The frequency is around 1%. Despite this, the disease is unfortunately still often diagnosed and treated too late, which can lead to damage and functional impairment of the joints. In this chronic joint inflammation, the body’s own immune cells damage the joint lining. This results in pain, swelling, immobile and stiff joints and possibly damage to the cartilage. Ultimately, rheumatoid arthritis cannot be cured, but with timely diagnosis and treatment, symptoms can be alleviated and the development of damage can be prevented or delayed.
Overview: What is rheumatoid arthritis?
Rheumatoid arthritis is an autoimmune disease that is mainly associated with inflammation of the joints. The immune system incorrectly identifies parts of the body as foreign and problematic. Inflammation is the noticeable and measurable result.
The inner skin of joints, bursae and tendon sheaths are attacked by immune cells and ultimately destroyed. The disease often progresses in episodes lasting several weeks. In addition to various joints, internal organs are sometimes also involved. Women are affected three times more often than men. Although rheumatoid arthritis can occur at any age, even in children, the risk increases with age. The onset of the disease is usually between 40 and 50 years of age.
Rheumatoid arthritis: causes and risk factors
The importance of the immune system in the development of rheumatoid arthritis is undisputed, although the exact causes are not yet fully understood. In addition to certain viruses and bacteria, which may well be a trigger, hereditary factors are also involved in the disease. In addition, obesity, smoking and periodontitis are among the factors that promote the development of the disease.
Rheumatoid arthritis probably develops over several years as a result of a combination of different factors. The complex human immune system develops a kind of misprogramming. Immune cells trigger inflammatory processes in the joints. As a result, the synovial membrane proliferates and joint effusion or synovitis can occur. Over time, the cartilage, bones and ligaments of the joint are destroyed. White blood cells remove dead particles while releasing other inflammatory substances. This starts a vicious circle that must be countered by treating and minimizing the risk factors.
Symptoms: Rheumatoid arthritis
In the early course of rheumatoid arthritis, there may be unspecific signs of the disease that do not initially point directly to the cause. These include:
- Exhaustion
- Loss of appetite
- Rare weight loss
- Fatigue
- Elevated temperature or slight fever
- Poor performance
- Sleep disturbances
- Sweating at night
In addition, there are typical signs that affect the musculoskeletal system with varying degrees of intensity, whereby the onset is often gradual and the symptoms can develop over weeks and months. The symptoms often occur in episodes, which means that the symptoms may subside in the meantime. As a rule, several joints are affected, whereby oligoarthritis (2-4 joints) or polyarthritis (> 4 joints) may be present. In rare cases, a single joint is affected (monoarthritis). Possible symptoms are
Joint pain
These are often more pronounced at rest. The pain increases with pressure, bending or stretching. The metacarpophalangeal joint, metacarpophalangeal joint, wrist and metatarsophalangeal joint of the toes are often affected symmetrically on both sides of the body. The finger end joints are not usually affected and therefore do not indicate rheumatoid arthritis.- Joint swelling: The swelling can lead to pressure on nerves (e.g. in the wrist area) with subsequent discomfort and numbness. The metacarpophalangeal joints (MCP) are typically affected.
- Joint overheating
- Rare reddening of the joints
- Decrease in mobility
- Morning stiffness: Immobile joints after waking up for up to an hour, usually improves with movement and during the course of the day. Morning stiffness that lasts only a short time is often found in osteoarthritis.
- Tendinitis: swelling and pain in the area of the affected tendons (e.g. in the wrist and ankle).
- Decreasing strength when gripping: This is an early sign and leads to noticeable limitations in everyday life (for example, opening screw-top jars).
- Joint deformation: This occurs in the case of prolonged, uncontrolled inflammation. Joint deformities have decreased in recent years due to better diagnostics and advances in therapy. The following deformations can occur.
Ulnar deviation (distortion of the fingers away from the thumb)
Swan neck deformity (hyperextension of the middle phalanx and buckling of the last phalanx)
Buttonhole deformity (protrusion of the knuckles of the middle finger joints)
Hyperextension of the thumb end joint
Deformation of the metacarpophalangeal joint of the thumb
- Rheumatoid nodules: In around a fifth of those affected, benign, coarse, rubber-like, sometimes movable nodules form on the tendons or under the skin, on the elbows, hands, Achilles tendon and shin. Like joint deformities, the frequency of these has decreased in recent years.
