yogabook / pathologie /rheumatoid arthritis

rheumatoid arthritis (chronic polyarthritis, rA, RA, CP)

Definition of

Systemic disease, in addition to the musculoskeletal system, internal organs are also affected. Affects 1% of Central Europeans, W:M 3:1, usually between 35-45 years of age; familial disposition HLA-DR4. Most common inflammatory disease of the joints. Gradual or sudden progression possible. Small fingers or toe joints are usually affected first, and later also hand (carpal), knee, shoulder, foot and hip joints. Special forms are Felty syndrome, Caplan syndrome, juvenile idiopathic arthritis. Worldwide prevalence 0.5-1%, 800,000 in Germany, the incidence increases with age. The psychosomatist Franz Alexander counts RA among the „Holy Seven“ alongside ulcus ventriculi, bronchial asthma, neurodermatitis, essential hypertension, hyperthyroidism and the IBD ulcerative colitis and Crohn’s disease. Diagnosis according to 2010 ACR / EULAR criteria for the classification of rheumatoid arthritis.

ICD M06

Cause

1. Unknown, systemic autoimmune disease, psychosocial factors have a triggering effect. Special form: juvenile RA

Symptoms

1. in the early stages: acute monarthritis of a large joint, pronounced affection of the spine
2. in adults: Leading symptom and highlight: symmetrical, painful morning stiffness, particularly in the metacarpophalangeal and middle joints of the fingers; the end joints are not affected. During the course of the day, the pain and stiffness subside; additional paresthesias in some cases.
3. later symmetrical swelling of the metacarpophalangeal and metacarpophalangeal joints („spindle fingers“)
4. later tendovaginitis, rheumatoid nodules near joints; 2 types, both not obligatory: Heberden’s nodule and Bouchard’s nodule
5. Later, the interphalangeal muscles atrophy, the skin of the affected fingers becomes thin and shiny, deformities slowly appear, first the ulnar deviation of the hand, then increasing stiffening of the joints, due to spontaneous tendon fractures also various deformities, e.g. the swan neck deformity, then also the buttonhole deformity and the 99-phenomenon
6. Highlight: positive Gaenzlen sign as an early symptom: painful handshake or avoidance of it
7. Pain under the soles of the feet
8. Special form: M.Still: the juvenile form, relatively unfavorable prognosis, generalized lymph node swellingand hepatosplenomegaly in addition to joint complaints
9. Concerns organs:
   1. Heart: preferably pericarditis
   2. Lungs: preferably pleuritis with complication pulmonary fibrosis
   3. Reticuloendothelial system affected, therefore lymph node swelling, slightly disseminated, spleen swelling, liver swelling
   4. Vessels: vasculitis
   5. Bone marrow: anemia

Diagnosis

1. Rheumatoid factors (RF antibodies) in serum (not conclusive)
2. ESR, CRP elevated; ACPAs (antibodies against citrullinated protein/peptide antigens)
3. Clinical status of the joints (count of the affected joints, DAS28: Disease Activity Score 28)
4. X-ray, MRI of the joints shows typical deformities
5. Soft tissue and bone scintigraphy

Therapy

1. Analgesics
2. Glucocorticoids
3. non-steroidal anti-inflammatory drugs
4. Basic therapeutic agents (long-acting anti-rheumatic drugs (LWAR), disease-controlling drugs
5. (disease-modifying anti-rheumatic drugs, DMARD), e.g. leflunomide, sulfasalazine, chloroquine,
6. Hydroxychloroquine, cyclosporine A, azathioprine and gold compounds
7. Methotrexate
8. other modern approaches such as antibodies, soluble receptors or antagonists, biologics
9. Rheumatism surgery, often with synovialectomy (the synovia is the main site of the disease process)
10. Joint resection
11. Arthroplasty
12. Fasting, elimination diets, nutritional therapy, especially vegan raw food in combination with lactobacillus supplements

DD

1. Gout: radial affection of the finger joints including the distal joints