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.

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 (the hinge joints between the individual bones of the fingers) and the metacarpophalangeal joints (large joints between the hand and finger bones). Over time, additional symptoms that are typical for rheumatoid arthritis like weakness can appear.

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.

Rheumatoid arthritis is an autoimmune disease, in which the body’s own immune system attacks the inner lining of the joints. The exact reason for this autoimmune response remains unknown.

Hereditary predisposition is one factor that plays a role in determining whether a person develops rheumatoid arthritis. 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. 

Around 1% of all adults in Germany have rheumatoid arthritis. The condition mostly develops after the age of 50. It can also occur at an earlier age and may even begin during adolescence, although such cases are rare. The condition affects twice to three times as many women as men and also begins approximately 10 years earlier on average in women. 

Rheumatoid arthritis typically begins with symptoms in the finger, hand, or toe joints, sometimes also in the elbows, ankles, or knees. 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, which increases in susceptibility to cardiovascular diseases. However, the risk of developing such diseases largely depends on other factors, including high blood pressure, diabetes, smoking, and high cholesterol.

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 applies to cases 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.

Rheumatoid arthritis is currently incurable. However, it can be treated with medication and with non-medical methods such as physiotherapy. Surgery is sometimes also required. 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.

Physiotherapy 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.

If medication fails to alleviate the symptoms and the condition progresses, the synovium – the inner lining of the joint – is sometimes surgically removed. If rheumatoid arthritis causes severe damage to the joints, an operation may relieve pain and other symptoms. The procedure may involve, for example, inserting a joint prosthesis or artificially fusing two or more bones in the joint (arthrodesis).

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.

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 support people in managing their disease more effectively in everyday life, participating in public life, and being able to continue to work or to return to working life. 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, physiotherapy 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.

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.