Rheumatoid Arthritis: Therapy

General measures

  • Nicotine restriction* (abstaining from tobacco use).
  • Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
  • Limited caffeine consumption (max 240 mg of caffeine per day; equivalent to 2 to 3 cups of coffee or 4 to 6 cups of green/black tea).
  • Aim for normal weight* ! Determination of BMI (body mass index, body mass index) or body composition using electrical impedance analysis.
    • BMI ≥ 25 → participation in a medically supervised weight loss program.
    • Falling below the BMI lower limit (from the age of 25: 20; from the age of 35: 21; from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → Participation in a medically supervised program for the underweight.
  • Avoidance of environmental stress:
    • Men with occupational exposure to inorganic dusts or vibrations – such as those encountered when operating jackhammers – had a higher risk of rheumatoid arthritis, according to a Swedish study.
    • In particular, quartz dusts are suspected causative.
    • Women who worked as graphic artists or in color printing also had an increased risk

* Smoking cessation and normal weight increased the chance of remission (influence on treatment response).

Vaccinations

The following vaccinations are advised, as infection can often lead to worsening of the presenting disease:

  • Pneumococcal vaccination
  • Flu vaccination
  • Herpes zoster vaccination (due tozoster risk in rheumatoid arthritis (RA): almost ten times higher than in the general population); some guidelines recommend vaccination as early as 50 years of age
    • Note: Vaccination of RA patients should be done before starting therapy with biologics or Janus kinase (JAK) inhibitors, if possible. The American College of Rheumatology (ACR) advises immunization at least two weeks before the start of therapy.One study demonstrated that patients treated with the JAK inhibitor tofacitinib two to three weeks after cardiac pes-zoster.vaccination had similarly good vaccine protection as RA patients on placebo.
    • Vaccination should not be given to patients with low CD4 cell counts and those on ongoing biologics therapy or high-dose glucocorticosteroid treatment.
    • In RA patients who had inadvertently received herpes zoster vaccination while on biologics therapy, no single case of herpes zoster occurred 6 weeks after vaccination.

Conventional non-surgical therapy methods

  • Radiosynoviorthesis (RSO, from radioactive isotope, synovial joint lining, orthotic restoration; RSO for short) is one of the nuclear medicine procedures used therapeutically in rheumatology and orthopedics for the treatment of chronic inflammatory joint diseases. The restoration of the synovium is based on the use of beta-emitters (radionucleotides). Beta radiation is an ionizing radiation that occurs during a radioactive decay, beta decay. These radionuclides are applied into the joint cavity so that an existing inflammatory process can be inhibited (stopped). The use of this procedure thus represents an alternative to the surgical removal of the synovium (synovial membrane). Rheumatoid arthritis is the main indication for the use of radiosynoviorthesis. Depending on the stage of arthritis, almost 75% of early rheumatoid arthritis can be successfully treated with radiosynoviorthesis. If the treatment takes place at a later stage, the chances of success are significantly reduced.

Medical aids

  • Rigid or functional orthoses may be used to relieve pain. An orthotic is medical equipment used to stabilize, relieve, immobilize, guide or correct limbs or the trunk.
  • Supply of assistive devices such as splints, forearm crutches, shoe inserts, stocking pullers, button aids, grasping pliers, pin thickeners, etc.

Regular check-ups

  • Regular medical examinations to monitor disease activity; every two weeks at the start of therapy, then every four weeks, and permanently every three months.

Nutritional Medicine

  • Nutritional counseling based on nutritional analysis
  • Observance of the following specific nutritional recommendations:
    • Avoid foods high in arachidonic acid (animal foods such as pork and pork products, tuna)!
    • High-fiber diet (whole grains, vegetables) → short-chain fatty acids propionate and butyrate, which are formed within fermentation processes of intestinal bacteria, have anti-inflammatory (anti-inflammatory) and at the same time have a positive effect on bone strength (number of osteoclasts / bone resorbing cells is reduced).
    • Fruits and vegetables (ie 5 servings of vegetables and fruits (400-800 g) a day).
    • Omega-3 fatty acids (sea fish; i.e. fish once or twice a week).
    • Low-salt diet (max. 5 g table salt / day).
    • Diet rich in:
  • Selection of appropriate food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Sports Medicine

  • Endurance training (cardio training) and strength training (muscle training).
  • To maintain function, diseased joints must be moved: Functional training, rehabilitation sports and especially slow sports reduce pain and improve mobility in people with inflammatory rheumatic diseases.
  • In general, sports with slow movements – such as swimming, Nordic walking, cycling – are more suitable, and the training sessions should be frequent and short for this. If many joints are inflamed, offers exercise therapy in warm water.
  • Muscle training is equally necessary. Because a strong musculature stabilizes and relieves the joints. Muscle training, however, only under physiotherapeutic guidance and only in quiet phases of the disease.
  • Preparation of a fitness or training plan with suitable sports disciplines based on a medical check (health check or athlete check).
  • Detailed information on sports medicine you will receive from us.

Physical therapy (including physiotherapy)

The following therapeutic measures are used in addition to drug therapy. They aim to improve joint mobility and muscle strength, maintain function and thus increase the patient’s quality of life in the long term:

Complementary treatment methods

  • Every patient with rheumatoid arthritis should receive occupational therapy to improve mobility and maintain and restore independence in daily living.It includes a supply of assistive devices – splints, forearm crutches, shoe inserts, stocking pullers, button aids, grasping tongs, pen thickening, etc.