Introduction

Photo of a woman wearing a red scarf (PantherMedia / racorn)

There are many different rheumatic diseases, but rheumatoid arthritis is probably the most common. In rheumatoid arthritis, people usually have several permanently inflamed joints. This causes the joints to gradually become deformed and stiff. Over time the muscles also weaken.

Someone with advanced rheumatoid arthritis may have difficulties with simple tasks such as washing themselves, eating with a knife and fork, or buttoning up a shirt. Other symptoms such as pain and fatigue can be very troublesome too. This disease can also affect other parts of the body, like the blood vessels or certain organs.

Rheumatoid arthritis usually gradually worsens over the course of many years. Various treatments can relieve the pain and slow the progression of the disease. Early diagnosis and treatment can help to prevent damage to the joints.

Symptoms

The first sign of rheumatoid arthritis is often the swelling of individual joints, causing pain and stiffness, especially in the finger joints. Other symptoms typical of rheumatoid arthritis may develop over time, such as muscle weakness. But rheumatoid arthritis can also cause more general symptoms in some people, like exhaustion or loss of appetite, or sometimes even a mild fever.

The typical symptoms of rheumatoid arthritis include the following:

  • Warm, swollen joints: It's common for the same joints to be swollen on both sides of the body, for instance the fingers of both the right and left hand.
  • Painful joints
  • Stiff joints: After longer periods of rest, and especially in the morning right after you wake up, your joints are stiff. They usually only become more flexible again after an hour or more, or once you have been active for a while.
  • Weakness: Painful, stiff joints often end up not getting as much use, which can cause the muscles to gradually weaken.
  • Exhaustion: Rheumatoid arthritis is an inflammatory disease that affects the entire body. So it often causes tiredness, general physical weakness and occasionally more extreme exhaustion (fatigue).
  • Rheumatoid nodules: As the disease progresses, small hard lumps called rheumatoid nodules sometimes develop under the skin. They're usually not sensitive to pressure or touch.

Rheumatoid arthritis symptoms vary a lot from person to person: It might be that a different joint is affected, or that other symptoms are causing the most trouble.

Swollen or stiff outer finger joints are very common. They are typically a sign of a specific form of osteoarthritis. These two conditions are often confused, but they are different: rheumatoid arthritis is an inflammatory disease and osteoarthritis is related to the effects of wear and tear on the joints. There are also major differences in terms of both treatment and outlook.Illustration: Joints commonly affected by rheumatoid arthritisRheumatoid arthritis: Commonly affected joints

Causes

Rheumatoid arthritis is an autoimmune disease. This means that your own immune system attacks your body. Our immune system can usually tell the difference between our own cells and foreign cells, organisms and other objects. That is how it can protect our body from germs and other harmful substances. An autoimmune disease disrupts this mechanism: The immune system mistakenly identifies our body's own cells as foreign substances and attacks them. This causes an inflammatory response that especially affects the joints in people who have rheumatoid arthritis.

Genes seem to be one of the factors that determine whether or not someone gets rheumatoid arthritis. There are also theories about certain viruses or bacteria causing autoimmune responses. The causes of rheumatoid arthritis are quite complex though, and have yet to be fully understood.

Smoking is a factor in the development of rheumatoid arthritis and may have a negative effect on its further progression. There are no other known behavior-related risk factors.

Prevalence

In Germany, about 1% of all adults have rheumatoid arthritis. It affects women twice as often, and usually develops in people over the age of 50. But women in particular may get rheumatoid arthritis at a younger age. Sometimes even children and teenagers are affected.

Outlook

Rheumatoid arthritis is usually first noticed in the fingers, wrists or toes, and sometimes the elbows, ankles, or knees as well. Both sides of the body are typically affected. Joints close to the torso, such as the shoulder joints or collarbone, may also become inflamed.

Rheumatoid arthritis can progress in very different ways. In one study involving people with rheumatoid arthritis, ten years after they had developed the condition

  • just under 50% of the participants reported minor limitations,
  • a good 40% reported moderate limitations, and
  • about 10% reported severe limitations in their everyday life.

These limitations include difficulties with things like getting up in the morning, getting dressed or preparing food – for example, opening packages, bottles or jars.

Symptoms may gradually worsen, or they might not change for a long time. Sometimes the symptoms come and go in episodes, so the inflammation and pain may suddenly get worse and then improve again after a while.

Effects

In the late stages of rheumatoid arthritis, parts of the body other than the joints may be affected in some people. The inflammatory processes can also affect the blood vessels, increasing the likelihood of cardiovascular disease. But this is relatively rare, and is influenced by whether someone already has other risk factors for cardiovascular disease – like being overweight or having high blood pressure.

