The disease known in German as polyarthritis is the most common inflammatory disease of the joints.
The term "chronic polyarthritis" reflects the most important characteristics of the disease:
- Chronic stands for a long duration of the disease,
- arthritis means joint inflammation and
- poly means a large number of affected joints.
Internationally, polyarthritis is also known as rheumatoid arthritis. This is therefore a synonym for polyarthritis.
Rheumatoid arthritis is a chronic, inflammatory systemic disease. It starts from
- the synovial membrane,
- the tendon sheaths and
- bursae
and leads to damage to the joints, tendons and bones. The small joints of the hands and feet are just as at risk as the large joints of the upper and lower extremities. The final stage of the disease can lead to severe disabilities.
The video shows the progression of the disease in the hip joint:
Around 0.5 to 1 percent of all people worldwide suffer from rheumatoid arthritis. In Germany, it is estimated that around 800,000 people suffer from the disease, with women being affected around three times more often than men. The disease can occur at any age, most frequently between the ages of thirty and fifty.
The development of rheumatoid arthritis is an immunological process. This leads to uncontrolled activity of the immune system, resulting in permanent inflammation.
It is likely that rheumatoid arthritis is caused by a genetically anchored different reaction capacity of the immune system.
In recent years, research has made many advances in understanding rheumatoid arthritis. Nevertheless, the cause of the disease has still not been clarified.
A malfunction of the immune system is conceivable: cells of the immune system attack the body's own substances (e.g. joint cartilage). This is why polyarthritis is classified as an autoimmune disease.
Infectious agents (viruses or bacteria) may also play a role at the onset of the disease. To date, there is no reliable information on this. A hereditary predisposition is probably also necessary, which leads to the outbreak of the disease when it comes into contact with certain infectious agents. It also influences the severity of the polyarthritis.
Tissue hormones that promote inflammation (so-called cytokines) also play an important role.
Research findings in recent years have opened up new possibilities for the treatment of rheumatoid arthritis. They can also lead to the hope of a better prognosis, even if the cause of the disease is unknown.
The inflammatory changes in the joint lining (pannus) are at the heart of the disease. The inflammatory growths of the synovial membrane overgrow the joint cartilage.
The persistent inflammation develops messenger substances and enzymes that further damage the cartilage. The pannus can also grow into the bone and attack the cartilage from the edge of the joint.
The pannus and joint effusion are followed by a painful movement disorder with muscle breakdown.
Joint destruction in rheumatoid arthritis © GraphicsRF / Fotolia
In later stages, the joint capsule becomes scarred with increasing restriction of movement. Other courses show progressive destruction of the cartilage and bone with sometimes serious misalignment of the joints (mutilation).
In the end, the result is a contracted, destroyed joint with
- gross deformation of the joint-forming bone parts,
- instability or
- connective tissue stiffness.
The cartilage damage leads to secondary osteoarthritis. It can overlay the clinical picture and even dominate in late cases.
Pathways of joint destruction in rheumatoid arthritis (according to Mohr):
- Cartilage destruction via the synovial fluid
- Proliferating synovial tissue (red pannus tissue) overgrows the cartilage and penetrates it destructively
- Proliferating synovial tissue pushes itself between cartilage and bone
- Proliferating pannus tissue penetrates the bone marrow
- Pannus tissue spreads from the medullary cavity back to the cartilage
Rheumatoid arthritis develops gradually or progresses in episodes, with periods of apparent inactivity in between.
The early stage is characterized by
- symmetrical, spongy joint swelling (especially in the middle and metacarpophalangeal joints of the fingers and toes)
- morning stiffness,
- pain.
However, an atypical attack with acute involvement of large joints also occurs. Rheumatoid nodules can develop on the extensor sides of the extremities.
The forms of progression are extremely varied. They range from occasional episodes of joint pain to progressive joint destruction.
A special feature is the affection of the synovial head joints. It can lead to displacement of the head in relation to the cervical spine and cause damage to the spinal cord. This results in varying degrees of sensory and movement disorders.
