2024-03-21 12:22:14
Rheumatic inflammation is often recognized by swollen finger joints. However, if it first occurs in the feet, the warning signals go unnoticed for a long time. The destruction of the joints can progress inexorably. We have with Dr. Ulrike Lorenz, senior physician in orthopedics at Marienstift Arnstadt, talked about the most important signs of rheumatism and how they can be treated.
Their symptoms are as diverse as the rheumatic diseases. What general warning signs should you look out for?
Ulrike Lorenz: In fact, the initial symptoms can be variable depending on the rheumatic disease that occurs. The most common inflammatory rheumatic disease, rheumatoid arthritis, often begins with rest and stress pain and swelling in the hand, finger or toe joints. This swelling is usually accompanied by morning stiffness lasting more than 30 minutes – i.e. the difficulty in being able to move these joints without restriction early in the morning after getting up. It is not uncommon for the swelling to occur symmetrically, i.e. on both hands or feet at the same time. Rarely, large joints, such as the knee or shoulder joints, can also be affected first by the inflammation.
In another form of inflammatory rheumatic disease, in which the spine can also be affected in addition to the joints, the first warning symptoms can be painful inflammation of tendon attachments, early morning rest pain in the lumbar spine area that improves with movement, or inflammation of individual entire fingers or Toes and asymmetrical inflammation of fewer joints. These early symptoms can be very unspecific signs of illness such as: B. Tiredness, fatigue, fever and weight loss are accompanied.
Ulrike Lorenz is a senior physician in orthopedics at Marienstift Arnstadt. Image rights: Marienstift Arnstadt
According to studies, rheumatoid factor can only be detected as an antibody in the blood of around half of all those affected. How do you get a reliable diagnosis?
Ulrike Lorenz: Rheumatoid factors and other detectable laboratory parameters do not have to be present in the blood for all rheumatic diseases. Therefore, confirming the diagnosis always consists of several examination procedures. The blood test is just part of it. What is crucial is the anamnesis, i.e. information about existing complaints, and the subsequent careful examination from head to toe. Another part of the examination is imaging procedures, such as: B. an ultrasound examination of the joints or an MRI scan, for example. B. the spine or the sacroiliac joints.
If you then suspect the presence of an inflammatory rheumatic disease and the blood values confirm this, then you can speak of a reliable diagnosis. And the other way around: If neither the anamnesis nor the clinical examination, the imaging tests and the laboratory values provide any evidence of an inflammatory rheumatic disease, then the diagnosis can almost certainly be ruled out. But there will always be a gray area in between. The experience of the treating doctor is very important here.
Early detection is a prerequisite for successful treatment of rheumatic diseases. Current figures show that in Germany there are only around 600 specialist internists specializing in rheumatology for around 1.5 million patients. Why is that?
Ulrike Lorenz: The aim is to start treatment as early as possible, preferably within three months, preferably four to six weeks after the onset of symptoms. Unfortunately, this doesn’t always work. One reason for this is that there are too few internal rheumatologists in relation to the population. The causes are manifold. On the one hand, the field of rheumatology is often underrepresented in studies: not every university has a chair in the field of rheumatology. On the other hand, the shortage of internal rheumatologists has existed for many years, which means there are fewer further training opportunities in this field even after graduation. The hospital billing system also currently favors other areas of internal medicine, in which further training positions can then be financed. The situation is similar in the specialty area of rheumatic orthopedics.
In contrast to hands, feet are often neglected when looking for signs of rheumatism. Which symptoms should I pay particular attention to?
Ulrike Lorenz: Pay attention to pain that persists even at rest or occurs in combination with swelling or redness of joints. Pain and swelling can also occur along the tendon. Inflammation of an entire toe must also be clarified. At the onset of the disease, between 20-50 percent of patients report problems with their feet. However, it is not uncommon for the feet to only be taken into account when mobility is restricted or there are problems with shoe selection.
What exactly is meant by rheumatic foot? Can it be avoided?
Ulrike Lorenz: By a so-called “rheumatoid foot” we mean typical foot changes that can occur as part of rheumatoid arthritis. In the area of the ankle joint and the heel this is a bending of the heel outwards, the flat foot, in the area of the metatarsus it is a lowering or complete loss of the longitudinal arch, the arched foot or flat foot. In the forefoot area, the metatarsal bones often move apart, known as splayfoot. This is often accompanied by misalignments of the toes, such as hallux valgus on the big toe, or on the little toes from claw toes to severe joint misalignments. Unfortunately, it cannot be avoided in every case.
A rheumatic foot can lead to a hallux valgus. Image rights: imago/Science Photo Library
Which therapies are indicated for the treatment of rheumatic foot?
