Rheumatoid arthritis: This is behind the inflammation of the joints

Rheumatoid arthritis: This is behind the inflammation of the joints

When your joints hurt, the term rheumatism quickly comes up. Rheumatism includes several hundred diseases. One of the most common forms is rheumatoid arthritis. Painful and swollen joints for six weeks are the main symptoms. Fingers and hands are often affected, but rheumatoid arthritis can also affect other joints. In this article, you can read why early therapy is so important, what role inflammation plays in the joints and what differentiates rheumatoid arthritis from other joint diseases.

What is rheumatoid arthritis?

About one in 100 people will develop rheumatoid arthritis in their lifetime. This is an inflammatory disease of the joints, which progresses over time and leads to ever more severe symptoms. Another name for the disease is chronic polyarthritis.

By definition, joints connect two bones. There are different types of joints. What they have in common is that a synovium covers them. The synovial membrane produces the synovial fluid needed as the “grease” for the joint.

In rheumatoid arthritis, chronic inflammation leads to the destruction of the synovial membrane and, in the long term, to the destruction of the joint.

 

Causes: how does rheumatoid arthritis develop?

The exact cause of rheumatoid arthritis is not yet fully understood and is the subject of current research. It is well established that immune system dysfunction plays a vital role in disease. Usually, our immune system can distinguish between “self” and “foreign”. However, this is not the case with rheumatoid arthritis. There is a detection error in the immune system, and in the case of rheumatoid arthritis, the immune system attacks the synovial membrane.

This so-called autoimmunity against the synovial membrane explains the inflammation as an essential symptom of rheumatoid arthritis. The immune system always causes inflammation since our body fights invading bacteria, for example. However, this case is a sign of the wrong immune response. In rheumatoid arthritis, this inflammation can affect the joints and spread to organs such as the lungs, heart or eyes.

Osteoarthritis or Arthritis? Where’s the difference?

These two terms are often confused as both conditions lead to joint pain. As already described, rheumatoid arthritis is an inflammatory joint disease. Osteoarthritis, on the other hand, is not caused by inflammation. Osteoarthritis is the wear and tear in the joint caused by age and wear and tear.

This difference in therapy is essential. Rheumatoid arthritis that is detected early can be treated well with anti-inflammatory drugs.

 

Rheumatoid arthritis or arthritis?

In addition to the difference between osteoarthritis and arthritis, many different clinical pictures fall under the term arthritis. Strictly speaking, arthritis is primarily simply an inflammation of the joint. Where this inflammation comes from can vary greatly.

For example, joint inflammation can occur as part of psoriasis (psoriasis). This is called psoriatic arthritis. If arthritis occurs in childhood, it is called juvenile rheumatoid arthritis. At least seven subtypes are distinguished here. However, rheumatoid arthritis in adults is the most common form of arthritis.

Recognizing symptoms – how does rheumatoid arthritis manifest itself?

Rheumatoid arthritis can begin gradually or suddenly, like a flare-up. Those affected are usually between 35 and 50 years old. Women are affected significantly more often than men. The typical symptom is swollen, painful and warm joints. As a rule, both sides of the body are affected, not just one.

Depending on the stage of the disease and its course, very different symptoms can appear:

  • painful, swollen and overheated joints, especially when moving
  • decreased strength in the hands
  • stiff joints, especially in the morning
  • fatigue
  • Muscle aches
  • Carpal tunnel syndrome
  • Pain in the joints, even at rest (in later stages)
  • Rheumatoid nodules (hard inflammatory nodules under the skin)
  • Entzündung des Rippenfells (Pleuritis)
  • dry conjunctiva (keratoconjunctivitis sicca)

The course of rheumatoid arthritis can vary greatly. The disease usually causes permanent symptoms, but sometimes there are phases of sudden deterioration. In other cases, those affected experience almost no symptoms between attacks.

Which joints are affected by rheumatoid arthritis?

Since rheumatoid arthritis is an autoimmune disease, various joints can be affected. The symptoms most often appear in the metatarsophalangeal joints, i.e. the lowest finger joints. Other affected joints include:

  • wrist
  • Finger middle joint
  • Knee
  • Metatarsophalangeal joint
  • shoulder joint
  • Ankle joint on the foot
  • Joints of the cervical spine
  • hip joint
  • Elbow joint
  • Temporomandibular joint

The affected joints are listed in descending order of frequency. Here, too, the difference to osteoarthritis can be made clear again. Arthritis usually affects the metacarpophalangeal joints (between the metacarpals and the finger bones), while osteoarthritis affects the finger joints (connection between the second and third finger bones).

 

How do you diagnose rheumatoid arthritis?

It is essential to detect rheumatoid arthritis early. If the joints are swollen for longer than six weeks, you should consult a specialist in rheumatology. The longer you wait, the worse your chances of successfully treating the disease. Especially in the first six months, essential structures such as cartilage, bones or tendons are not yet attacked by the inflammation and can be protected with the right drug therapy. 

If rheumatoid arthritis is suspected, doctors can use various diagnostic options.

In addition to the physical examination, the blood values play an essential role. A test for various rheumatism proteins in the blood is carried out. These proteins, also known as rheumatoid factors, are created when the immune system is wrongly directed against your body. There are a whole range of different markers that can be determined. If these are positive, it is referred to as seropositive rheumatoid arthritis.

These rheumatoid factors do not have to be positive for everyone. You can also have rheumatoid arthritis without detecting rheumatoid factors in your blood. In this case, it is referred to as seronegative rheumatoid arthritis.

To see the damage to the joints in later stages, you can take an X-ray of the corresponding joints.

Therapy: What helps against rheumatoid arthritis?

Early therapy is crucial for the success of therapy in rheumatoid arthritis. The goal of therapy is “remission”. This means the inflammation is controlled, and no further joint destruction occurs.

To achieve remission on the one hand and to relieve the pain of those affected on the other hand, there are two pillars in the therapy of rheumatoid arthritis. On the one hand, the so-called essential therapy. These medications are long-acting anti-rheumatic drugs. They are summarized under the acronym “DMARD” (“disease-modifying-anti-rheumatic-drug”). One of the oldest representatives, which is still used today, is methotrexate (MTX). Methotrexate slows down the immune system’s excessive reaction and can help slow down the destruction of the synovial lining in the long term.

The second pillar of treatment is pain medication such as Ibuprofen—these help against the symptoms but not against the actual illness.

What can I do on my own?

Since the “DMARDs” affect the immune system, you are more susceptible to infections. For this reason, complete vaccination protection should be provided to protect against preventable diseases. General measures to strengthen the immune system are also recommended.

If your joints hurt during acute inflammation, you can try cooling them specifically to alleviate the discomfort.

A healthy, balanced diet and sufficient physical exercise also have a beneficial effect on the prognosis.

 

Prognosis – is rheumatoid arthritis a severe disease?

The course of the disease can vary from person to person. An accurate prediction is, therefore, difficult. The prognosis depends on many different factors. Women are more likely to have a more severe course than men. High inflammatory parameters (specific blood values ​​that can indicate inflammation in the body) and smoking also tend to lead to a worse prognosis.

The inflammation gradually leads to the destruction and deformation of joints, which can be detrimental to everyday life. If the heart or lungs are also affected by the inflammation, this can hurt life expectancy.

In recent years, however, more and more drugs have been approved for the treatment of the disease. These so-called biologicals or biologics can be used in severe forms of rheumatoid arthritis. The benefits and risks of these drugs are still being researched.

Overall, rheumatoid arthritis can have a limiting effect on quality of life. However, new therapeutic approaches and early diagnosis can mitigate the negative long-term consequences.

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