Medicated local therapy

In the acute stage, compresses of the affected joint can be made several times a day with cold NSAR gels (e.g. Voltaren ® Emulgel) or cold quark. In chronic stages, it is better to use blood circulation-promoting ointments (e.g. Thermo Reumon ® Cream). In the case of acute infestation of one or a few joints, the doctor can make intra-articular injections (injection into the joint) of local anesthetics (= local anaesthetics) and steroids (cortisone).

A further therapeutic option is the synoviorthesis (=sclerotherapy of the inflamed joint mucosa). Here, sclerosing drugs (e.g. morrhuates or osmic acid) = chemosynoviorthesis or radionuclides (e.g. yttrium 90, rhenium 186 or erbium 169) = radiosynoviorthesis are injected into the joint. Tendon sheaths or tendon insertions can be infiltrated locally with a local anaesthetic and, if necessary, a water-soluble steroid (cortisone).

Homeopathy and rheumatoid arthritis

Rheumatic diseases can also be treated by homeopathy. Of course, rheumatoid arthritis cannot be cured by this, but the symptoms of the disease can be significantly alleviated. Also the nutrition can play a role in rheumatoid arthritis.

Surgical therapy

Surgery in chronic polyarthritis becomes necessary whenever drug therapy is no longer able to contain the inflammatory activity sufficiently. Surgery is relatively urgent if there are pronounced axial deviations of a joint (e.g. pronounced X-leg) or if the joint destruction is progressing rapidly. Even in cases of imminent tendon tears or neurological deficits, surgery should not be delayed too long.

In chronic polyarthritis, several operations are often necessary.Sometimes combination operations can be performed, otherwise, when determining the sequence, interventions on the legs should be performed first, if the need for surgery is equal, in order to maintain walking ability in any case. In addition, the joints near the trunk should be operated first, then the joints further away from the trunk, e.g. the wrist in front of the finger joints, because with an unstable wrist the finger function will always remain limited despite successful surgery. A distinction is made: Depending on the joint and the stage of destruction of the joint surfaces, the doctor will recommend the appropriate operation.

Joint-protective interventions are, for example, synovectomy and tenosynovectomy. In these procedures, the inflamed joint mucosa or tendon sheath tissue is removed radically by surgery. The inflammatory flare of the disease is interrupted.

This halts the cartilage-destroying process and the destruction of the bone and reduces the overstretching of the joint capsule and the ligaments leading to swelling. The tendons are protected from tendon tears by removing the inflammatory tissue that penetrates the tendons. These procedures are indicated as long as the joint surfaces are still intact and there is still swelling of the joint for at least 6 months despite consistent drug therapy.

The aim of articular surface-correcting interventions is to restore an even load on the joint components in the case of severe axial deviations, or to remove the joint from the main load zone in the case of limited cartilage damage. For this purpose, the bone is cut through and stabilized in the corrected position with screw-plate wires. These procedures are usually performed in younger patients and combined with a synovectomy.

However, since the inflammation in rheumatoid arthritis primary chronic polyarthritis affects the entire joint evenly, joint surface-correcting procedures (except for the forefoot) are rarely performed in rheumatoid arthritis. Joint resection procedures are performed when the joint surface is destroyed but the ligaments, joint capsules and muscles are still in good condition. The destroyed parts of the joint are removed, the joint surface is reshaped and replaced by an interponate of the body’s own tissue (e.g. capsule tissue, fatty tissue, muscle fascia).

However, such procedures are not possible on the large joints that carry the body weight (knees, hips), as they would not be able to withstand the load. Such operations are usually performed on the forefoot. Joint replacement procedures are now possible on almost all joints.

The destroyed parts of the joint are removed and replaced by an artificial joint (endoprosthesis, hip prosthesis, knee prosthesis). Depending on age, general condition and mobility of the patient and the bone quality, cementless or cemented endoprostheses can be used. In case of joint instability, a coupled system may have to be used or the ligamentous apparatus may have to be stabilized.

With the joint-replacing interventions, a very good pain reduction is achieved, and after appropriate physiotherapeutic exercise treatment, good mobility and rapid resilience. A disadvantage is the limited durability of the endoprostheses. Joint stiffening interventions create a stable and also heavy loadable situation.

The destroyed joint surfaces are removed, the joint partners are placed on top of each other in a functionally favourable position and fixed with plates/screws/nails or wires until ossification/stiffening has occurred. They are only indicated to a limited extent in patients with R. A., since stiffening places increased stress on the adjacent joints, which are usually also affected by the disease. They are usually performed when a joint replacement is not or no longer possible, often primarily on the toe, finger, hand and ankle joints and on the spine.

Joint protection surgery
Articular surface correcting interventions
Joint resection surgery
Joint replacement surgery
Joint stiffening procedures

There are general and specific risks associated with all surgical procedures, about which the surgeon informs the patient prior to planned interventions. Some, such as the risk of wound infection or impaired wound healing, are increased in patients with chronic polyarthritis by the disease itself or by drug treatment.Therefore, before a planned surgical procedure, it is absolutely necessary to discuss with the doctor about a necessary dose reduction or discontinuation of medication. Most patients with rheumatoid arthritis suffer from osteoporosis, on the one hand because of the limited mobility, on the other hand because of the steroid intake after a longer period of illness. The reduced bone quality increases the risk of fractures during surgery.