Rheumatoid arthritis:
symptoms and causes

Rheumatoid arthritis (also known as chronic polyarthritis) is an inflammatory joint disease that occurs in regular flare-ups. The fingers, hands and toes in particular are affected and show typical swelling or deformities. In principle, anyone can get rheumatoid arthritis – including children (polyarticular juvenile idiopathic arthritis).

Women are affected three times more often than men. In Switzerland, a total of around 85,000 people suffer from rheumatoid arthritis.

With ongoing medication, the symptoms can be effectively mitigated and further joint destruction can be slowed.

Rheumatoid arthritis is a chronic, systemic disease – which means it affects the whole body, even though the typical symptoms mainly occur in the hands and feet.

Later, larger joints such as the elbows, shoulders or knees are usually affected.

• Rheumatoid nodules in fatty tissue under the forearms and hands
• Sicca syndrome: functional disorders of the salivary and lacrimal glands
• Carpal tunnel syndrome: trapping of the median nerve in the arm, leading to numbness
• Ulnar tunnel syndrome: impairment of the ulnar nerve
• Baker’s cyst: accumulation of fluid in the hollow of the knee

If rheumatoid arthritis is suspected, patients should act quickly. If the disease is detected within the first six months, the chances of protecting the joints from further destruction are greatest.

If the disease affects internal organs, it may result in renal inflammation, liver fibrosis, pleurisy, changes in the heart valves or pericarditis.

Rheumatoid arthritis is a lifelong disease. A complete cure is not possible. The aim of treatment is to extend symptom-free periods and alleviate symptoms during a flare-up. If rheumatoid arthritis is treated quickly, the complete destruction of joints can be stopped or significantly delayed.

Various medications are available, which can be combined with complementary treatments such as physiotherapy, ergotherapy, heat therapy, massage, rehabilitation, relaxation techniques and lifestyle modifications with regard to exercise and nutrition.

Drug therapy for rheumatoid arthritis
The following medications are part of the basic rheumatoid arthritis treatment and are considered to be very helpful in achieving remission:

• DMARDs (disease modifying anti-rheumatic drugs) slow down and sometimes stop the progression of the disease.
• Glucocorticoids (cortisone) help with joint damage.
• NSAIDs have an anti-inflammatory effect in acute cases.

The treatment of rheumatoid arthritis is complex and depends on the stage of the disease. The various options should therefore be discussed with a rheumatologist.

Surgical interventions for rheumatoid arthritis
Invasive procedures are also possible for rheumatoid arthritis. These include:

• Joint aspiration
• Radiosynoviorthesis (RSO)
• Synovectomy
• Joint replacement, e.g. with prostheses

Nutrition for rheumatoid arthritis
Clinical studies suggest that diet may have an effect on rheumatoid arthritis. Polyunsaturated fatty acids have anti-inflammatory and antioxidant effects, while red meat and salt seem to have a negative effect.

Smoking is not advisable. Avoiding nicotine has a positive effect on the course of the disease.

Rheumatoid arthritis is an autoimmune disease. It is not yet known exactly what causes it. Women between the ages of 55 and 64 are particularly affected, which is due, for example, to the decrease in female sex hormones. Men develop rheumatoid arthritis far less frequently and on average only 10 years later – between the ages of 65 and 75.

Genetic factors probably contribute to the disease’s development, as rheumatoid arthritis occurs frequently within families. Environmental and hormonal factors can also be involved, as can being overweight and smoking.

If rheumatoid arthritis is suspected, most people will first go to their family doctor. The doctor can then refer them to a rheumatologist who, with his or her experience, will find the right treatment together with the patient. The doctor will take the patient’s medical history and then perform a physical examination.

This requires a blood test, as rheumatoid arthritis causes abnormal blood values. These include:

• Increased CRP (C-reactive protein)
• Rapid blood sedimentation rate
• Low haemoglobin
• Increased caeruloplasmin (protein produced by the liver)
• High α2 and γ bands
• Anaemia

Rheumatoid arthritis is also indicated by the presence of what are known as rheumatoid factors, as well as anti-CCP antibodies and autoantibodies (e.g. antinuclear antibodies). These are determined by means of blood tests.

Imaging techniques (such as x-ray, ultrasound, scintigraphy, magnetic resonance imaging) of the hands and feet are also used to determine the diagnosis.

Rheumatoid arthritis presents patients with severe challenges.
Failure to get treated quickly enough or optimally increases the risk of severe progression, which can reduce life expectancy.

An additional burden is placed on patients by comorbidities, i.e. the simultaneous occurrence of different diseases. People with rheumatoid arthritis are more likely to develop osteoporosis, atherosclerosis or depression, for example.

Psychological support can help to reduce pain and stress and improve quality of life in general. Other options include relaxation techniques such as autogenic training. Stress and pain management programmes can be learned with the help of a psychotherapist.