Under rheumatism today we understand any particular form of disease. This is an equally blurred and therefore scientifically and medically useless expression such as “tearing”, “tearing the limbs” or the like and means nothing other than “flowing” pain that appears here and there again. However, in order to be able to intervene effectively in the event of an illness, we doctors must seek to find out what causes it was caused. This is by no means easy with rheumatic diseases. Usually they are based on a whole set of causes.
Different forms of rheumatism
It is therefore no wonder when the affected patients accuse the most varied of conditions. However, we have to make a strict distinction between cause and inducement, between living pathogens that need to become effective, such as rheumatic fever or other contributing conditions of the climate, workload, etc. Because with this disease, too, the reaction of the body is of primary importance.
If you consider all of this, you will see that the doctor cannot treat a rheumatic ailment with one drug or a few remedies, but that he has to use several coordinated therapeutic measures. Within the rheumatic diseases we must fundamentally differentiate between the inflammatory and non-inflammatory, degenerative diseases, i.e. those caused by tissue breakdown and remodeling without infection. Only the first group includes those forms that rightly bear the name rheumatism: for example acute rheumatism or rheumatic fever.
Chronic rheumatism with two forms of joint inflammation (arthritis), which can be clinically and serologically separated by blood tests, and stiffening spinal rheumatism. The second group includes degenerative bone, joint and soft tissue diseases with rheumatic symptoms. According to abbreviationfinder.org, arthrosis and spondylosis with accompanying or resulting pathological soft tissue processes in muscles, tendons, tendon sheaths, bursa and nerves.
At this point we should mainly speak of chronic rheumatic joint inflammation. Not only are they the most difficult to treat from a medical point of view, they can also be a very noticeable burden on each individual. About rheumatic fever, mainly an illness of childhood, let me just say that it can be treated with real medicaments, with the help of penicillin.
In Germany, this long-term treatment is increasingly being carried out successfully. In this way, rheumatic relapses and their danger to the heart and thus to the life of the children can be prevented.
We do not have such preventive options for chronic inflammatory rheumatism. In addition, we know too little for sure about the causes and conditions of this suffering.
It is therefore necessary to recognize the first signs as early as possible in order to start effective therapy in good time. The main symptom of chronic rheumatism is inflammation of the joints (arthritis).
In severe cases, many, if not all, joints are gradually involved. The first signs of this ailment are usually nocturnal discomfort with pulling and tingling in the fingertips and a sensation of morning stiffness in the hands, which only gradually disappears during the day.
Symptoms, complaints & signs
At the beginning, chronic joint inflammation becomes noticeable through general symptoms such as tiredness or loss of appetite. Usually there is also a slight fever. After a while, there are warm, swollen or reddened joints, increasing joint stiffness and other specific signs. In rheumatism, the symptoms take a gradual course, but some symptoms can appear suddenly.
Some patients experience sudden attacks of pain or restricted mobility. Mostly symmetrical joints are affected, i.e. both wrists, shoulders, knees or ankles. Initially, the pain usually occurs in the finger and toe joints – also symmetrical and creeping or sudden.
As the disease progresses, the mobility of the joints decreases. The bones deform and the patient feels severe pain, which occurs mainly at night and during other periods of rest. In the later stages, chronic joint inflammation manifests itself as a stiffening of the affected joints. If the ankles are affected, the patient can no longer walk properly and has to take excessive breaks.
In addition, bad postures often occur, which in turn can lead to complaints. After all, physical exertion is no longer possible without drug treatment. The disease can be clearly diagnosed based on the increased levels of inflammation in the blood.
These phenomena are sufficient to obtain medical advice. If the diagnosis can be made early in this way or at least the suspicion of a developing inflammatory rheumatic disease can be raised, much will be gained. In these early cases, treatment with powerful drugs, such as the modern hormones of the adrenal cortex, will not always be necessary. As a rule, the doctor will give instructions to maintain and increase the resistance of the body and to protect the joints in such a way that later misalignments and stiffening are avoided.
As soon as inflammation and swelling appear, however, bed rest should be observed. If the patient obeys this immediately, without wasting time, it is often possible to inhibit the inflammatory episode simply by doing this. That’s why. Even a housewife should not have to stay at home in this situation.
In general, the doctor and patient will endeavor to improve their overall physical condition. This also includes the treatment and elimination of infectious processes, which can often arise from chronically diseased tonsils and teeth, and less often from other areas. Here it is a matter of relieving the organism, which should not use up its forces on two fronts. In contrast, the so-called herds are not the cause of the chronic rheumatic ailments. No doctor or dentist can therefore promise the patient a cure for his rheumatism if he has tonsils and teeth removed. If these are demonstrably sick, then they have to be eliminated anyway.
