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understanding
age
Rheumatism
• Early detection
• Current therapeutic options
• Recommended by sufferers and support groups
Understanding Rheuma-
tism PAGE
EDITORIAL 5, 7
INFLAMMATORY RHEUMATIC
ILLNESSES 20
HEUMATOID ARTHRITIS
R
(CHRONIC POLYARTHRITIS) 21
MORBUS BECHTEREW 32
PSORIATIC ARTHRITIS 40
GOUT 45
MEDICINAL THERAPY 48
NON-MEDICINAL THERAPY 56
GENDER-SPECIFIC DIFFERENCES 62
PAGE
DEGENERATIVE RHEUMATISM64
ARTHROSIS 65
OSTEOPEROSIS 72
SOFT-TISSUE RHEUMATISM78
FIBROMYALGIA 79
AUTOIMMUNE ILLNESSES86
SELF-TESTS113
SELF-HELP GROUPS114
CONTACTS:
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„Understand rheumatism“ All text in has been researched to the best of our knowledge. Errors are excepted. Despite careful scrutiny, Publisher and media owner not
responsible for typographical and substantive errors. For the sake of readability, often only the masculine form of the name of persons (e.g. the patient) is used, respectively,
but that both the female and the male form meant. No part of this publication may be reproduced in any form (photocopy, microfilm or any other process) without the written
permission of the publisher or electronically stored, processed, copied, used or distributed.
Prim. Univ.-Prof. Dr. Ludwig Erlacher Prim. Doz. Dr. Günter Höfle
Leiter der 2. Medizinischen Abteilung, SMZ-Süd, Wien Leiter der Abteilung für Innere Medizin,
LKH Hohenems
Dear Readers,
You are now holding the 5th revised and updated edition of the “Understanding Rheuma-
tism“ patient advisor in your hands.
The great amount of feedback from sufferers highlights the need for understandable
information for patients. We are convinced that better knowledge of rheumatic illnesses
is of great importance, and that sufferers profit from knowing more about their illness.
Modern Rheumatology places a common goal, a common basis for decision-making by
Rheumatologists and patients, at the center of treatment – and achieving this, “knowl-
edge“ is a key requirement.
We have therefore joined together with medical journalists and experts to create this
comprehensive collection of articles. Here you will find a wealth of clearly-structured,
understandable information. You will find numerous answers to common questions,
subdivided according to the individual illnesses that are important to you.
In closing, we would like to point out that the pages 103 through 106, as well as the
advertisements in this edition, do not represent content disputed among scientists.
This compendium is a collection of many individual expert opinions. It can therefore
not be considered a basis for matters of medical controversy. Mainly, it is intended to
provide you with assistance – even for consultations with your doctor – as it conveys
important basic knowledge concerning the various Rheumatoid illnesses.
PAGE
KYTTA SALBE71
MOBIFLEX116
Dear readers,
Informative guides like this one from the “Understanding Health“ series enjoy great
popularity among pharmacy customers. The demand is so great that some editions
have already sold out, such as “Understanding Rheumatism,” the 4th Edition of which
was published in 2012. Therefore, due to the obvious need by those suffering from
rheumatism, this 5th revised edition is now available.
Chronically ill persons often seek competent, reliable answers to their questions.
Health guides such as “Understanding Rheumatism” provide valuable information.
Our scientific advisors, with the support of whom all articles in this edition have
been written, ensure that the content is up-to-date.
The most important rheumatic illnesses, such as Rheumatoid Arthritis, Psoriatic Ar-
thritis, Morbus Bechterew, Arthrosis and Osteoporosis have been illustrated here in
a clear, comprehensive manner. In addition to therapeutic options, tips for patients
for dealing with their illness can be found in this guide. The dedicated “Help from
the Pharmacy“ chapter offers an overview of the support and products provided by
pharmaceutical professionals.
Real-Life Success:
A Sufferer Reports
Interview with Hans Spitzauer, five-time
Olympic medalist and European sailing
champion.
