Symptoms
Rheumatoid arthritis is a chronic, inflammatory and systemic joint disease. It manifests as pain, symmetrically tense, achy, warm, and swollen joints, swelling, and morning stiffness that lasts for more than an hour. Initially, the hands, wrists, and feet are most affected, but later numerous other joints are also affected. Over time, deformities and rheumatoid nodules develop and the joint is destroyed. This leads to disability and daily activities become severely limited. The disease may be accompanied by a feeling of illness, lack of appetite, fatigue, fever and a poor general condition.
Causes
Rheumatoid arthritis is an inflammatory autoimmune disease in which the immune system attacks the joints. Risk factors include:
- Heredity
- Female gender
- Age
- Smoking
Diagnosis
Diagnosis is made in medical treatment on the basis of complaints, patient history, with imaging and laboratory methods.
Nonpharmacologic treatment
- Application of heat or cold
- Exercise, sports
- Muscle and joint training, e.g. fango kneading, hydrotherapy.
- Massages, physiotherapy
- Operations, artificial joints
- Aids, e.g. bottle opener
- Give up smoking
Drug treatment
Non-steroidal anti-inflammatory drugs (NSAIDs):
- Such as ibuprofen and naproxen and COX-2 inhibitors have analgesic and anti-inflammatory properties and are used for symptomatic treatment. One problem is the adverse effects that can occur, especially with long-term use. NSAIDs have no effect on the course of the disease and cannot prevent progression. Other analgesics such as paracetamol and opioids are effective exclusively against pain.
Glucocorticoids:
- Such as prednisone and methylprednisolone have anti-inflammatory properties and are administered locally directly into the joint or systemically. They can slightly affect the course, but have numerous and sometimes serious side effects in long-term treatment.
Non-biological basic therapeutics (DMARDs, disease-modifying antirheumatic drugs) slow down or halt the course of the disease. Therapy should be started as early as possible. DMARDs prevent joint damage and are part of the standard therapy for rheumatoid arthritis. The effect is sometimes delayed. Methotrexate is often used as the 1st-line agent. The group is heterogeneous and includes antimalarials, immunosuppressants, and antibiotics:
- Methotrexate, methotrexate prefilled syringe (e.g., Metoject).
- Leflunomide (Arava, generic).
- Hydroxychloroquine (Plaquenil, generics)
- Chloroquine (Nivaquine)
- Sulfasalazine (Salazopyrin EN)
- Azathioprine (Imurek, generics)
- Ciclosporin (Sandimmune)
- Cyclophosphamide (Endoxan)
- Gold compounds (Tauredon)
- Minocycline (CH: off-label).
- Penicillamine (CH: off-label)
Janus kinase inhibitors:
- Baricitinib (Olumiant)
- Ruxolitinib (Jakavi)
- Tofacitinib (Xeljanz)
- Upadacitinib (Rinvoq)
Biological DMARDs (biologics): TNF-alpha inhibitors inhibit the interaction of the cytokine TNF-alpha with its receptors. TNF-alpha plays an important role in inflammatory and immunologic processes and in tissue destruction. The effects occur rapidly. The drugs are immunosuppressive and may promote the occurrence of infectious diseases:
- Adalimumab (Humira)
- Certolizumab (Cimzia)
- Etanercept (Enbrel)
- Golimumab (Simponi)
- Infliximab (Remicade)
Other biologics:
- Abatacept (Orencia)
Monoclonal antibodies:
- Rituximab (MabThera)
- Sarilumab (Kevzara)
- Tocilizumab (Actemra)
Interleukin-1 receptor antagonists:
- Anakinra (Kineret, CH: not commercially available).
For self-medication, numerous preparations are available, such as comfrey ointments, topical NSAIDs, Arnica ointments, essential oils, rheumatism patches and teas.
