Chronic Joint Inflammation (Rheumatism): Causes, Symptoms & Treatment

Today, we do not understand rheumatism as a specific form of disease. It is an equally blurred and therefore scientifically as well as medically useless expression as “tearing”, “limb tearing” or the like and says nothing more than “flowing” once here, then again there appearing pain. However, in order to be able to intervene effectively in a disease, we doctors must try to find out what causes it. This is by no means easy in the case of rheumatic diseases. Usually, they are based on a whole bundle of causes.

Different forms of rheumatism

Infographic of pain regions and affected joints in rheumatoid arthritis. Click image to enlarge. It is therefore no wonder if a wide variety of conditions are blamed by affected patients. We must, however, strictly distinguish between cause and inducement, between necessarily acting living pathogens as in rheumatic fever, or other contributing conditions of climate, work load, etc. Because also with this illness it depends primarily on the reaction of the body. Whoever considers all this will realize that the physician cannot treat a rheumatic ailment with one drug or a few remedies, but must make use of several curative measures coordinated with each other. Within the rheumatic diseases we must basically distinguish the inflammatory from the non-inflammatory, degenerative, i.e. caused by tissue degradation and remodeling without infections. Only in the first group belong those forms which rightly bear the name rheumatism: for example, acute rheumatism or rheumatic fever.

Chronic rheumatism

Chronic rheumatism with two forms of inflammation of the joints (arthritis), which can be separated clinically and serologically by blood tests, and stiffening spinal rheumatism. The second group includes degenerative bone, joint and soft tissue diseases with rheumatic manifestations. Arthroses and spondyloses with accompanying or resulting pathological soft tissue processes in muscles, tendons, tendon sheaths,

bursae and nerves. At this point, we will mainly talk about chronic rheumatic joint inflammations. They are not only the most difficult to treat medically, but can also burden each individual in a very tangible way. About rheumatic fever, mainly a disease of childhood, only this much should be said, that with it a real medicinal treatment is possible, namely with the help of penicillin. Here in Germany, this long-term treatment is being carried out with increasing success. In this way, rheumatic relapses with their danger for the heart and thus for the life of the children can be prevented. In chronic inflammatory rheumatism we do not have such preventive possibilities. In addition, we do not know enough about the causes and conditions of this disease. Therefore, it is necessary to recognize the first signs as early as possible in order to start an effective therapy in time. The main symptom of chronic rheumatism is inflammation of joints (arthritis). In severe cases, many, even all joints are gradually affected. The first signs of this ailment are usually nocturnal misfeelings with pulling and tingling in the fingertips and the sensation of morning stiffness in the hands, which only gradually disappears during the day.

Syptoms, complaints, and signs

At the beginning, chronic joint inflammation is noticeable through general symptoms such as fatigue or loss of appetite. A low-grade fever usually occurs as well. After some time, warm, swollen or reddened joints, increasing joint stiffness and other specific signs are added. In the case of rheumatism, the symptoms take a gradual course, but some symptoms may appear quite suddenly. For example, some patients experience sudden attacks of pain or restricted movement. Mostly symmetrical joints are affected, i.e. both hand, shoulder, knee or foot joints. Initially, the pain usually occurs in the finger and toe joints – also symmetrical and gradual or sudden. As the disease progresses, the mobility of the joints decreases. The bones become deformed and the patient experiences severe pain, which occurs mainly at night and during other periods of rest.In the later stages, chronic joint inflammation is manifested by 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, incorrect postures often occur, which in turn can lead to discomfort. Finally, physical exertion is no longer possible without medical treatment. The disease can be clearly diagnosed on the basis of increased inflammation levels in the blood.

Diagnosis

These manifestations are sufficient to seek medical advice. If the diagnosis can be made early in this way, or if at least the suspicion of a developing inflammatory rheumatic condition can be raised, much is gained. In these early cases, treatment with strong-acting drugs, such as the modern hormones of the adrenal cortex, will not always be necessary. Usually the physician will give prescriptions to maintain and increase the body’s resistance and to protect the joints in such a way as to prevent late deformities and stiffness. As soon as inflammation and swelling appear, however, bed rest must be observed. If the sick person follows this immediately, without wasting time, this alone often succeeds in inhibiting the inflammatory episode. Therefore. even a housewife should not have to stay at home in this situation. In general, the doctor and patient will strive to improve the overall physical condition. This also includes the treatment and elimination of infectious processes, such as those that can arise particularly frequently from chronically diseased tonsils and teeth, and less frequently from other sites. Here it is a matter of relieving the organism, which should not consume its forces on two fronts. On the other hand, the so-called foci are not the cause of chronic rheumatic diseases. Therefore, no doctor or dentist may promise the patient a cure for his rheumatism if he has his tonsils and teeth removed. If these are demonstrably diseased, then one must have them removed anyway.

