With rheumatism ( ancient Greek ῥεῦμα rheumatic , German , flow ' , flow' Flowing ') or rheumatism , and rheumatic disease , complaints on support and are musculoskeletal designated by flowing, tearing and drawing pains, often associated with functional limitation. The medically correct term for rheumatism is "rheumatic disease ".
Early attempts at treatment of people suffering from rheumatism were made in the 7th century BC. In Mesopotamia (with the Assyrian king Asarhaddon ) with liquorice , massages and sweat-inducing substances (Asarhaddon's doctor, Arad-Nana, diagnosed his employer with an inflammation that is localized in the head, hands and feet, and recommended the alleged focus of the disease, the (carious) teeth, to be removed).
The term "rheumatism" arose from the ancient humoral pathology in connection with the "flowing of bad juices" and was later transferred to diseases with flowing, tearing pains in joints, tendons and muscles.
The traditional terms rheumatism and rheumatism were coined with the Liber de Rheumatismo et Pleuritide dorsali (completed 1591, published 1642) by Guillaume de Baillou (1538-1616). According to the teaching of humors ( humoral pathology ) at the time, he believed that cold "mucus" flowed from the brain to the extremities and triggered the corresponding complaints, but for the first time differentiated (in contrast to the Corpus Hippocraticum and Galenos ) the terms rheumatism and catarrh as well as the clinical pictures of gout, localized arthritis and general rheumatism.
In the 16th century, Paracelsus called rheumatic conditions “tartar” diseases, derived from tartarus ( tartar ), since the harmful substances that cause pain are supposed to be deposited in the body like in a wine barrel. The English doctor Thomas Sydenham attributed rheumatism to inflammation of the blood in the 17th century. Erik Waaler discovered the first rheumatoid factor accidentally in 1939 while diagnosing syphilis (using a complement- consuming test) in a patient who also suffered from rheumatoid arthritis .
The first significant anti-rheumatic drugs were gold preparations against rheumatoid arthritis and the cholchicine-containing autumn crocus, which was used against gout (even today) and was brought from Asia to Byzantium in the 5th century and later supplemented with allopurinol . Cortisone was first used against rheumatoid arthritis in 1948, followed by chloroquine and D-penicillamine later. For the treatment of rheumatic fever , the salicylic acid contained in the bark of willows (Salix species) was used towards the end of the 19th century (however, willow bark was already an antipyretic and rheumatic drug), before acetylsalicylic acid became the standard agent used for this around 1900 (came in 1961 then to market indomethacin).
The rheumatic forms include very different clinical pictures, which are divided into four main groups according to their cause. A further subdivision is made within these groups. The following classification scheme currently applies:
- Inflammatory rheumatic diseases ( autoimmune ):
Rheumatoid arthritis ( rheumatoid arthritis )
- it is rheumatic fever (also known as acute arthritis, polyarthritis rheumatica acuta and acute rheumatism verus) since 1953 clearly distinguished
- Juvenile idiopathic arthritis
- Collagenoses (connective tissue diseases):
- Vasculitis (diseases with inflammation of the blood vessels)
- Polymyalgia rheumatica
- Rheumatoid arthritis ( rheumatoid arthritis )
- Degenerative ("wear-related") rheumatic diseases
- Metabolic disorders associated with rheumatic complaints
- Rheumatic non-inflammatory diseases of the soft tissues with symptoms such as pain in the muscles and tendons
- Fibromyalgia (non-inflammatory soft tissue rheumatism, "soft tissue rheumatism")
The "International Classification of Diseases of the Musculoskeletal System and Connective Tissue ( ICD -10-GM, 2005)" now distinguishes between 200 to 400 individual diseases, which differ greatly in terms of symptoms, course and prognosis. Therefore, the diseases of the rheumatic type are difficult to overlook and difficult to diagnose - "What one cannot explain, one likes to see rheumatism [...]".
Origin and course
What many diseases of the rheumatic type have in common is that the immune system is disrupted, whereupon the body attacks its own structures such as the synovial membrane (in rheumatoid arthritis ). These so-called autoimmune diseases can also occur as systemic diseases in the form of collagenoses , in which not only one organ (e.g. the lungs with the formation of a pleural effusion caused by exudate ) or a body region, but similar tissues in many different organs are the target of the misdirected immune system.
