Rheumatic diseases are some of the most common reasons for consulting a physician. We distinguish between degenerative and inflammatory rheumatic diseases whereby the most common symptom in both cases is massive pain. While degenerative disorders can often be treated successfully by physical therapy or by applying pain/inflammation reducing agents (infiltrations and infusions are also possible), inflammatory rheumatic diseases require immunomodulation, i.e. agents that actively influence the immune system.
Osteoporosis, osteoarthritis and fibromyalgia are also rheumatic diseases, and are treated by a rheumatologist.
Treatment of inflammatory rheumatic diseases has improved dramatically during the past few years due to the development of so-called Biologicals and JAK-inhibitors. We know today that most of the common inflammatory diseases can be brought to a halt or at least be slowed down, providing the best suitable treatment is started at an early stage.
However, since these biological drugs affect the immune system and may cause some side-effects, they should only be prescribed by an experienced rheumatologist based on his careful diagnosis.
Many rheumatic diseases require long-term guidance and treatment. A good relationship between patient and doctor is, therefore, of great importance.
The most common rheumatic diseases at a glance.
Rheumatoid arthritis (RA) is the most common inflammatory joint disease. Common symptoms include pain, swelling and morning-stiffness mainly of the hand- and finger joints but also of the knees, ankles and metatarsophalangeal joints.
If these symptoms remain unrecognised and untreated for a longer period of time, irreversible damage and loss of function of the affected joints can occur.
The diagnostic assessment should be performed by an experienced rheumatologist and might require specific laboratory blood tests and distinct radiological tools (like for example X-ray, MRI and ultrasound).
The therapeutic tools have been widely expanded during the last years and have two goals: pain reduction and pain “freeness” as well as successful inhibition of inflammation and remission of the disease.
Besides the “classical” non-steroidal anti-inflammatory drugs and, if necessary, glucocorticoids, so called disease modifying antirheumatic drugs (DMARDs) are the main stand of RA-therapy. DMARDs actively influence the immune response and inhibit disease activity. Another class of substances that have been shown to be highly effective in RA therapy if DMARDs (fully or partly) fail are the so called biologicals and, even more recently, the JAK-inhibitors. These drugs specifically aim at distinct messenger substances perpetuating the disease.
However, there is no “better” or “worse” drug, so the ideal therapy should be considered taking many factors like age, desire to have children, distinct organ functions into account to tailor and also – if necessary – adapt the ideal therapy.
The term seronegative Sponyarthropathies represents a group of diseases that is characterised by a negative rheumatoid factor.
Three main diseases can be differentiated:
- Psoriatic arthritis
- Ankylosing Spondylitis
- Reactive Arthritis
Seronegative spondylarthropathies can affect perpheral joints (fingers, hands, feet, ankle or knees) but also the spine and the sacroileacal joints (mainly in ankylosing spondylitis). Due to the heterogenity of the spondylarthropathies, the diagnosis requires sensitiveness and experience
Similar to rheumatoid arthritis during the last decade the therapeutical options could be expanded. TNF blockers as well as Interleukin-17 blockers can stop or decelerate the progression of the disease and/or limit the pain.
Connective tissue diseases
Connective tissue diseases
This term comprises distinct autoimmune diseases that affect organ systems:
- Systemic lupus erythematosus
- Systemic sclerosis/Scleroderma
- Mixed connective tissue diseases
- Poly- and Dermatomyositis
It is not uncommon that these patients suffer from unspecific symptoms like fatigue, muscle and joint pain but also dryness of the mouth, skin rash and of the fingers and hand. Connective tissue diseases may progress very slowly with very decent symptoms, can flare from time to time or can also occur very suddenly. However, if some of these complaints persist for a longer period of time, it is absolutely necessary to perform an assessment by a rheumatologist.
This comprises a detailed anamnesis, status, specific laboratory tests but also screening of other organs like the kidneys, heart, ling etc. After these evaluations a specific therapy can be started.
Vasculitides represent a group of autoimmune diseases that are characterised by an inflammation of the vessel wall. Amongst them are giant cell arteriitis, Wegeners granulomatosis (M. Wegener), Takayasu Arteriitis, Churg Strauss Vasculitis and others. Depending on the kind of Vasculitis, younger or older patients as well as large (like the aorta) or small vessels can be affected.
The symptoms can vary: Giant cell arteriitis is often is associated with temporal and jaw pain, whereas Wegener Granulomatosis might present itself with sinusitis, failure of kidney function and coughing. Since, vasculitides represent very complex diseases; they require an extensive diagnosis followed by an immunosuppressive therapy.
Polymyalgia rheumatica and Giant cell arteritiis
Polymyalgia rheumatica (PMR) and Arteriitis temporalis are often mentioned in the same context since the can (but only rarely) occur together.
PMR is a soft tissue rheumatism, which mainly affects older people and is characterised by intense tensions and muscle pain. This pain is located mainly in the shoulders and hips. The disease is usually characterised by a typical laboratory constellation and should be treated by an experienced rheumatologist for a longer period of time.
Giant cell arteriitis is part oft the group of vasculitides and is an inflammation oft the large and medium sized vessels often characterised with temporal pain and pain of the jaw muscles. Also affecting mainly the elderly and diagnosed to late, it can lead up to blindness. There are several ways to diagnose the disease and ultrasound is a more and more commonly used method. Early recognized the disease usually can be treated well by a rheumatologist.
Polymyalgia rheumatica and Giant cell arteritiis
Most of our joints are coated by a cartilage surface that facilitates the smooth movements joints perform during daily activities. However this cartilage surface can be reduced with increasing age due to overuse or traumatic affections narrowing the neighbouring bones leading to intense pain and inflammation.
The joints mostly affected by osteoarthritis are on the one hand the large joints like hip and knee but on the other hand also the finger and thumb joints.
The most important differential diagnosis, which sometimes can be tricky to distinguish, is rheumatoid arthritis. From a therapeutic point of view there exist several treatment options including pharmaceutical drugs, physical therapy and orthopaedic procedures.
My close collaboration with other disciplines allows to develop a wholistic treatment concept.
Osteoporosis represents a widespread disease, affecting more and more people with an increasing life expectancy. Initially (similar to high blood pressure) not associated with any symptoms, the effects on the long-term might be serious.
The risk of bone fractures (mainly hip fractures) during exercise or after tumbling is increased and might lead to prolonged hospitalisation. Spontaneous fractures of the vertebral spine are common and often require high dose intake of pain killers.
Thus, the early diagnosis and even better, prevention of development osteoporosis is in great demand. Using osteodensitometry, i.e. measurement of bone density, osteoporosis or a preliminary phase, so called osteopenia, can be diagnosed.
By blood and urinary analysis bone metabolism can be precisely determined allowing a tailored therapy aiming to stop the loss of bone mass or even increase it.
The term fibromyalgia describes a non inflammatory soft tissue disease, occurring as an idiopathic disease or, secondary, in combination with other rheumatic diseases.
The leading symptom is an unspecific muscle pain that can affect the whole body and often is associated by extensive fatigue and sometimes depression. From a differential diagnostically point of view it is extremely important to separate it from other inflammatory diseases.
If the diagnosis of primary fibromyalgia is confirmed there exist several therapeutic options, including medical, physical and life-style approaches.
Pregnancy and rheumatic diseases
Pregnancy might influence the course of inflammatory rheumatic diseases. Moreover, some of the drugs that are used for the treatment of these diseases are contraindicated and might be harmful during pregnancy. Thus, in inflammatory rheumatic diseases a pregnancy should be carefully planed and tightly controlled by an experienced rheumatologist.