Characteristic deformities occur in the later stages. These include
- the ulnar deviation of the long fingers (ulnar deviation),
- a prominent ulnar head,
- swan-neck deformity and buttonhole deformity of the long fingers and
- loss of function due to tendon ruptures.
Pain and restricted mobility are most pronounced in the morning. The immobility on waking is referred to as morning stiffness. Depending on the activity of the disease, this morning stiffness can last for several hours.
In addition to this typical onset of rheumatoid arthritis, occasionally only a few large joints are inflamed at the beginning, often the shoulder joints in old age.
Over the course of weeks or months, more and more joints can become inflamed. In addition to the joints, the tendon sheaths become inflamed and swollen (e.g. the finger extensor tendons on the back of the hand). The spine, usually the cervical spine, and bursae can also be affected, the latter often at the elbow.
General symptoms such as
- Fatigue,
- poor performance,
- fever,
- night sweats and
- possible weight loss
show that the whole body is involved in the inflammatory process.
A characteristic feature of up to 20 percent of cases is the formation of so-called rheumatoid nodules, particularly in the elbows and fingers.
The disease often progresses in episodes, which means that the joints are particularly painful for some time. This is accompanied by a pronounced feeling of illness.
Overall, the course of rheumatoid arthritis is very variable. Spontaneous remission (without therapy) can be expected in around 10 percent of sufferers.
The special feature of this disease is the attack of inflammatory cells and substances on the joint cartilage and bone. If the inflammation continues unchecked, these joint structures are increasingly broken down and the joints are destroyed. The video shows the process of joint damage.
In severe cases, other organs can also be affected, e.g.
Correct diagnosis at an early stage is important for all rheumatic diseases. This enables the doctor to initiate effective therapy to prevent secondary damage.
The diagnosis of rheumatoid arthritis is made
- based on the symptoms of the disease and
- by means of a rheumatological examination
examination. The doctor uses recognized criteria as a guide. For example, the American College of Rheumatology (ACR, American Rheumatology Society) has presented criteria. They help to identify previously unexplained multiple joint inflammation as rheumatoid arthritis. These include
- Stiffness of the joints in the morning,
- joint inflammation in three or more joint regions,
- joint inflammation of the finger joints,
- symmetrical affection,
- rheumatoid nodules, rheumatoid factors and
- typical X-ray changes.
Laboratory tests can identify rheumatoid factors and inflammatory markers. Rheumatoid factors are also found in other diseases, although they have no diagnostic significance. They therefore do not prove rheumatoid arthritis, but only indicate it.
The laboratory test is often uncharacteristic in the early stages. However, there is a permanent increase in inflammatory parameters. Rheumatoid factors can be detected in 80 percent of cases of the disease. The CCP value is much more accurate for diagnosis.
X-ray examinations are required at the onset of the disease and during the course of the disease in order to assess the extent of bone damage.
Additional information about soft tissue in the joint is obtained using ultrasound, e.g.
- joint effusion and
- the inflammatory thickening of the synovial membrane.
More complex diagnostic imaging procedures are used for specific questions. These include magnetic resonance imaging(MRI) for inflammatory involvement of the cervical spine.
If the cause is known, the disease can be treated or cured with targeted causal therapy. Unfortunately, the cause of the development of polyarthritis is still not fully understood.
A whole spectrum of therapeutic measures is therefore often required. They aim to alleviate pain and disease activity and improve the prognosis.
The rheumatologist compiles the individual therapeutic measures according to the patient's individual disease situation. They then check the effectiveness of the therapy in collaboration with the family doctor.
Drug therapy for chronic polyarthritis
A range of medications is available for the treatment of chronic polyarthritis. There are different groups of drugs and a large number of preparations with different efficacy and side effect profiles. For this reason, special experience is required when adjusting drug therapy.
The most important thing is to adjust therapy with so-called basic drugs. These can prevent the progression of the disease. With the combined use of different basic drugs (so-called "combination therapy") and the development of new drugs, it is possible to halt the progression of the disease process and improve the quality of life of more and more patients.