When should one go to the doctor?

If symptoms suddenly increase in intensity or duration, or if new symptoms are added, a doctor should be consulted. Likewise, if unaccustomed movement restrictions suddenly occur and everyday life can no longer be managed as before. If there are repeated infections or other complaints, there may be a serious complication that needs to be clarified quickly by a doctor and treated if necessary. In principle, in the case of chronic joint inflammation, regular consultation should be held with the responsible physician. If increased mood swings or other mental suffering are noticed, a discussion with a therapist is advisable. Chronically ill patients in particular should seek psychological support at an early stage and also talk to the doctor about suitable medication. In the event of high fever or circulatory problems, it is best to contact the emergency medical service. Mild symptoms that nevertheless cause severe discomfort should be clarified at the hospital. In the best case, a day clinic that specializes in arthritis is visited directly. If frequent urination, thirst, paleness, fatigue and other symptoms of chronic renal failure are noticed, a visit to the doctor is recommended. Complaints such as fatigue, loss of appetite and increased blood pressure indicate advanced kidney disease – in this case, consult the doctor immediately and have the complaints clarified. If cardiovascular problems or signs of organ failure become apparent, the emergency physician must be called immediately. The same applies to symptoms of blood poisoning and other severe complaints that massively affect the general condition. In this case, medical clarification and treatment are absolutely necessary. People with chronic kidney disease, diabetes and high blood pressure are particularly susceptible to chronic renal failure. In addition, inflammation of the urinary tract and various medications (e.g., analgesics, x-ray contrast media, and aromatic hydrocarbons) can promote the disease. If these risk factors apply to you, you should talk to your family doctor as soon as you experience any of the symptoms mentioned above. Further contacts are the nephrologist (kidney specialist) and a specialist clinic for kidney diseases. In case of severe symptoms, it is best to contact the emergency medical service.

Treatment and therapy

The main symptom of chronic rheumatism is joint inflammation (arthritis).It is also advisable that the patient suffering from rheumatism prefers a mixed full diet. There is no special rheumatism diet. Only the real metabolic diet is different. The chronic rheumatic should eat what is good for him. But he should pay attention to sufficient quantities of protein, thus eat meat, eggs, milk and cheese. In addition plentifully vitamin-containing vegetables, fruit and salads. Fats should be limited. It is also very important to spend time in fresh air, so that the often poor blood circulation of the chronically ill improves. Sunbaths are often not tolerated. However, if they are good for you, you can sunbathe, but not in excess, only gradually increasing the exposure to a maximum of half an hour. A body strengthened in this way in its general resistance will better tolerate and derive more benefit from the prescribed treatment with physical and medicinal means, especially that with medicinal baths, even in the full development of its rheumatic condition. In the local treatment of chronic articular rheumatism, the active cooperation of the patient is crucial. Even the early diagnosed cases, in which the joints are not yet formed and stiffened, require often repeated daily exercises of all joints, each time only briefly, for no more than two minutes. This is important

This is important in order to immediately notice any new disabilities and report them to the doctor. Special attention should be paid to the hand, finger and knee joints. If the knees stiffen into an unfavorable bending position, it is sometimes only possible to avoid the person’s need for care with the help of orthopedic surgery. It is disastrous when compassionate relatives or nurses push a pillow or a roll under the knee joints of the patient lying in bed in order to reduce the pain. This encourages the harmful bending stiffness. To protect the hip joints from bad posture, the mattress of the bed should be unyieldingly hard. This also prevents curvature of the spine. For the shoulder joints, swinging exercises of the arms are important. All this presupposes that muscle strength is maintained or regained. Doctor and physiotherapist have prepared specific exercises for individual muscle groups, which the sick person must perform at least three times a day. Such treatments, supported by other physical measures such as baths, packs and massages, or by medications, require proactive therapy plans that change according to changes in the patient’s condition, and a great deal of effort, patience and confidence on the part of both the patient and the practitioner. The treatment with medicines, which is usually the most appreciated by patients and physicians, has hardly been mentioned so far. With good reason! In spite of their popularity, almost indispensability, all these remedies are of limited effectiveness without physical therapy, especially without persistent active exercises. One should never rely on them alone. Of course, no physician will dispense with internally applicable remedies. After all, they all have an anti-inflammatory effect and are valuable for the rapid elimination of pain and swelling that would interfere with our main treatment. However, the physician alone decides which preparation is useful for the individual patient. Here is a word about the use of prednisone and its related substances. They have been likened to a fire suit that shields the body from the

