Symptoms and treatment options for rheumatoid arthritis
After a day of gardening, your wrists hurt, your knees hurt, and your hip joints demand rest. The cause is clear here: The joints hurt because we put a lot of strain on them. So there is no need to worry. The situation is different if you have severe finger, knee or hip pain, especially in the morning, if you need a long time to be able to move normally and the affected areas also warm up and swell - with no apparent cause. Then you may have rheumatoid arthritis; medicine calls it rheumatoid arthritis - and that requires quick action.
Rheumatoid Arthritis - The Most Important Facts
- Joint rheumatism is the most common inflammation of the joints.
- The affected joints not only hurt, they also swell and warm up.
- Usually both sides of the body and several joints are affected, for example the hands, knees and hips.
- Another symptom is general malaise.
- As rheumatoid arthritis progresses, joints stiffen and deform. The ability to move decreases.
- The disease is not curable. Medical treatment can slow down the process and alleviate the symptoms.
- The best way to treat this inflammation is through a package of medication, physiotherapy, and occupational therapy. In addition, psychotherapy is often necessary. Some patients have only one operation as the disease progresses.
- Rheumatoid arthritis is a systemic disease that manifests itself particularly in the joint mucous membranes. Your own immune system attacks the joints.
Rheumatoid arthritis means that multiple joints become inflamed permanently. This condition is common, affects one in 100 people and affects women more often. Inflammation affects the whole body, presumably it is an autoimmune disease in which the body's defense system does not protect the body but attacks it.
The inflammations show up as swellings, joint effusions and the temperature at the scene is increased. Joint stiffness is typical in the morning when getting up, but movement can also be restricted during the day.
In the early phase, many symptoms are non-specific. This includes fatigue, excessive sweating, lack of hunger and an unexplained weight loss.
In the further course, rheumatoid arthritis is characterized by bony deformations of the joints, which can lead to the joints completely losing their function. On the fingers, this means that those affected can no longer bend their fingers or grasp objects - the effects are almost the same as paralysis. Rarely, but possible, is inflammation spreading to internal organs such as the heart and lungs.
Depending on where this form of arthritis manifests itself, the effects differ. These include muscle tension, redness, severe pain, swollen joints, deformed spine, eye infections or inflamed internal organs.
Causes of Rheumatoid Arthritis
The exact cause of this disease is still unknown. Medicine knows that the immune system targets the joints of the body, which it is normally supposed to protect. However, why the immune defense becomes an “aggressor” is unknown. Science suspects a connection between genetic aspects and environmental influences. For example, 70 percent of sufferers have the HLA-DR4 genetic pattern, in contrast to only 30 percent of people as a whole.
Course of the disease
Joint rheumatism takes on very different forms. For some it begins so "timidly" that they only recognize the problem late - for example with sporadic complaints in the finger joints. Others suddenly start. Her knees and wrists hurt like out of the blue.
For most people, however, arthritis starts in the joints of the fingers as well as the hands, and the end joints of the fingers usually do not hurt. Due to the inflammation, the respective joint skin swells and the swollen joint appears plump. The tendons on the fingers, which are used for bending and stretching, also ignite regularly. If the knees or shoulders are affected, the bursae lying there will become particularly inflamed.
For some patients, things go quickly: in a few weeks, most of the joints in the body become inflamed. Others experience temporary pain in their wrists for years, followed by a flare that attacks other joints: cervical spine, elbows, hips, shoulders, toes, and feet.
What happens in rheumatoid arthritis?
The inflammation decalcifies the bone that sits on the joint. Later she destroys the bone where it attaches to the joint capsule. Then the articular cartilage regresses. As a result, the articular surfaces and articular bones move out of their normal position and form in an incorrect position. The mobility at this point is now restricted. Such destruction of the tension "rel =" noopener "target =" _ blank "> fingers, for example, means that those affected can no longer hold a cup or open a zipper.
Medical treatment - the basics
Joint rheumatism is a very serious condition that progresses until various joints are destroyed. This process cannot be reversed, so medical treatment must start as early as possible. Medications that work against pain and inhibit inflammation cannot prevent the deformation. Therefore, so-called basic medication must be taken. This is where the patient's reaction to a product and the doctor's expertise decide on the product. Those affected are under constant surveillance of the medicine, because the medication can cause serious side effects.
Medicines slow the course
Basic medications work better the earlier they are used. Then they can not only slow the inflammation down, but even stop it before the affected person cripples. The classic basic medicine is methotrexate. Unfortunately, this does not work for all patients. Adalimunab offers an alternative today, which those affected can even inject themselves twice a week, which means more autonomy compared to other medications and also makes professional life easier.
