Today, more than 200 individual clinical conditions are counted among the various forms of rheumatic illnesses. What they have in common are inflammatory reactions in joints, tendons, connective tissue, blood vessels or the skin. An erroneous regulation of the immune system causes the body to attack its own cells. Not everyone suffering from a joint disease has rheumatism, and not everyone with a rheumatoid factor found in the blood has a rheumatic illness.
The following fall into the category of inflammatory rheumatic illnesses (caused by an autoimmune deficiency)
- Rheumatoid Arthritis (Chronic Polyarthritis)
- Spondylitis ankylosans (Morbus Bechterew)
- Psoriasis Arthritis (Joint Inflammation with Psoriasis)
- Juvenile Idiopathic Arthritis
- Reactive Arthritis (following infections with borrelia, chlamydia, yersinia, shigella, salmonella, mycoplasma and campylobacter)
- Lupus erythematodes
- Sjögren Syndrome
- Polymyositis and Dermatomyositis
- Morbus Wegener
- Vasculitides (inflammatory diseases of the blood vessels)
- Polymyalgia rheumatica (inflammatory rheumatism of the body's soft parts)
Metabolism Disorders, accompanied by inflammatory joint diseases
- Gout (caused by crystals of uric acid or other crystals in the joint)
- Hemochromatosis (iron metabolism disorder)
- Polyarthrosis (hereditary premature joint degeneration)
Rheumatism is not an illness that only affects older people. Children and young people can contract it, too. Frequent cases of rheumatism in the family may indicate a hereditary disposition.
The signs of rheumatoid arthritis are spontaneous painful swellings and redness of one or several joints.
Often, the joints at the base of fingers, but also knee, elbow, hand and shoulder joints are affected. Morning stiffness is typical, and the joints' flexibility improves over the course of the day and with the help of exercise. The illness frequently proceeds in stages, over weeks and months, often followed by painless intervals. The progressive destruction of the joint is the work of aggressive cells, which produce enzymes (collagenases) that infiltrate cartilage and bones, destroy their structure and ultimately result in arthrosis.
Suspicions of a rheumatic disease can be clarified through a precise interview of the patient and the examination of all typically affected joints, using ultrasonographic examination or the help of imaging procedures such as x-ray and magnetic resonance tomography. Blood and serum tests may confirm the diagnosis.
Yet the results of testing the blood for presence of what is called a rheumatoid factor may also be positive for other diseases such as hepatitis C, endocarditis (an inflammation of the heart's muscle) or parasitoses. A negative result does not exclude rheumatoid arthrosis. The determination of the anti-citrulline antibody (ACPA) is more specific. In most cases, the blood sedimentation rate and the CRP value in the blood are heightened. For a diagnosis of Morbus Bechterew, HLA B27 must be determined, and in cases of a suspected collagenosis, ANA and AMA must be tested.
Therapy administers anti-inflammatory drugs such as Antirheumatic Drugs (Diclofenac, Ibuprofen or Coxibe). Cortisone preparations can be used systematically, in the form of pills or through local injections, in order to stop the joint's degeneration. Basic therapeutic preparations (Methotrexate, Sulfasalazine, etc.) and recently also Biologicals (TNF Blockers), though they can not heal the disease, may delay the structural destruction of the body's joints and soft parts.
Surgical treatment of rheumatic diseases makes sense in cases where the degenerative process in a joint can not be stopped by medication but only though the removal of the joint's inner membranes (synovectomy). In individual cases, a radioactive substance is injected into the joint.
In many cases of advanced degeneration of the joint, the patient's quality of life can be improved today by the surgical replacement of the joint (total endoprosthesis - TEP).