Rheumatoid arthritis

Rheumatoid arthritis is also commonly referred to as rheumatism. The term rheumatoid arthritis refers to chronic inflammation that normally affects multiple joints causing them to ultimately become deformed and stiff. Rheumatoid arthritis is treatable but not curable.

At a glance

  • Rheumatoid arthritis is an autoimmune disease. 
  • In Germany, approximately one percent of all adults have rheumatoid arthritis.
  • Women are twice as likely to be affected.
  • Rheumatoid arthritis can cause the joints to gradually become deformed and stiff.
  • Muscle strength also diminishes over time.
  • Rheumatoid arthritis is treated with medication or other approaches like physical therapy.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Rheumatoid arthritis: doctor sitting at a desk examining the hand of the person sitting opposite. A stethoscope is lying on the table.

What is rheumatoid arthritis?

There are many different types of rheumatic disease. However, the term rheumatism is usually used in reference to rheumatoid arthritis. Rheumatoid arthritis typically causes chronic inflammation of multiple joints. Consequently, the joints can become deformed and stiff over time. Muscle strength also diminishes over time.

If the disease is advanced, it can also affect other areas of the body, e.g., blood vessels or certain organs. People with severe rheumatoid arthritis have pain and feel exhausted. Even simple tasks like personal hygiene, eating with a fork and knife, or closing buttons can be difficult.

What are the symptoms of rheumatoid arthritis?

The first sign of the disease is usually swelling at individual joints resulting in pain and joint stiffness. Swelling appears primarily at the proximal interphalangeal joints and the metacarpophalangeal joints. Over time, additional symptoms that are typical for rheumatoid arthritis like weakness can appear.

Typical rheumatic symptoms include swollen joints that are warm to the touch, debility and exhaustion, stiff joints, rheumatic nodules and painful joints.

Typical rheumatoid arthritis symptoms are:

  • Warm, swollen joints: Typically, the same joints on both sides of the body are swollen, e.g., the finger joints of the right and the left hand.
  • Painful joints
  • Stiff joints: Primarily after longer periods of rest, particularly when getting up in the morning. The joints usually require over an hour or a period of sustained activity to regain mobility.
  • Weakness: People tend to move painful and stiff joints less, causing the musculature to weaken over time.
  • Exhaustion: Since this inflammatory disease affects the entire body, rheumatoid arthritis often causes tiredness, a general feeling of weakness, and sometimes fatigue.
  • Rheumatoid nodules: Small hard nodules can form under the skin in advanced disease. They are usually not sensitive to pressure or touch.

These symptoms are not the same in all people. Therefore, various joints can be affected. The symptoms that are most problematic can also vary.

Important: Many people have problems with swollen or stiff distal interphalangeal joints. However, they are typically a sign of a certain type of arthrosis. Rheumatoid arthritis and arthrosis are often confused although they differ greatly from one another. Rheumatoid arthritis is an inflammatory disease while arthrosis is the result of wear. The treatment and progression of the two diseases also differ greatly.

What causes rheumatoid arthritis?

Rheumatoid arthritis is an autoimmune disease, i.e., a disease in which the body’s immune system mistakenly attacks healthy cells. The immune system normally differentiates between the body’s own and foreign cells, organisms, and substances and thus protects the body from pathogens and other harmful substances. In people with an autoimmune disease, this mechanism no longer functions properly. The immune system incorrectly identifies some of the body’s own cells as foreign substances and attacks them. This causes inflammation. In the case of rheumatoid arthritis, the joints are primarily affected by the autoimmune reaction.

The disease processes in rheumatoid arthritis are complex and not yet fully understood. Genetic predisposition probably plays a role. There are also theories that autoimmune responses can be triggered by infection with certain viruses or bacteria.

It is known that smoking can promote rheumatoid arthritis and have a negative impact on disease progression. Other external risk factors have not yet been identified.

What is autoimmune disease?

The video below provides basic information on the human immune system and typical autoimmune diseases.

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How common is rheumatoid arthritis?

Around 1% of all adults in Germany have rheumatoid arthritis. It is twice as common in women as in men.

Around 1% of all adults in Germany have rheumatoid arthritis. Women are twice as likely to be affected. The disease usually develops after the age of 50. However, primarily women can develop the disease at a younger age. Sometimes rheumatoid arthritis even develops during adolescence.

How does rheumatoid arthritis progress?

