches are available, which can also enable a lower dosage of the basic medication. However, these are not to be assessed as an alternative, but as a supplement to basic medicinal treatment. (jvs, tf, fp)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters, Barbara Schindewolf-Lensch

Swell:

  • Medical Center for Quality in Medicine (ÄZQ): Rheumatoid Arthritis (accessed: August 14, 2019), patient-information.de
  • Herold, Gerd: Internal Medicine 2019, self-published, 2018
  • Professional Association of German Internists: Rheumatoid Arthritis (accessed: August 14, 2019), internisten-im-netz.de
  • Institute for Quality and Efficiency in Health Care (IQWiG): Rheumatoid Arthritis (accessed: August 14, 2019), gesundheitsinformation.de
  • German Society for Rheumatology e.V .: Management of early rheumatoid arthritis, as of August 2011, dgrh.de
  • Robert Koch Institute (RKI): Issue on inflammatory rheumatic diseases, as of: 2010, rki.de

ICD codes for this disease: M06ICD codes are internationally valid encryption codes for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.


Video: Rheumatoid arthritis - causes, symptoms, diagnosis, treatment, pathology (November 2021).