introduction

Meanwhile, numerous rheumatological diseases are known, which are all characterized by certain symptom complexes. Nevertheless, it often takes years for those affected to receive the definitive diagnosis of the disease, as, among other things, numerous other diseases that can cause similar symptoms must be ruled out in advance.

In some cases, the symptoms of the disease are so inconspicuous, such as fever, malaise, muscle aches that can not immediately be concluded on a rheumatoid disease or studies are sought. Nonetheless, the quickest possible recognition is advantageous in order to prevent or slow down the progression of a cartilage and bone destruction associated with inflammation during the course of an inflammation and associated movement restriction.

Pain in rheumatism

Joint pain is a common symptom of rheumatism. These occur especially in the morning and can improve as the day progresses. A needs-based treatment can help to avoid, among other things, pain-related movement restrictions. Many analgesics used for this purpose additionally reduce the inflammation of the joints.

Recognizing rheumatism only on the basis of the pain is almost impossible. However, it is typical that the pain on and around the affected and usually also swollen joint occur, as well as the often symmetrical involvement of the joints on both sides of the body and that over several weeks. The complaints, as well as the pain are often relapsing with partly weeks long, symptom-free intervals. Furthermore, in the context of weather changes, many sufferers experience an aggravation of the pain symptoms.

Rheumatism on the knee

In rheumatic diseases there is an immunological-related, chronic inflammation of the joint mucosa, which in the course of destruction and wear of the cartilage and ultimately can lead to osteoarthritis (joint wear). In technical terms, the disease is referred to as rheumatoid arthritis, which means as much as joint inflammation as a result of a rheumatic disease. If the knee joint is affected, this leads to swelling and sometimes severe pain in this area. Both belong to the distinguishing features of a rheumatic joint disease, but can also occur in other diseases of this joint.

Suspected rheumatic causes include persistent pain and swelling lasting 6 weeks or more. In advanced disease, the joint wear in X-rays or MRI is recognizable. A rapid imaging alternative is the ultrasound, with the help of which the inflammation of the mucous membranes in the knee can be displayed well. However, a possible bone or cartilage destruction is not assessable.

In rheumatic disease, the synovial fluid, in this case the knee joint, has a characteristic composition of certain cells. It is possible to examine this fluid in the laboratory. The affected knee is punctured after local anesthesia. It is a small procedure with minimal risk. Also, a blood test can facilitate the detection of a rheumatic disease. Please read the section "Blood tests for rheumatism" below.

It is also typical for a rheumatic disease that the affected joints, in this case in the area of ​​the knee in the morning, are stiffened. It takes at least an hour until those affected can fully move the joints again. A sudden change in weather is often associated with a worsening of symptoms, which is also indicative of a rheumatic disease.

Another distinguishing feature of rheumatic disease with infestation of the knee joint is a disease of other joints of the body, often the fingers with similar symptoms, such as pain, stiffness in the morning. An important distinguishing feature is that in rheumatism not only one knee joint, but also the other joint is affected. This is called "symmetrical involvement of the same joints of both body halves".

Rheumatism on the hands

A rheumatic disease on the hands is similar to other affected joints with swelling and pain. Typical recognition features and procedures for detection have been described in more detail under the heading "Rheumatism on the knee" and can also be transferred to the hands.

An infestation of the finger joints is very characteristic of a rheumatic disease. Typically, not only one finger joint but several and these are affected symmetrically on both halves of the body. As a result of the inflammation, nodular foci form on the joints, which are called rheumatoid nodules and consist inter alia of inflammatory cells. They are among the diagnostic features of a rheumatic disease and are often found in other joints, especially at the elbow joint.

An advanced disease often leads to a loss of strength of the hands, a limited fine motor skills and deformations of the fingers by the bone destruction and the pain.

Rheumatism in children

Rheumatic diseases can manifest as early as childhood. Temporary inflammation of the joints (arthritis) with swelling, pain and redness of the joint may occur as a result of inflammation of the gastrointestinal tract or urinary tract with certain bacteria. This form is called "reactive arthritis". An important distinguishing feature is the simultaneous occurrence of ocular, joint and urinary tract inflammation. However, it is not caused by the bacteria mentioned, but by the antibodies that the body has formed in response to the infection and which now attack structures in the eyes, joints and urethra.

Juvenile idiopathic arthritis is a chronic joint inflammation that is similar to that of adults, but by definition appears before the age of 16. The cause is still unclear. A typical distinguishing feature is the relapsing course of the inflammations with intermediate, symptom-free phases. As already said, the signs and symptoms of rheumatism in adulthood, such as swelling and pain in the joints and rigidity of the joints, are especially similar in the morning. In contrast to the disease in adulthood, only one joint can be inflamed here. Due to the pain, the children unconsciously take a rest, which can lead to shortening of muscles and sinews, so-called contractures and permanent restrictions of movement.