When should you go to the doctor?
If the symptoms suddenly increase in intensity or duration, or if new symptoms appear, you should speak to a doctor. Likewise, if unfamiliar movement restrictions suddenly occur and everyday life can no longer be managed as before. If infections or other complaints keep coming back, there may be a serious complication that needs to be clarified quickly by a doctor and, if necessary, treated. In principle, the responsible doctor should be consulted regularly in the case of chronic joint inflammation.
If you notice increased mood swings or other mental illnesses, it makes sense to talk to a therapist. The chronically ill in particular should seek psychological support at an early stage and also talk to the doctor about suitable medication. If you have a high fever or circulatory problems, it is best to contact the emergency medical service. Mild symptoms that still cause severe discomfort should be clarified in the hospital. In the best case scenario, they go straight to a day clinic that specializes in arthritis.
If you notice frequent urination, thirst, paleness, tiredness, and other symptoms of chronic kidney failure, a doctor is recommended. Symptoms such as fatigue, loss of appetite and high blood pressure indicate advanced kidney disease – in this case, consult a doctor immediately and have the symptoms clarified. If cardiovascular complaints or signs of organ failure become noticeable, the emergency doctor must be called immediately.
The same applies to symptoms of blood poisoning and other severe complaints that have a massive impact on general well-being. In this case, a medical evaluation and treatment is absolutely necessary. People with chronic kidney disease, diabetes, and high blood pressure are particularly prone to chronic kidney failure.
In addition, inflammation of the urinary tract and various drugs (e.g. analgesics, X-ray contrast media and aromatic hydrocarbons) can promote the disease. If these risk factors apply to you, you should speak to your family doctor quickly if you have the symptoms mentioned. Other contacts are the nephrologist (kidney specialist) and a specialist clinic for kidney diseases. In the event of severe complaints, it is best to contact the emergency medical service.
Treatment & Therapy
It is also advisable that the patient suffering from rheumatism prefers a mixed diet. There is no special rheumatism diet. It is only different with real metabolic gout. The chronic rheumatism should eat what gets him. But he should pay attention to sufficient amounts of protein, i.e. eat meat, eggs, milk and cheese. In addition, plenty of vegetables, fruits and salads rich in vitamins. Restrict fats. It is also very important to stay in the fresh air, so that the often poor blood circulation in the chronically ill person is improved.
Sunbathing is often not tolerated. However, if you get them, you can sunbathe, but not in excess, but only gradually increasing up to a maximum of half an hour. A body strengthened in its general resilience in this way will, even with full development of its rheumatic disease, better tolerate and benefit from the prescribed treatment with physical and medicinal means, especially those with therapeutic baths.
In the local treatment of rheumatoid arthritis, the active cooperation of the patient is crucial. Even the early diagnosed cases, in which the joints are not yet deformed and stiffened, often require repeated daily exercises of all joints, each time only briefly, at most two minutes. This is important in order to immediately notice new disabilities and report them to the doctor.
Pay special attention to the hand, finger and knee joints. If the knees stiffen in an unfavorable flexion position, it is sometimes only possible to avoid the need for care with the help of orthopedic surgical interventions.
It is disastrous when compassionate relatives or sisters push a pillow or a roll under the knee joints of the patient lying in bed in order to reduce the pain. This promotes the damaging stiffening of the flexion. In order to protect the hip joints from bad posture, the mattress of the bed should be unyieldingly hard. This also prevents curvature of the spine. Swinging exercises for the arms are important for the shoulder joints.
All of this assumes that muscle strength is maintained or regained. The doctor and physiotherapist have specific exercises ready for the individual muscle groups, which the patient must perform at least three times a day. Such treatments, supported by other physical measures such as baths, packs and massage or by medication, require foresighted, depending on the changes in the findings, changing therapy plans and a lot of effort, patience and confidence on the part of both the patient and the practitioner.
Up to now there has hardly been any talk about the treatment with medicinal products, which is usually most valued by patients and doctors. With good reason! Despite their popularity, all these remedies are almost indispensable without physical therapy, especially without persistent active exercise. You can never rely on them alone. Of course, no doctor will do without internally applicable remedies. They all have an anti-inflammatory effect and are valuable for quickly relieving pain and swelling that would interfere with our main treatment. However, the doctor alone decides which preparation is useful for the individual patient.
