Rheumatic diseases | Pain in the joints

Rheumatic diseases

Rheumatic diseases typically lead to joint pain of various degrees.Rheumatoid arthritis is the most common inflammatory joint disease. It particularly frequently affects women and can develop between the ages of 35 and 45. The pain typically begins at first at the finger and toe joints, whereby the final joints, in contrast to the joints close to the trunk, are not affected.

Patients often complain of morning stiffness in the joints, which only improves after about 30 minutes. In addition, there is often swelling, overheating and redness of the joints. The disease usually progresses in phases, with a relapse lasting between one week and several months.

As the disease progresses, more and more joints can be affected, typically symmetrically on both sides. Therapy There are currently various options for treating rheumatoid arthritis. First, a conservative treatment with painkillers and anti-inflammatory drugs is attempted.

Some special drugs, such as methotrexate, are also preferred at first. If an improvement of the symptoms cannot be achieved with these measures, alternative therapy concepts can be resorted to. These include surgical procedures that are delayed as long as possible.

As in the case of arthrosis, a joint stiffening (arthrodesis) or a joint replacement by means of an endoprosthesis can be performed. In addition, the joint can also be removed without replacement; this is often used for the small toe joints. In the early stages of the disease, a synovialectomy can have a positive influence on the course of the disease. The so-called synovia, the mucosa of the joint capsule, which is the origin of the inflammatory process, is removed. If it is removed early, a decrease in inflammation with improvement of symptoms can usually be observed.

Gout

Gout is a disease characterized by the deposition of uric acid crystals in various tissues and joints. Possible causes are e.g. a kidney dysfunction or a disturbance in the purine metabolism, which increases the uric acid level in the blood of the diseased person. When the blood is supersaturated, the excess uric acid eventually precipitates in the form of crystals.

It is predominantly men who are affected by the disease, which usually manifests itself between the ages of 40 and 60. The gout is intermittent and, if left untreated, leads to long-term damage to joints and cartilage, as well as to kidney failure. Typical symptoms of gout are sudden onset of very severe pain in the affected joints, which are also swollen and extremely reddened and overheated.

In principle, any joint can be affected, but very often the acute attack of gout occurs in the base joint of the big toe. In contrast to rheumatoid arthritis, the terminal joints of the fingers and toes can also be affected. Untreated, such an attack lasts about 2-3 weeks.

The gout can change from an acute to a chronic form in which the attacks are less severe, but the disease has already led to significant damage and functional impairment. TherapyThe diet should be adapted to the disease. High uric acid levels in the blood should be avoided.

A protein-rich diet with an increased intake of unsaturated fatty acids is generally recommended. Animal products, especially meat, sausage and fish, should be avoided as far as possible, as these contribute to an increase in the uric acid level in the blood. An acute attack of gout is treated in particular with anti-inflammatory drugs (NSAIDs), which slow down the inflammatory process and improve the pain.

In the case of chronic gout, certain drugs such as uricosurics and uricostatics are used. Uricosurics reduce the reabsorption of uric acid in the kidney, which means that uric acid is excreted more often with the urine. Uricostatics intervene in the uric acid metabolism and inhibit the enzyme (xanthine oxidase) that forms uric acid.

This lowers the uric acid levels in the blood. Reactive arthritis refers to an inflammation of the joints following a previous immune reaction of the body to a certain stimulus. Such a stimulus can be, for example, a previous bacterial infection, but also a vaccination or similar.

Reiter’s disease is an inflammation of the joints after a bacterial intestinal or urinary tract infection.Mostly young men between the ages of 20 and 30 are affected, who in addition to the joint inflammation can develop urethritis (urethritis) and conjunctivitis/ inflammation of the eye skin (conjunctivitis/uveitis). The combination of these symptoms is also known as Reiter’s triad. In reactive arthritis, the knee and ankle joints are the preferred sites, but in principle any joint can be affected.

The joints are often swollen and overheated, often resulting in severe joint effusions. It is assumed that the body’s previous reaction to the bacterial infection causes a kind of autoimmune disease to develop, which then acts against the body’s own tissues. TherapyPredominantly anti-inflammatory drugs are used in combination with cooling of the affected joint. Since reactive arthritis is usually no longer a pathogen, antibiotic therapy is not recommended. In chronic cases, immunosuppressive drugs can be given.