In drug therapy, doctors distinguish between basic therapy and symptomatic therapy:
Basic therapy has been virtually revolutionized in recent years. New basic therapeutics, so-called biologics, intervene directly in the inflammatory process of the synovium at various points. However, blocking substrates (antibodies) can now also be used effectively at other points in the inflammatory process. For example, they can be used against interleukin-1 or activated inflammatory cells.
The aim of this new biologic therapy is to achieve remission of the disease, i.e. to bring the inflammation to a quiescent state. Cytostatic drugs such as methotrexate or azathioprine are also used.
Non-steroidal anti-inflammatory drugs such as ibuprofen, diclofenac or cortisone preparations are available for symptomatic therapy. Attention must be paid to undesirable side effects with all preparations. The consequences of long-term cortisone therapy are a well-known example.
Overview of drug therapy:
- Rheumatic painkillers (so-called non-steroidal anti-inflammatory drugs): help with inflammatory pain
- Cortisone: rapid effect on the inflammatory reaction (but problematic in the long term due to side effects)
- Basic rheumatism medications: help in the long term against inflammation and joint destruction
- Local therapy measures: Cortisone injections into joints, chemical or nuclear medicine synoviortheses (sclerotherapy of the inflamed synovial membrane)
Nutrition for chronic polyarthritis
A suitable diet can also improve symptoms. For example, a diet rich in calcium and vitamin D can prevent osteoporosis (bone loss). Unfortunately, the course of the disease cannot be fundamentally influenced by a change in diet.
Vitamin D helps to prevent polyarthritis © bit24 / Fotolia
Physical therapy for rheumatoid arthritis
Physical therapy continues to play an important role alongside medication.
Suitable positioning and splinting of the affected extremity should be ensured at an early stage. This helps to prevent contractures and joint misalignments.
Physiotherapy and occupational therapy for mobilization and muscle care play an equally important role. Heat applications (packs, baths, mud) are mainly used in intervals and for spa treatment. Patients usually tolerate cold therapy better during flare-ups.
Malpositions and contractures can be treated functionally using suitable splints.
Surgical therapies for chronic polyarthritis
Early surgical removal of the synovial membrane (synovialectomy) can improve the clinical picture by removing the inflammatory pannus and also slow down further destruction in the affected joint.
Alternatively, or in combination with radiosynoviorthesis, the proliferating synovial tissue can be suppressed using a radionuclide.
In addition to synovialectomy, a number of surgical reconstructive procedures can be considered:
- Tendon replacement arthroplasty,
- joint reconstructions,
- capsular retraction and
- nerve solutions
can improve the situation of destroyed joints individually or in combination. Under certain circumstances, they can also counteract the progression of destruction.
Endoprosthetic joint replacement is one of the most successful surgical procedures for rheumatism patients. Today, an artificial joint is available for almost all joints. The application depends primarily on the pain, but also on
- progressive destruction and
- functional deficits.
Rheumatism patients often suffer from multiple joint destructions, so that a step-by-step plan must be drawn up in a specialist clinic. It should exhaust all possibilities of conservative and surgical therapy.
Important measures for chronic polyarthritis at a glance
- Physiotherapy: to maintain joint function, muscle strength and mobility
- Physical therapy: to relieve pain, e.g. cold therapy, electrotherapy
- Occupational therapy: how do I relieve my joints, how can I put weight on them, which aids?
Other measures include
- Orthopaedic therapy: insoles, crutches, splints, surgical measures (e.g. joint prostheses)
- Psychological therapy: for coping with illness and pain
- socio-medical measures: Job security, retraining, rehabilitation
- Education and information contribute significantly to the success of the therapy
Tips for dealing with the disease
Rheumatoid arthritis is a long-term disease. In addition to changes in the joints and organs of the body, it also leaves its mark on the person's emotional life. Dealing with pain and functional limitations on a daily basis and having to give up activities that used to be taken for granted is not easy to cope with.
Changes in daily life are necessary, both in terms of the professional and family situation. The help of other people must be called upon in order to cope with the disease in everyday life.
Patient training and information from
- books,
- information leaflets and
- the Internet
can help to adjust to the new life situation.