While the basic medicines slow down or even stop the course of the inflammation, medicines based on cortisone serve to suppress the inflammation and relieve the pain. They are suitable as a transition until the effects of basic medicine have started. Pure pain relievers such as diclofenac or ibuprofen also inhibit inflammation and relieve pain, but do not counteract the destruction of the joints. Glucocorticoid, which acts in the body like the corticoid, is injected into the diseased area.
Other treatment options
From the beginning of the disease, physiotherapy and occupational therapy serve to keep the joints in motion and to keep overloading low. Those affected see a future in which they may cripple step by step and this leads to enormous suffering. That is why support from psychology and psychotherapy is a concern for patients.
If the joints are destroyed, usually only surgery will help. The broken natural joints are then replaced by artificial joints.
Symptomatic treatment and basic therapy
The symptomatic treatment relieves the symptoms. It is usually at the beginning of therapy if the exact diagnosis has not yet been made or the basic medication is not yet effective.
Cox2 inhibitors relieve pain and inhibit inflammation, but the possible side effects include severe heart and brain damage and thrombosis. If you have a tendency to such diseases, you must not take these drugs. Non-steroidal anti-inflammatory drugs (NSAIDs) also retard inflammation, relieve pain and contain no cortisone. The oldest remedies for articular rheumatism are salicylates. Other medicines are arylacetic acid derivatives, arylpipionic acid derivatives, anthranilic acid derivatives and oxicams.
These NSAIDs all have major disadvantages. Severe side effects affect the gastrointestinal tract and range from gastric complaints to gastric bleeding. Changes in the blood picture, kidney problems and allergies can also be the unwanted consequences.
The basic remedy - methotrexate
The basic remedies are immunosuppressive drugs, which are medicines that suppress the body's defenses. This includes classic methrotrexate. Patients usually take this once a week with a dose of ten to 15 milligrams. It prevents the inflammatory cells from multiplying. Around four to six weeks after taking the drug, the condition of many affected people improves. Methotrexate is suitable for mild and moderate joint rheumatism to stop the destruction of the bones. The body uses methrotrexate like folic acid and builds the medicine into the cells instead.
The effects of methotrexate are enhanced by:
- and erythromycin.
In addition, alcohol increases the effect of methotrexate, but you should largely avoid alcohol consumption if you have a rheumatic disease. Allopurinal, however, weakens the effect.
Azathioprine helps because it stops cells from multiplying. It inhibits the enzyme that converts dihydrofolic acid into tetrahydrofolic acid. The following lack of tetrahydrofolic acid now causes cells that are rapidly reproducing to stop reproducing. This counteracts the progress of the inflammation, but it also weakens the immune system in general, because the white blood cells are also prevented from multiplying. Those affected are more exposed to infections than before. If the agent reduces the number of blood platelets, bleeding may result.
If the liver and kidneys are damaged, this remedy should not be taken, and if so, only after a thorough examination by specialist medicine. Even without such prior exposure, the effects on the liver, kidneys, bone marrow and blood count must be checked continuously. Immunosuppressants can cause bad damage here. A very rare side effect is closed hepatic veins with symptoms such as jaundice (yellowing of the skin and eyes), abdominal pain and chronic fatigue. Inflammation of the pancreas is also possible.
A medical check of the effect is also essential because of the following problems: If you are taking anti-cancer drugs, or cimetidine or captopril, then you must lower the dose of azathioprine in any case. You must not have live vaccines injected during treatment with azathioprine.
Attention: Azathioprine causes genetic damage. Women, like men, must therefore use contraception during the period of action. Only six months after stopping the drug there is no longer any danger for the future child.
This basic agent is used in long-term therapy and injected under the skin every 14 days. It is supplemented with methotrexate and therefore both agents are often combined. The first effects appear after 14 days at the earliest, if nothing has changed after three months, it can be assumed that adalimumab does not have the effect that was hoped for and other medications should then be used. Does adalimumab work and those affected stop taking it from time to time, sometimes followed by rheumatism.
This basic remedy also requires a detailed medical preliminary examination. In particular, it is a question of whether there is a weak heart or whether the affected person has active infections. With latent tuberculosis (TBC), patients are first treated with vitamin B6 for nine months before the drug is administered and then only under strict control.
During therapy, doctors pay particular attention to whether those affected lose weight, their performance dwindles, lymph nodes swell, night sweats break out or fever occurs. Scientific studies on side effects in pregnant and lactating women are still pending and it is therefore advisable to switch to alternative treatment methods during this time that can not harm the child.