Tear ducts and saliva glands may also become inflamed, lowering production of tears and saliva. In very rare cases organs like the lungs, the liver or the kidneys may also be affected.

Diagnosis

After an in-depth discussion of the problem with your doctor, you will have a thorough physical examination. The most important thing is to see which joints are swollen. Specific finger and toe joints are usually inflamed in rheumatoid arthritis. But swelling and pain in larger joints like the shoulders or knees may also be a sign of rheumatoid arthritis. It's also important to find out how many joints are affected and how long they've been inflamed.

Blood tests are used to detect certain antibodies and signs of inflammatory response. But these tests only have limited usefulness in early diagnostics because the results may vary for other reasons as well.

It can be difficult to diagnose rheumatoid arthritis at an early stage because the symptoms are often very mild in the first few weeks and months, and may not be typical. Rheumatologists are specialists for diseases like rheumatoid arthritis and are a good starting point for someone who thinks they may have it. It's easier to diagnose rheumatoid arthritis in someone who has had it for a longer time. This is because, in addition to the typical physical symptoms, changes in the joints are often clearly visible or can be seen using x-rays or ultrasound. It's not always possible to see these changes in the first few weeks or months.

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Treatment

Rheumatoid arthritis is treated with both medication and non-drug approaches, such as physiotherapy. There are also various support aids available for making everyday tasks easier. Which of these treatments are suitable options will depend on, for example, how severe the inflammation and the symptoms are, how advanced the disease is, the expected progression of the disease – and how well previous treatments have worked.

Medication can

  • reduce inflammation and help keep the disease from getting worse,
  • relieve symptoms like pain and swelling, and
  • help people move their joints more easily again, or at least maintain joint flexibility for as long as possible.

There is currently no cure for rheumatoid arthritis.

Physiotherapy and sports can help improve or maintain flexibility, strength and joint function. Many types of sports are suitable for people who have rheumatoid arthritis, including cycling, brisk walking, dancing, aerobics, strength training, swimming and water aerobics. Occupational therapy can be used to maintain your flexibility and hand strength, and to learn how to cope with rheumatoid arthritis in everyday life.

Psychological treatments are also sometimes used to help relieve pain and minimize the impact it has on everyday life. They are also intended to help relieve disease-related anxiety and depression that some people develop.

Support aids are designed to help compensate for physical limitations and help with daily activities. These include orthopedic shoe inserts, grabbing aids and specially designed cutlery.

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Rehabilitation

Rehabilitation is one option for people whose rheumatoid arthritis has not been well managed for a longer period of time and who may have not been able to go to work for a while as a result. The information about rehabilitation given here is specific to the situation in Germany, but the circumstances may be similar in other countries. The aim of rehabilitation is to cope with the disease better in everyday life, to start getting out of the home again, and to continue working or be able to go back to work again. But it may also be suitable for retired people. Rehabilitation can help them gain maximum independence and prevent the need for extra nursing care.

A number of different specialists are involved in rehabilitation, including rheumatologists, physiotherapists, occupational therapists, social workers and psychologists. Rehabilitation usually lasts about three weeks. Having inpatient rehabilitation means that you will stay at the hospital or rehabilitation center the entire time. Outpatient rehabilitation involves day-long visits to the center.

Depending on the goals of rehabilitation and your insurance plans, the costs will be paid by statutory pension, health or accident insurance (in Germany). Conditions for coverage require that a doctor has decided that rehabilitation is necessary and that the rehabilitation application has been approved by the insurer.

Everyday life

Rheumatoid arthritis and associated problems like pain, exhaustion, drug side effects and physical limitations can all have a major impact on everyday life. People who have rheumatoid arthritis often need more time for everyday activities and may require more and longer breaks to rest. There are a number of different time-consuming things that they have to take care of: frequent visits to the doctor, taking their medication correctly, and getting hold of support aids. High levels of exhaustion can also mean that people who have rheumatoid arthritis need more sleep, have difficulties concentrating and find it hard to stay active. The disease is often associated with feelings like anxiety about the future and sadness, as well as anger at having rheumatoid arthritis. This is not always easy for others to understand.

But many people learn to manage their disease so that they can cope better with the symptoms and are still able to live a fulfilling life despite the limitations.

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Further information

There are a number of different options for people with rheumatoid arthritis to find support within Germany, including self-help groups and information centers. Support services may be organized quite differently from region to region, though, and they are not always easy to find. Our list can help you find and make use of local services.

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Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?”

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