Causes of the immune system malfunction are still unknown. In some cases, however, familial and gender-specific clusters can be identified, and characteristic genetic markers can be detected in many people affected by certain rheumatic diseases, both of which suggest a certain influence of genetic factors. In a small group of inflammatory rheumatic diseases, the so-called infectious arthritis, there is a causal connection with past, mostly bacterial infections v. a. the intestine or the urogenital tract recognizable.
It has also been shown that even the consumption of fewer cigarettes a day can double the risk of developing rheumatism. Especially if women smoke for many years, they are at high risk of developing rheumatism.
As a result of the chronic inflammation, those affected by joint-related forms ( rheumatoid arthritis or chronic rheumatoid arthritis ) suffer from pain, swelling or effusion of the joints and, as a long-term consequence, from joint destruction, malpositions and loss of function. Serious, often life-threatening complications due to chronic inflammation in the structures of various organs particularly often cause diseases from the groups of collagenoses and vasculitis .
The course of a disease and the response to therapy can be extremely different from patient to patient, even with the same diagnosis. In addition, the boundaries between the various rheumatic diseases are often blurred. Signs of several overlapping diseases can occur in just one patient ( overlap syndrome ). In general, however, it has been shown that rheumatism patients can stay longer and longer at work, which of course indicates an improvement in therapy in recent years.
Contrary to popular belief, rheumatism is by no means just a disease of older people. Young adults and even children are also affected by rheumatic diseases, such as juvenile idiopathic arthritis .
Arthrosis (joint pain caused by wear and tear) usually occurs at an advanced age, while the inflammatory form ( arthritis ) typically appears for the first time between the ages of 20 and 50. Hence the popular opinion that rheumatism is an "old people's disease".
The core of rheumatism diagnostics is a thorough medical history and physical examination. This can often be used to narrow down the type of disease.
The detection of antibodies (rheumatoid factors) and genetic markers in the patient's blood is an important factor for the precise classification of a diagnosis. What is difficult here is that these are not necessarily associated with a specific disease and even some people who have been proven to be sick do not have the corresponding antibodies or genetic markers. In diagnostics, they usually do not have a demonstrative, but rather a trend-setting character.
The various imaging methods, in particular conventional X-ray diagnostics , computer tomography , magnetic resonance tomography and scintigraphy, serve to secure the diagnosis, determine the stage of a disease and monitor the progress .
Rheumatic diseases are usually not caused where their external manifestations are found. Every therapy is preceded by a qualified differential diagnosis which, based on the typical manifestations, clarifies the cause. The therapy is then tailored to the clinical picture, planned as a whole, or updated successively.
For rheumatic diseases, drug therapies are almost exclusively effective. Changes in lifestyle and especially in diet have at best a supportive effect. Surgical interventions such as synovectomies and reconstructive surgery with joint replacement generally do not eliminate the cause of the disease, but at best alleviate its consequences. There is also the option of radiosynoviorthesis .
In the majority of rheumatic diseases, physical therapy is also a necessary supportive therapeutic measure. In this way, long-term pain and restrictions can be reduced in many cases. Cold therapy in particular can be anti-inflammatory and analgesic. In rheumatoid arthritis, whole-body cold therapy has also proven itself, where possible, as pain-relieving symptomatic therapy in children.
Medication of autoimmune rheumatic diseases
In acute phases in particular, pain reliever and anti-inflammatory drugs have proven effective, which are used in lower doses to support long-term therapy:
- nonsteroidal anti-inflammatory drugs (NSAIDs), e.g. B. naproxen or diclofenac , also specific COX inhibitors such as celecoxib
- steroidal anti-inflammatory drugs (corticoids), e.g. B. Prednisolone
Due to the clear risks and possible side effects, an individual assessment and indication must be made, especially for long-term prescriptions. In addition, pain relievers that do not have anti-inflammatory effects can be added:
- non-opioid analgesics , e.g. B. metamizole or paracetamol
- Opioid - analgesics , eg. B. tramadol or oxycodone
Used as a long-term therapy because it has an unspecific effect on the disease process and so promises long-term success:
- Basic drugs , also DMARD = disease modifying antirheumatic drugs ( disease-modifying antirheumatic drugs ), e.g. B. Immunosuppressants , especially methotrexate , but alternatively also azathioprine and cyclosporine A , as a reserve agent also leflunomide , alternatively also alkylating agents such as cyclophosphamide ; furthermore sulfasalazine, especially in spondylarthritis , chloroquine / hydroxychloroquine for lighter, non-erosive courses . The previously common basic therapeutic agents D-penicillamine and various gold preparations have almost completely disappeared due to their unfavorable profile of action.