Adalimumab should not be used if those affected have active tuberculosis (TBC), severe viral infections, particularly HIV or hepatitis B, cardiac insufficiency NYHA III and IV. If they suffer from a tumor or multiple sclerosis (MS), then check the Specialists exactly whether treatment with the preparation is possible. If hypersensitive, treatment with adalimumab is not possible.
Treatment must be stopped if a severe infection breaks out, a severe allergy develops, or heart failure develops or worsens during therapy. Typical side effects of this basic remedy can occur:
- A headache,
- Respiratory infections,
- Sore throat,
- Itchy rash,
- Stomach pain,
- Infection with herpes,
- changed blood values,
- Weight loss
- and flu-like symptoms.
It is less common
- Nerve pain,
- delayed wound healing,
- Inflammation of the stomach and mouth,
- Eczema or fungi on the vagina,
- severe fever,
- Pain in joints and muscles,
- High blood pressure,
- Conjunctivitis and
- Visual disturbances.
A very rare but potentially fatal side effect is blood poisoning.
Cortisone supplements are not a basic remedy, but are occasionally used to reduce inflammation and relieve pain. Depending on the duration of use and the amount of the dose, these preparations have a strong impact on long-term therapy. Side effects of cortisone include possible inflammation of the joints and possible bacterial inflammation, which in the worst case can cause blood poisoning.
Patients' behavior is also a risk of excessive cortisone administration. These preparations reduce the pain and this can easily lead to the affected person being overwhelmed by the damaged joint. Agents with cortisone are particularly important for acute rheumatism attacks, where low doses often work, at which the risk of serious side effects is minimal.
Biologicals are agents from molecular biology that block the inflammatory substances of the immune system. Biologics are an alternative, especially if the basic remedies do not work or those affected suffer too much from the side effects. Infusions with rituximab have shown success for those affected. This medication is administered twice in a four-hour infusion at 14-day intervals and helps those affected by rheumatoid arthritis for up to one year. Rituximab is known from cancer therapy and has also been approved for rheumatism therapy since 2006. As a drug for the therapy of autoimmune diseases, it works against the cause of rheumatic inflammation, but can also lead to a weakened immune system. This in turn increases the susceptibility to diseases caused by pathogens.
Plant-based agents are suitable as part of rheumatism therapy if they inhibit inflammation. Plants that have this effect include
- and ash.
The active ingredients contained in it are nowadays high doses in plant extracts.
Extract from nettle leaves inhibits substances that are responsible for cell communication, other herbal products contain the active ingredient salizine. This releases salicylic acid when ingested and this inhibits inflammation.
Chloroquine is used against malaria, but it also helps against rheumatism symptoms. Possible side effects are headache and visual disturbances. Long-term therapy requires regular ophthalmological checks.
Danger to internal organs
Almost every second person affected not only suffers from joints, but also from other organs. In addition to tension, this also includes internal organs such as the lungs, liver, kidneys, gastrointestinal tract and glands.
In every fifth patient with rheumatoid arthritis, the lungs become inflamed, more precisely the alveoli. Signs are strong cough and difficulty breathing.
Blood and heart
Inflammation in the blood vessels then shows up in circulatory disorders in punctiform wounds, skin ulcers and necrotic tissue. Atherosclerosis is also a common consequence. People with joint rheumatism have an increased risk of suffering a heart attack due to arteriosclerosis on the coronary arteries. The disease can also cause a heart valve defect and inflammation of the heart muscle and sac. This in turn can be life-threatening.
The sooner the better
It became clear that rheumatoid arthritis can be best treated in any form if it is recognized early. So what should you pay attention to? If two or more joints have been swollen for more than five weeks for no apparent reason, then see a rheumatologist or a specialist in joint diseases.
What can you do yourself?
- First, because the exact causes of rheumatoid arthritis are unknown and, secondly, there is a genetic predisposition, there is little you can do to prevent them. The situation is different during treatment, where it is crucial that you actively participate.
- In the case of acute pain, you can cool the corresponding joint: Place cooling bags on it or hold the body region under cold water. This is particularly good for rheumatoid arthritis in hands and tension.
- Smoking is unhealthy, everyone knows that. Specifically, rheumatism has a negative impact on the course of the disease.
- Movement is very good. But this should urgently protect your joints. Cycling, gymnastics and swimming fit perfectly. You should avoid sports such as weightlifting, shot put and bar exercises. Discuss the appropriate sport with your doctor or an occupational therapist.
- Wear comfortable shoes that do not strain you when you walk, but protect your joints. You can also buy extra orthopedic shoes or get special insoles.
- Take part in a patient training course or try out a self-help group. (Dr. Utz Anhalt)
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.
ICD codes for this disease: M79ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.