This includes approximately 200 individual diseases with different forms – but one thing all have in common: pain. The good news is, many patients can be helped already well with the medicines available today – but the decisive factor is a possible early start of therapy.
When speaking generally of rheumatism, one usually thinks so inflammatory joint pain. Physicians together under the generic term “rheumatism” However, a variety of different diseases together, associated with severe pain and loss of motion. Not only joints can be affected, but also the bones, muscles, tendons and ligaments. Is this autoimmune rheumatic forms may also organs such as heart, kidney, gut or the brain be affected – some with life-threatening consequences.
Every can meet rheumatoid arthritis
Rheumatoid arthritis include degenerative joint and spine diseases such as osteoarthritis. Do not confuse these wear-related joint pain, however, rheumatoid arthritis (RA) – the most common form of inflammatory rheumatic diseases. Women are mostly affected twice as often as men (see figure).
It is commonly assumed that rheumatism is a disease of old age. In fact, they can also affect anyone. In particular, the autoimmune inflammatory form occurs already in young adults and children. Rheumatism is 15,000 affected by asthma and diabetes even in the third most common site of chronic diseases in childhood and adolescence. This is referred to Juvenile idiopathic arthritis (JIA).
Smoking doubles the risk of RA
The individual cause of RA is not explored until today, it is nonetheless clear that it is an autoimmune disease. The own immune system attacks the body’s own cells and tissues. It can no longer distinguish between their own and other bacteria or viruses and produces antibodies and inflammatory cells that destroy untreated gradually the articular cartilage in the joints.
The hereditary predisposition plays in this dysregulation of the body an important role – it is nowadays also assume that the interaction certain pollutant (toxins) may favor the onset of disease. Smoking example, is responsible for the disease proven in many patients. In a Swedish study, the risk for RA increased by 50 percent in women who smoked daily between one and seven cigarettes. Also covered are a deterioration of disease progression and response to therapy in smokers.
History of RA drugs: Already much achieved
The “oldschool” rheumatism therapy, acetylsalicylic acid (ASA), saw the light of day in 1897 and is still today as a painkiller for use. Inhibition of joint inflammation is possible with cortisone since the middle of the 20th century. Even the “Papa” has – employed considered and well measured – until today its place in the RA treatment. At the same time methotrexate (MTX) has been developed – the “mommy” has blossomed since the gold standard and is usually used as the first basic therapy for RA.
Frequently a classic basic therapy must be modified, however – the “teenager” among rheumatoid drugs, biologics, for about 15 to 20 years to expand the range of choice and can dwell on a drug extend to several years. Biologics have revolutionized the treatment of rheumatism: These drugs bioengineered keep target specific messenger substances of the immune system and thus the attacks on the body’s own structures. Especially in combination with MTX, a hitherto unknown good efficacy on the disease activity, pain, quality of life and disease progression can be achieved.
Improving the quality of their lives goes hand in hand with high costs. Biologics are expensive, so they are only generally used when two therapies with other basic medicines have been unsuccessful or have not been tolerated.
Important pillars: non-pharmacological interventions
Around one third of RA patients speaks or not optimally respond to treatment.
Basically, it comes in RA therapy to disease remission. Initially this can be achieved much more frequently than at a later date. In addition to drug treatment and non-drug therapies play a crucial role (see figure). Pain relief, improvement or maintenance of body functions, daily activities and social participation are the focus. Largely established the accompanying physical therapy, and the patient should be encouraged to exercise regularly. Skåne causes – except during acute attack – the opposite and rather leads to functional movement restrictions.
Also relaxation techniques and pain, illness and stress management programs are supportive recommended in order not to fall into a vicious cycle of fear and pain amplification.
More rarely, it happens that RA patients with highly damaged joints an artificial joint replacement need (endoprosthesis). However, an operation may be needed to correct a deformity of the joint. As a last resort is considered a surgical stiffening of the affected joint.