- Biologicals (biologicals, biological DMARDs): In addition to the well-known and well-documented "conventional" basic drugs, other highly effective and specifically effective drugs are used more and more frequently against rheumatic diseases. A group of these drugs frequently used in rheumatology are the TNF-alpha blockers . Disadvantages of biologicals are the very high costs, the increased susceptibility of the patient to infections caused by the immunosuppressive effect and the lack of long-term experience in therapy with many of these active ingredients. They are therefore only used when treatment with classic basic therapeutic agents has not had an adequate effect or treatment with these is fundamentally ruled out due to contraindications or intolerance.
Biologicals exist in the form of antibodies, soluble receptors or antagonists against proinflammatory cytokines such as IL-6 or TNF-alpha , e.g. B. abatacept , adalimumab , anakinra , etanercept , infliximab and rituximab .
In addition, further medication measures must often be initiated against frequent serious side effects, but sometimes also independently occurring phenomena such as Raynaud's syndrome .
The antiphlogistic antipyretic analgesics with the active ingredients phenylbutazone and oxyphenbutazone , which were still on the pharmaceutical market in the mid-1980s, were banned in Germany in January 1984 due to side effects or their use for the treatment of ankylosing spondylitis and gout was restricted for no longer than a week.
Thermotherapy includes any application of cold and heat as part of physical therapy .
During the acute episode of the disease, the local application of cold (cryotherapy) to the affected joints often has a positive effect on the inflammatory process and the associated symptoms.
Promising results are achieved by using cryotherapy as whole-body cryotherapy in cryo chambers at temperatures as low as minus 160 ° C. After repeated use, pain relief occurs, which lasts for a few hours to a few weeks. The treatment not only has a symptomatic effect , but also accelerates the healing processes in the damaged joints and tissues through better blood circulation and changes in hormone levels.
Naturopathic treatments, phytotherapy
Modern phytotherapy in Europe uses standardized and approved extracts from plants. These are common in rheumatism therapy for secondary therapies to alleviate the sequelae of diseases of the rheumatic type, but usually lack scientifically proven evidence of effectiveness.
The oral consumption of non-toxic plants has no detectable direct (systemic) effect. Taking herbal remedies such as dandelion , nettles , birch leaves or sand-sedge has not been proven to have a healing effect on diseases of the rheumatic type.
In the phytotherapy of various rheumatic diseases, the following plants are used today:
Despite the introduction of effective (chemical) painkillers, the common use of willow bark offers no advantages over preparations with salicylic acid derivatives. In phytotherapy , care must always be taken to use tested and standardized preparations. These contain a set amount of effective ingredients. The toxic ingredients from plants were removed from standardized preparations or their content was reduced. This reduces the risk of poisoning and allergies; but these are not excluded. Non-standardized medication is generally not advisable.
At the beginning of the 20th century, samaderark was imported into Europe for the treatment of "rheumatism", among other things. Proof of effectiveness is not known.
World Rheumatism Day
The World-Heart-day (ger .: world arthritis day ) was first in 1996 by the Arthritis and Rheumatism International launched (ARI), the international association of self-help associations rheumatism affected. The aim is to make the public aware of the concerns of people with rheumatism on this day. World Rheumatism Day always takes place on October 12th worldwide.
The German Rheuma League first introduced the anniversary in Germany in 2005 and has been celebrating October 12th ever since with a special motto and campaign focus.
- German Society for Rheumatology e. V.
- Leaflet series of the German Rheuma League : The most important information quickly and easily understandable , in English, Turkish and Russian (Link checked on July 29, 2018)
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- world arthritis day (English language website)
- World Rheumatism Day on the website of the German Rheumatism League