Ulrike Lorenz: In any case, the basis of treatment is drug therapy with tablets, injections or infusions: basic therapy. This systemic therapy must be closely monitored and optimized. Among other things, it suppresses the inflammation of the inner membranes of the joints and the tendon sheaths and can thus prevent the destruction of joints, capsules, ligaments and tendons and thus the loss of stabilizing structures. Unfortunately, the destruction of these structures cannot always be prevented as the disease progresses.
In the early stages of foot changes, symptoms can be reduced using custom-made insoles. Adjustments to the shoe can also help alleviate symptoms and make the rolling process easier. However, they are not suitable for every patient. If a single joint is inflamed, cortisone infiltrations or the injection of radioactive drugs into the inflamed joint can help. In the case of more advanced misalignments where a ready-made shoe no longer fits, wearing custom-made orthopedic shoes can also relieve discomfort.
Depending on the stage of the disease and taking into account the course of the disease, operations in both early and advanced stages can also be helpful in maintaining the stability of the foot or avoiding subsequent damage and thus alleviating the patient’s symptoms. However, the operations must always be integrated into the overall picture of the chronic disease, because these are diseases in which several joints in the body are often affected. The aim of every therapy method is to relieve pain and maintain or improve the patient’s mobility.
Are there any natural remedies you would recommend? Anti-inflammatory supplements? Or can only heavy artillery help against rheumatism?
Ulrike Lorenz: Rheumatism includes more than 100 diseases from various areas, such as wear-related rheumatic diseases (e.g. arthrosis), metabolic disorders that can be associated with rheumatic complaints and non-inflammatory diseases of the soft tissues (e.g. fibromyalgia). For some of these diseases, natural remedies can be effective as sole therapy.
In the case of autoimmune inflammatory rheumatic diseases, natural healing methods and anti-inflammatory foods can be used very well as supportive therapy. However, they are not suitable as sole therapy to treat the disease. This risks the destruction of organs, joints or tendons. Among the many possible natural healing methods, these include: B. the use of leeches, especially for degenerative changes. Regular exercise therapy through joint-friendly sports such as swimming, water aerobics, walking, ergometer training or cycling promotes joint mobility, strengthens the muscles and helps to reduce pain. Regular practice of Tai Chi or yoga can have a beneficial effect on the course of the disease and improve quality of life.
A nutritious diet can also have a positive effect on the course of the disease and supplement drug therapy. We recommend foods that contain anti-inflammatory Omega 3 fatty acids, e.g. B. fatty fish, linseed oil, avocado or walnuts. Green leafy vegetables and berries, apples or grapes are also a good addition to the diet. Some spices are also said to have anti-inflammatory effects, such as: B. Garlic, turmeric and ginger. They are best used raw.
It is assumed that the immune system of rheumatism patients does not function properly. As a patient, can I stop the progression of the disease using my own resources or at least influence it positively?
Ulrike Lorenz: Inflammatory rheumatic diseases are autoimmune-related diseases. This means that it is not possible to stop the progression of the disease with your own resources, but you can definitely have a positive influence on the progression of the disease. There is good experience with rheumatoid arthritis, for example, with fasting, which can support drug therapy and can be carried out approximately once a year for seven to ten days. However, it must be discussed in advance with the attending physician and should be carried out under clinical supervision. Appropriate stress management can also help you live better with an inflammatory disease. Overall, there are a variety of ways to do something good for your body if you have a chronic illness. Those affected can discuss this with their treating doctors and take advantage of the very good advice offered, e.g. B. at the German Rheumatism League.
Wearing comfortable, well-fitting shoes, which should be made of soft material if possible, is particularly recommended for the feet in order to avoid pressure points. Flat heels are recommended to reduce stress on the forefoot. Skin and toenails should be cared for and the feet should be inspected daily with the help of a mirror, similar to patients with diabetes mellitus, as sensory disorders in the foot area can also occur in rheumatic diseases. This self-inspection helps to detect redness at an early stage, which can be the precursor to a pressure ulcer.
And vice versa: What should rheumatism patients avoid?
Ulrike Lorenz: In general, smoking and alcohol in large quantities, as well as too little exercise or too much incorrect exercise. Too little sleep or poor stress management can also have a negative impact on the disease. When it comes to food, the intake of arachidonic acid, which is increasingly found in animal foods such as lard, liver, butter, cream, sausage and meat as well as eggs, should be reduced. Arachidonic acid is involved in the formation of inflammatory messenger substances and can therefore promote joint inflammation.
MDR (cbr) First published on May 20, 2021.
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