Here is a word about the use of prednisone and its related substances. It has been compared to a fire suit that shields the body from the fire of ignition without extinguishing it. It continues to smolder and flares up again when the hormone protection is removed. If you only need to give prednisone and the like for a short time, for example in the case of acute rheumatic fever in children, it is undisputedly effective and does not have any undesirable consequences. Unfortunately, it is different with chronic rheumatism. Long-term therapy is also required for these permanent states.
If undesirable side effects occur, among which gastric disorders are still relatively harmless, the dose must be reduced or the prednisone must be discontinued altogether. This threatens the risk of the inflammatory joint symptoms returning with all their consequences for the psychological state of the disappointed patient.
Serious damage caused by these hormones, which deeply affect the body’s metabolism, can be largely averted through the increasing familiarity of doctors with these agents. But the prednisone must never be prescribed and taken like a mere painkiller. The patient may never increase or decrease the dose on his own initiative just to get rid of his pain for a while.
Rheumatism sufferers must always bear in mind that their well-being never depends on tablets or injections alone. The improvement of his condition, the maintenance or return of his mobility as a gift from heaven never falls into his lap. He himself has to help day after day, has to use the longer or shorter pain-free periods for the exercises that the doctor prescribes and the physiotherapist teaches him.
Only then will he take full advantage of the facilities our healthcare system has in store for him. The sanatoriums responsible for each federal state in the rheumatism baths to clinical institutions with the aim of functional restoration and the restoration of general health (rehabilitation) can only fulfill their task if the rheumatism sufferers help themselves.
Outlook & forecast
Chronic joint inflammation is different for each patient, so that no general statements on the prognosis are possible. As a rule, however, painful, inflammatory conditions alternate with symptom-free phases. If the rheumatism remains untreated, the joints increasingly lose mobility and bone and muscle wasting occurs.
At an advanced stage, those affected suffer from the onset of joint stiffness as well as deformations and immobility, so that they have to rely on outside help. This poor prognosis can be significantly improved with the right therapy. Modern drugs are able to achieve remission (i.e. resting) of the disease. The most important prerequisite for this is that the patient takes his medication continuously and for a lifetime – even in symptom-free phases. Regular care by an experienced rheumatologist can also significantly improve the prospects of chronic joint inflammation.
If the treatment is not carried out, on the other hand, there is a risk of serious complications such as deformation of the feet and fingers or osteoporosis (bone loss). Rheumatism is often particularly severe in young patients. Usually more than 20 joints are permanently or recurrently inflamed. The presence of the so-called rheumatoid factor in the blood, high CCP values and nicotine consumption also worsen the prognosis.
Follow-up care for a diagnosed chronic joint inflammation cannot aim to prevent its recurrence. There is no cure for rheumatism. The disease continues to progress. Follow-up care can, however, slow down the course of the symptoms, prevent complications and make everyday life worthwhile for those affected.
From a medical point of view, several measures are available for this: medication, occupational therapy, physiotherapy and, if necessary, an operation. The extent and intensity of treatment depend on the underlying signs. Follow-up care usually consists of a close-knit network. The patient and doctor agree on regular check-ups to check or adjust the effectiveness of the measures taken.
At the meetings, the descriptions of the person concerned are particularly important. The doctor then performs a physical assessment. A blood test and x-rays can also clarify the chronic joint inflammation. The patient can do a lot himself to make his everyday life more bearable.
Corresponding measures will be discussed as part of a patient training course. Those affected should move around slightly every day. Swimming and cycling, for example, are suitable. A healthy diet has also been shown to help alleviate the symptoms. The consumption of nicotine and alcohol should absolutely be stopped.
You can do that yourself
Those affected have many options to cope with the restrictions caused by rheumatism. There are technical aids or alternatives for most everyday utensils (potato peelers, bottle openers, cutlery, etc.). Seats should also be designed as ergonomically as possible. The same goes for work utensils such as a keyboard and mouse. The disease should be dealt with openly at an early stage in the workplace. Only in this way can the workplace be redesigned in good time (as required and possible) so that the person concerned can still carry out his tasks.
Exercise should definitely be sought in order to maintain the mobility of the damaged joints. Water sports and gymnastics are particularly suitable here because they are easy on the joints. Warmth and cold compresses only help to a limited extent. Heat can even make inflammation worse. Cold is only suitable for acute pain.
The diet should force the absorption of omega-3 fatty acids, as these have an anti-inflammatory effect. At the same time, you should aim for adequate fluid intake and a healthy diet.
Clear discussions help against the psychological stress that comes with chronic joint inflammation. Letting other people help you where it is necessary helps in everyday life. Communicating pain can also help – especially against the background of upcoming tasks. The reduced possibilities must be accepted by the person concerned. At the same time, relaxing and pleasant things should consciously find their place in everyday life.