Rheumatoid arthritis typically begins with symptoms in the finger, hand, or toe joints, sometimes also in the elbows, ankles, or knees. Both sides of the body are usually affected. Joints close to the torso, e.g., the shoulders or the clavicle, can also become inflamed.

The further progression of the disease can vary. A study surveying people with rheumatoid arthritis regarding symptoms ten years after disease onset yielded the following results:

  • Almost 50 percent reported minor limitations.
  • 40 percent reported moderate limitations.
  • Approximately 10 percent reported significant limitations in everyday life.

For example, participants were asked about difficulty getting up, getting dressed or preparing food, e.g. opening packages, bottles, or jars.

Rheumatic symptoms increase in some people over time but they can also remain unchanged for a long time. Some experience episodes, i.e., the inflammation and pain suddenly increase but then decrease again.

In the late stage, the disease can affect other regions of the body in addition to the joints. The inflammation in the body can also affect the blood vessels, resulting in susceptibility to cardiovascular diseases. However, this occurs relatively rarely and usually only if there is already an increased risk of cardiovascular disease for other reasons – for example, as a result of obesity or high blood pressure.

How is rheumatoid arthritis diagnosed?

The doctor will first ask questions and thoroughly examine the patient while paying particular attention to which joints are swollen. Swelling of certain finger and toe joints is an indication of rheumatoid arthritis. The same is true in the case of pain and swelling in large joints like the shoulders or knees. The duration of the symptoms and the number of inflamed joints are also important for the diagnosis.

Analysis of a blood sample can also detect certain antibodies and inflammatory markers. However, these results are only conditionally significant because blood test results can vary for other reasons.

Important: It can be difficult to detect rheumatoid arthritis in the early stage. Symptoms are often only mild and are not always typical in the first weeks to months. In the case of suspicion of such a disease, it is important to make an appointment to see a rheumatologist.

How is rheumatoid arthritis treated?

Rheumatoid arthritis is currently incurable. However, it can be treated with medication and with methods like physical therapy. There are various ways to make everyday life easier.

Medications can inhibit inflammation and can delay progression of the disease. They can also help to alleviate symptoms like pain and swelling and to improve joint function or to preserve it for as long as possible.

Physical therapy and exercise help to improve or maintain mobility, strength, and joint function. Suitable types of exercise for people with rheumatoid arthritis include cycling, walking, dancing, aerobics, strength training, swimming, and water aerobics.

Treatment depends on the severity of the inflammation and the symptoms, how advanced the disease is, and the prognosis. The effectiveness of previous measures is also taken into consideration. Psychological support can also help to better manage pain and limitations in everyday life.

For more information, for example about the importance of exercise for those with rheumatoid arthritis, visit gesundheitsinformation.de.

How can rehabilitation be used to treat rheumatoid arthritis?

Rheumatoid arthritis that cannot be controlled or that makes someone unable to work for a longer period of time can be an indication that rehabilitation is needed. The goal is to help people better manage their disease in everyday life, to be able to participate in public life, and to maintain or restore their ability to work. Rehab can also be considered for older people with the goal of allowing them to live as independently as possible and to prevent the need for care.

Rehab usually lasts three weeks and includes various areas of specialization, e.g. rheumatology, physical therapy and ergotherapy, social work, and psychology. In the case of inpatient rehab, the patient stays at the clinic for treatment. In the case of outpatient rehab, the patient stays at home and visits the clinic during the day.

Depending on the goal of rehabilitation and the patient’s insurance, the costs are covered by statutory pension, health, or accident insurance. A doctor must first determine that rehabilitation is necessary and the rehab request must be approved by the insurance provider.

Rheumatism: woman standing and holding both arms in front of her chest. The woman is clutching her wrist of one hand with the other.

What is everyday life with rheumatoid arthritis like?

The disease is usually associated with pain, fatigue, and physical limitations. Medication can also cause side effects. This can all greatly affect everyday life. For many people with rheumatoid arthritis, normal activities can take longer and they need to rest more frequently and longer than others. Frequent doctor’s visits, treatment, and taking medications take a lot of time. Due to their fatigue, many people with rheumatoid arthritis require more sleep. They have trouble concentrating and find it difficult to get moving.

Rheumatoid arthritis can also cause emotional stress. It can trigger fear of the future, sadness, as well as anger. This can be difficult for others to understand.

Nonetheless, many people manage to cope with their disease so that their symptoms fade into the background and they can live a fulfilling life in spite of their limitations.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG). As at:

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