Facts and figures of rheumatoid arthritis
- Rheumatoid arthritis is the most common form of arthritis. In the Western industrialized countries about 1 to 2 percent of the adult population are affected. These and other figures vary, depending on which source one assumes. It mainly affects women. You become ill three times more often than men. Children and young people can get rheumatoid arthritis. Although rheumatoid arthritis occurs mainly between the 30th and 80th year, is their disease peaks between the ages of 35 and 50 years.
- In almost all concerned, it comes in the course of the disease to damage the joint bones. At 40 percent after 6 months, at 60 percent within one year and 80 percent within 2 years after disease onset. Rheumatoid arthritis leads therefore in a very short time to a permanent disability and early retirement of many patients.
- Although rheumatoid arthritis has not completely curable, but it can by a consistent and professional treatment by a specialist (internist rheumatologist). The earlier the treatment, the better the prognosis. The best treatment results are achieved when the targeted treatment begins within 12 to 16 weeks after onset. Unfortunately in Germany Affected make representations on average after 21 months with a specialist. And that relates to only 22 percent of sufferers. In addition, due to the shortage in technical and specialist practices is often a long wait for further delaying an optimal treatment.
Treatment of Rheumatism
The medications available today up to 70 percent of patients can be treated. But this also means that about one third is not optimally responsive to treatment or develop intolerances.
In order to realize the vision of a symptom-free life or even healing of RA, some further developments as well as exploring other treatment approaches are still needed. For example, alternative therapies are required base with fewer side effects. Still very far away seems the possible regeneration already damaged joint tissue.
Even the word “personalized medicine” plays in connection with the widespread use of biologicals an important role. In rheumatology, this approach is still in its infancy, however: By biomarkers appropriate therapy should be personally tailored for each patient – so a prediction can be made on the preparation works for which patient. Examples from the fields of cancer and HIV show that costs can be saved through the targeted use of drugs, as the method of “trial and error” is now becoming obsolete.
Even today it is attempted in the treatment of rheumatism, targeted treatments (treat to target) offer and to consider individual factors such as impaired renal function, age or having children.
Within studies, you are already one step ahead. Here are experimental approaches, such as the deletion of the immune memory by stem cell transplantation, tested. In the first results could be shown that for a so-called “immune Reset” can develop a healthy new immune system – this is achieved, the patient is considered cured. This treatment goes but with high risks associated not only erroneous autoantibodies are turned off, even protective antibodies are destroyed. This leads to a high risk of infection, which can lead to death. This approach needs to be further studied extensively in studies and is reserved for patients who are currently responding to any conventional regimen or who have a life-threatening form of rheumatic disease.
Rheumatoid arthritis can not be cured up to now. Treatment is aimed primarily to the fact, to ease the pain, to reduce inflammation (which at the same time the progression brakes) to obtain, and the function of joints and muscles. What action is appropriate in a particular case depends on the type of disease. In mild forms, the administration of so-called NSAIDs (non-cortisone anti-inflammatory drugs), short NSAIDs enough. These drugs relieve pain, swelling and inflammation. but keep the destruction of articular cartilage is not entirely and do not affect the progression of the disease.
Side effects of drug therapy
Due to the risk of serious side effects (eg, life-threatening gastric ulcers), these drugs should only be taken under medical supervision for a prolonged period. Newer products of this group seem – not to cause adverse effects on the stomach – with the same effectiveness.
In severe forms, or high disease activity and joint destruction imminent DMARDs are necessary, that is, drugs that affect low demonstrable disease progression. Proven here have gold, chloroquine, D-penicillamine, sulfasalazine and methotrexate. The effect of these agents occurs slowly (at the earliest after 6 to 12 weeks), the rate of side effects is relatively high (about 40%).
A reliable means is cortisone, a naturally occurring hormone that acts as a strong anti-inflammatory. Cortisone is administered in high doses in the “push” a short time and the dose then reduced gradually. Is a long-term administration required is dosed as low as possible. In this way one achieves a high efficiency and is dangerous side effects of the way.