Rheumatoid Arthritis - Symptoms And Diagnosis

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Rheumatoid Arthritis - Symptoms And Diagnosis
Rheumatoid Arthritis - Symptoms And Diagnosis

Video: Rheumatoid Arthritis - Symptoms And Diagnosis

Video: Rheumatoid Arthritis - Symptoms And Diagnosis
Video: Rheumatoid arthritis - causes, symptoms, diagnosis, treatment, pathology 2023, September

Rheumatoid Arthritis: Symptoms & Diagnosis

Rheumatoid arthritis (RA), also known as chronic polyarthritis (CP), is a permanent inflammation of the joints. A constant inflammatory process in the synovium leads to the destruction of cartilage, bones and ligaments. This causes pain, swelling and a limitation of the function of the affected joints. RA can occur at any age, including children. It is more common in women than in men. Almost one percent of the population is affected. The cause of the disease is still unknown.


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  • What are the symptoms?
  • How is the diagnosis made?
  • Whom can I ask?
  • How are the costs going to be covered?

What are the symptoms?

The first symptoms of rheumatoid arthritis are usually inflammatory joint pain combined with swelling in the small joints and wrists. Joint stiffness in the morning often occurs - often lasting for several hours. For example, this can make it difficult to clench your hand into a fist. Typically, several symmetrical joints on both sides of the body are inflamed, initially especially the small joints on the hands and feet. As the disease progresses, more and more joints are involved. The inflammation often spreads to larger joints (elbows, shoulders, hips, knees, ankles). The cervical spine can also be affected.

Soft tissue involvement of RA manifests itself in inflammation of the tendon sheaths in the area of the fingers, as well as the bursa, and in rheumatoid nodules (thickening in the subcutaneous fatty tissue and in other places, e.g. on internal organs). A possible early symptom is the so-called carpal tunnel syndrome, which typically occurs on both sides and sometimes even precedes the inflammation in the joints. Fluid accumulates in the joint as a result of the inflammation. This leads to swelling and the clear joint contours disappear.

In addition, diseases of almost all internal organs and organ systems can occur, for example:

  • Eye inflammation,
  • Enlargement of the liver and spleen,
  • Swelling of lymph nodes,
  • Inflammation of the lung tissue,
  • Changes in the blood count with inflammation-related anemia and increased formation of blood platelets,
  • inflammatory diseases of the blood vessels (vasculitis).

Shear-shaped course

The majority of patients experience the disease in so-called relapses. Pain-free phases and rheumatism attacks alternate. This course of the disease can drag on for years, but it can also lead to functional impairment of the joints after just a few months. The disease usually progresses fastest in the first two years, so early diagnosis is important.

Without treatment, there is no cure; the disease usually progresses in stages, which can lead to permanent joint damage. The heart muscle, the lungs or the kidneys can rarely be affected. Rheumatoid nodules can also develop. Concomitant diseases such as heart attacks, strokes, diabetes, osteoporosis or complications such as infections can arise.

How is the diagnosis made?

The diagnosis is based on a precise anamnesis, the physical examination with special consideration of the joints as well as laboratory tests (sedimentation rate, CRP, rheumatoid factor, anti-CCP antibodies) and examinations using imaging methods (X-ray, magnetic resonance tomography, ultrasound).

Typical signs and signs of rheumatoid arthritis are:

  • Pronounced morning stiffness of the joints for at least one hour (six weeks),
  • Inflammation (arthritis) in at least three areas of the joint (for six weeks)
  • Inflammation of the metacarpal and metacarpophalangeal joints and / or the metatarsophalangeal joints (for six weeks)
  • symmetrical pattern of joint involvement (i.e. on both sides of the body for six weeks),
  • Rheumatoid nodules,
  • Detection of rheumatoid factor in the serum,
  • Evidence of typical changes and deformations of the fingers and wrists in the X-ray image.

In untreated patients in advanced stages, the changes and deformations are already visible to the naked eye. The disease activity or the course of the disease can be determined by means of various composite scores (numerical values). The DAS28 (Disease Activity Score) is used as the standard instrument. The number of painful and swollen joints, the sedimentation rate and the overall assessment of the disease activity by the patient are taken into account. DAS28 values range from 2.0 to 10.0, with higher values reflecting higher disease activity. In addition, there are also the SDAI (Simplified Disease Activity Score: similar to DAS28, the doctor's assessment is also taken into account) and the CDAI (Clinical Disease Activity Score:laboratory values are not taken into account).

Whom can I ask?

In the event of the following complaints, you should immediately consult a general practitioner or a specialist in internal medicine (specializing in rheumatology):

  • Joint pain and swelling that won't go away;
  • Morning stiffness in the joints, which subsides after an hour at the earliest (usually during the day);
  • Knuckles that are no longer recognizable when the fist is clenched;

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

  • Right to treatment
  • Visit to the doctor: costs and deductibles
  • What does the hospital stay cost?
  • Prescription fee: This is how drug costs are covered
  • Rehabilitation & cure
  • Medical aids & aids
  • Health Professions AZ

and via the online guide to reimbursement of social insurance costs.