The examination of the blood for certain markers, the synovial fluid and the production of X-ray, CT, MRI and ultrasound images contribute significantly to the detection of the disease. Children's blood is also frequently screened for certain genetic markers which, if present, would also contribute to the detection and support the suspicion of idiopathic rheumatoid arthritis.

Participation of the eyes

A rheumatic disease presents not only through joint complaints, even if these problems often restrict those affected at the beginning of most of the problems. Since it is an autoimmune-mediated disease, the co-responsible antibodies can also "attack" other structures in different parts of the body and cause an inflammatory reaction. Components of the eye are very often affected in this case.

Inflammations of the anterior segment of the eye, including the iris, ciliary body and cornea, are often associated with pain and redness of the eye. Redness that lasts for more than 48 hours or recurrent over several weeks should therefore be clarified by an ophthalmologist. This is important because many complications, such as increased intraocular pressure (glaucoma) or swelling of the yellow spot (the site of sharpest vision), can occur with blindness during the course of the disease and chronic inflammation.

Only by these symptoms a rheumatic genesis as cause can be recognized, especially if a rheumatism is not yet known, almost impossible. There are no specific tests that can be performed on the eye to detect rheumatism. The attending physician will perform further tests to rule out, among other things, an infection with bacteria, viruses or fungi.

The inflammation in the anterior portion of the eye, whatever the cause, can be detected using, among other things, an ophthalmological examination instrument, the slit lamp. In the course of the examination, the iris and the yellow spot are also evaluated in order to rule out possible complications. The intraocular pressure is also measured in case of suspected elevation.

Frequently, the dermis of the eye also becomes inflamed as part of a rheumatic disease. This is referred to as scleritis and is characterized, among other things, by pain in applying pressure to the eyes. Again, the dermal inflammation is not a specific identifier for rheumatism. It may also be associated with other conditions such as gout or infections.

Blood test for rheumatism

In general, the blood test is a diagnostic building block that makes an important contribution to the detection of a rheumatic disease. In the following, certain parameters are presented, which may be indicative of rheumatism. It is important that the parameters are always considered in combination and not individually individually, as some also increased or decreased in other diseases or infections, that are not specifically suitable for the diagnosis of rheumatism.

  • BSG: BSG is the abbreviation for erythrocyte sedimentation rate. Increased ESR occurs, among other things, as a result of inflammatory processes. This is the case with rheumatic diseases, but also other autoimmune diseases, infections by bacteria / viruses or the use of certain medications. Thus, increased ESR is a nonspecific parameter in the diagnosis of rheumatic joint inflammation.
  • C-reactive protein (CRP): C-reactive protein is one of the most important parameters for the assessment of acute inflammatory processes in the body. It is produced in such cases by the liver and is able to initiate certain defense mechanisms in the body. In autoimmune diseases, including in rheumatoid arthritis, this is not intentional, as the body attacks and destroys itself.
    Increased CRP in the blood reflects the inflammatory process within the joints, but may also be elevated in the context of other autoimmune diseases and especially bacterial infections. Thus, like the erythrocyte sedimentation rate (ESR), it is one of the nonspecific blood parameters in the detection of a rheumatism. The CRP value is used primarily to diagnose an acute inflammatory event within the body without distinguishing an infectious (bacterial, viral) or non-infectious (rheumatism, other autoimmune diseases) cause. A rough assessment of the severity of the disease is also possible using this parameter.
  • Rheumatoid Factor: The rheumatoid factor is an antibody that targets autoantibodies as part of an autoimmune disease. For this reason, it is also called "autoantibodies" (directed against their own body constituents). In 70% of patients with rheumatoid arthritis, this antibody can be detected in the blood. They are "rheumatoid factor positive". There is no correlation between the amount of rheumatoid factor in the blood and the disease activity. A high rheumatoid factor does not mean that the disease must be particularly bad at the given time.
    If the rheumatoid factor is detected in the blood, paradoxically this does not necessarily prove that a rheumatic disease is present.
  • CCP antibodies: The presence of this antibody in the blood is a specific hallmark of rheumatoid arthritis and correlates with its disease. In contrast to the rheumatoid factor, the CCP antibody, which is also referred to as ACPA in laboratory diagnostics, is not also found in other diseases in the blood, and therefore serves in particular for the detection and detection of a rheumatism. A classification of severity, as well as conclusions about the course of rheumatic joint disease are also possible with the help of this antibody. You are already 10 years before onset of the first symptoms, such as swelling or pain in the blood detectable.

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