As rheumatoid arthritis progresses, it may also lead to other inflammatory foci in other organs. This means that various diseases of the heart, lungs, liver, kidneys, eyes and blood vessels can lead to a wide range of symptoms, and depending on the organ affected, the situation may be life-threatening. Possible organ manifestations are
- Pericarditis
- Inflammation and dryness of the eyes and mouth
- Inflammation of blood vessels (vasculitis)
- Inflammation of the lungs with proliferation of connective tissue (pulmonary fibrosis)
- Pleurisy (inflammation of the pleura)
- Inflammation of the cornea and conjunctiva of the eyes
Special mention should also be made of the generally increased risk of cardiovascular events (e.g. heart attack) in arthritis patients, so that appropriate measures should be taken (including diet, exercise, optimal adjustment of blood lipid levels, blood sugar and blood pressure).
Rheumatoid arthritis: diagnosis at the USZ
Although early detection (within the first three months of the onset of symptoms) of rheumatoid arthritis is extremely important, diagnosis can be difficult due to the non-specific initial symptoms. There are no clear tests, so a combination of self-observation by the person affected and diagnostic methods is the most successful option. The diagnosis of rheumatoid arthritis requires a great deal of experience. The main pillar is a detailed survey in which the following points, among others, are recorded:
- In which joints are there pain and swelling?
- When do the complaints occur (especially the question about pain at rest)?
- How long does the morning emphasis resp. the morning stiffness?
- Restrictions in everyday life?
- Accompanying symptoms?
A physical examination is also carried out in which all joints, including unaffected joints, are inspected and palpated for tenderness, swelling and functional impairment. In addition, the following blood values are checked:
- Various inflammation values (erythrocyte sedimentation rate, C-reactive protein). These are often elevated.
- Autoantibodies (rheumatoid factor, anti-citrullinated protein/peptide antibodies, also known as ACPA, possibly other antibodies). These antibodies are often positive (seropositive rheumatoid arthritis), but not always (seronegative arthritis).
- It is not uncommon to find anemia in the laboratory, due to chronic inflammation (inflammatory anemia).
Some of these blood values can sometimes indicate rheumatoid arthritis years before the onset of the disease. If you have an elevated ACPA level, you can take targeted countermeasures to prevent the disease or at least mitigate and slow down its progression if necessary:
- X-ray: typical changes in affected joints on hands and feet (late signs)
- Ultrasound: bone defects and areas of inflammation in joints, bursae, tendon sheaths
- Rarely MRI (magnetic resonance imaging), scintigraphy
Rheumatoid arthritis: prevention, early detection, prognosis
As the causes of rheumatoid arthritis are not fully understood, prevention and early detection are only possible to a limited extent. It is certain that smoking and obesity promote the development of the disease and accelerate its progression. Furthermore, these risk factors are associated with a more severe course and a less good response to therapy. Good oral hygiene can also counteract the development of rheumatoid arthritis.
Early detection is possible in some cases by means of a blood test for rheumatoid factors and the ACPA value explained above. In the case of existing rheumatoid arthritis, a complete cure is not possible. The damage caused cannot regenerate. The aim is therefore to slow down and, in the best case, completely reverse the disease activity. The combination of various therapeutic measures with an adapted lifestyle usually achieves good results.
Self-help groups
The exchange with people who are affected by the same disease can be a great support in coping with the disease. Advice on finding a suitable self-help group is available from Selbsthilfe Zürich. Self-Help Zurich and the University Hospital Zurich are cooperation partners in the national project “Health literacy thanks to self-help-friendly hospitals”.
Rheumatoid arthritis: Treatment
Treatment of rheumatoid arthritis is ideally made up of many different components. In addition to medication, injections and, less and less frequently, surgery, treatment also includes supportive physiotherapy, occupational therapy and physical therapy. Patients should work out a treatment plan with their doctor that is tailored to their individual needs.