the fire of inflammation without extinguishing it. It smolders on and flares up again when the hormone protection is removed. If prednisone and the like need to be given only for a short time, for example, in the acute rheumatic fever of children, it is unchallenged effective and does not entail any undesirable consequences. In chronic rheumatism, unfortunately, it is different. For these permanent conditions one also needs a permanent therapy. If undesirable side effects occur, among which stomach disorders are still among the relatively harmless ones, the dose must be reduced or the prednisone discontinued altogether. This poses the risk of a return of the inflammatory joint symptoms with all their consequences also for the psychological state of the disappointed patient. Serious damage caused by these hormones, which interfere deeply with the body’s metabolism, can be largely prevented by increasing the doctors’ familiarity with these drugs. Never, however, should prednisone be prescribed and taken like a mere pain pill. The patient must never arbitrarily increase or discontinue the dose just to be rid of his pain for a while.The rheumatism patient must always keep in mind that his well-being never depends on tablets or injections alone. The improvement of his condition, the preservation or return of his mobility never falls into his lap as a gift from heaven. He himself must help day by day, must 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 health care system has in store for him. The health resorts responsible for each province in the rheumatism baths to clinical institutions with the aim of functional recovery and restoration of general health (rehabilitation), can fulfill their mission only if the rheumatism sufferers themselves help.

Outlook and prognosis

Chronic joint inflammation progresses differently in each patient, so it is not possible to make general statements about prognosis. 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 atrophy occurs. In the advanced stage, those affected suffer from the onset of joint stiffness as well as deformities and immobility, so that they are dependent on outside help. This poor prognosis can be significantly improved by the right therapy. For example, modern drugs are able to achieve remission (i.e. dormancy) of the disease. The most important prerequisite for this is that the patient takes his medication continuously and throughout his life – even in symptom-free phases. Regular care by an experienced rheumatologist can also significantly improve the outlook for chronic joint inflammation. If treatment is not given, however, there is a risk of serious complications such as deformities of the feet and fingers or osteoporosis (bone loss). In young patients, rheumatism often takes a particularly severe course. Here, usually more than 20 joints are permanently or recurrently changed by inflammation. The presence of the so-called rheumatoid factor in the blood, high CCP values and nicotine consumption additionally worsen the prognosis.

Follow-up

Follow-up care for diagnosed chronic joint inflammation cannot aim to prevent recurrence. There is no cure for rheumatism. The disease progresses continuously. However, follow-up care can slow down the course of the symptoms, prevent complications and make everyday life worth living for those affected. From a medical point of view, several measures are available for this purpose: Medication, occupational therapy, physiotherapy and, if necessary, surgery. The extent and intensity of treatment depend on the underlying signs. Follow-up care usually consists of a close-meshed network. Patient and physician agree on regular check-ups to verify or adjust the effect of the initiated measures. During the meetings, the patient’s descriptions are of particular importance. The physician then performs a physical examination. Furthermore, a blood test and X-rays can provide clarity about the chronic joint inflammation. The patient can do a few things himself to make his everyday life more bearable. Appropriate measures are discussed as part of patient education. Patients should take light exercise every day. Suitable sports include swimming and cycling. A healthy diet has also been shown to help alleviate symptoms. The consumption of nicotine and alcohol should be discontinued.

What you can do yourself

In order to master the restrictions that are due to rheumatism, sufferers have many options. For example, there are technical aids or alternatives for most utensils of daily use (potato peeler, bottle opener, cutlery, etc.). Likewise, seating surfaces should be designed as ergonomically as possible. The same applies to work utensils such as keyboard and mouse. In the workplace, the disease should be dealt with openly at an early stage. Only in this way can the workplace be redesigned in good time (according to need and possibility) so that the person affected can still perform his or her tasks. Exercise should definitely be strived for in order to maintain the mobility of the damaged joints. Water sports and gymnastics are particularly suitable here because they are gentle on the joints. Hot and cold compresses only help to a limited extent.Heat can even intensify inflammation. Cold is suitable at best for acute pain. The diet should promote the intake of omega-3 fatty acids, as these have an anti-inflammatory effect. At the same time, sufficient fluid intake and a healthy diet should be aimed for. Clear discussions help against the psychological burdens, which accompany the chronic joint inflammation. Getting help from others where it is needed helps in everyday life. Sharing pain can also help – especially against the backdrop of upcoming tasks. The reduced possibilities must be accepted by the person affected. At the same time, relaxing and pleasant things should consciously find a place in everyday life.