What does “Rheumatism“ actually addition to the pain, the illness also
mean? causes massive psychological pressure
The term “Rheumatism“ can be translat- for the involved parties.
ed as “pain in the musculoskelatal sys-
tem.“ This term applies to all longer- Isn‘t Rheumatism a problem experi-
term functional disturbances in the enced only by older people?
musculoskelatal system (this includes No. Rheumatism is not necessarily linked
bones, joints and muscles). Rheumatism to advancing age. The typical patient that
– otherwise known as the “illness with suffers from chronic inflammatory
many faces“ – therefore serves as ge- rheumatic systemic disease (e.g. Rheu-
neric term for over 400 illnesses, behind matoid Arthritis) is 40 years young and
which lies a seemingly endless multi- female. Patients who suffer from Fibro-
tude of afflictions and causes. myalgia are only 35 years old on average.
The first symptoms of Morbus
Do I have Rheumatism – and will it Bechterew, another inflammatory rheu-
heal by itself? matoid illness, appear around the 23rd
Every third person is, in the course of his year of age. Arthrosis is not necessarily a
or her life, affected by rheumatic ail- sign of old age.
ments. Early detection, in particular
early diagnosis, is especially important. What illnesses are considered
Unfortunately, many sufferers realize ”Rheumatism”?
too late that the possibility exists that A classification of rheumatic illnesses
they could be ill with Rheumatism. can be carried out respective to the rheu-
This, however, is valuable lost time for matic disorder, according to the causes:
the health of the joints. Therefore, as
soon as the first warning signs appear 1. Inflammatory Rheumatism: Inflam-
(joint pain and swelling, stiffness in the mable rheumatic joint affliction (e.g.
mornings, etc.) then go see a doctor Rheumatoid Arthritis, Juvenile Idio-
right away! pathic Arthritis, Psoriatic Arthritis).
What applies to all types of Rheuma- 2. Degenerative Rheumatism: Erosive
tism is the fact that those who have fall- joint and spinal changes (e.g. Arthro-
en ill to Rheumatism once in thier lives sis)
often needs long-term therapy. If not 3. Soft-Tissue Rheumatism: Extra-artic-
properly treated, inflammatory Rheuma- ular Rheumatism (e.g. Fibromyalgia),
tism progresses in any case, leading to as well as abrasion and overloading of
impairment of the musculoskeletal sys- tendons or bursa in the case of local
tem and causes irreversible joint damage. pain in only one joint (e.g. calcific ten-
If not given enough attention, debilita- donitis)
tion, disability and, in the worst cases, 4. Joint diseases caused by metabolic is-
early retirement can be the results. In sues (e.g. Gout)
WANN
WO
WIE
What role does the mind play to no illness activity, and following pri-
throughout the course of the illness? or consultation with a doctor. Indepen-
For sufferers, the illness also brings about dent of the exact rheumatic illness di-
a great deal of mental stress, since it has agnosis, an increase in the mother‘s
to do with a chronic – lifelong – illness. illness activity means a minimally-in-
Much self-discipline is often required for creased risk of miscarriage, premature
the years of pharmaceutical therapy. Pain birth and impaired growth of the child.
and stress management also play an im-
portant role. Psychological help, such as Does illness activity change during or
stress training, autogenous training and after birth?
behavior therapy, can have positive ef- The prognosis for the mother depends on
fects on the course of the disease. the exact diagnosis: In the case of Rheu-
matoid arthritis and Morbus Bechterew,
Why are so many people with Rheu- an improvement in illness activity dur-
matism not in therapy? ing the pregnancy is to be expected; how-
The patient care in Austria, with suitable ever, in about a third of patients, illness
medication, physiotherapy and other sup- activity could actually increase. The re-
port is anywhere betwen very good and duced illness activity is traced to the
excellent. The problem lies elsewhere: ev- changed immune situation during preg-
ery second sufferer of Rheumatism has nancy...in other words, how a “foreign
never been to see a doctor, and often only body“ is tolerated. In the case of collage-
suspect a rheumatic condition very late. nosis, such as Systemic Lupus Erythema-
Consequently, the doctor can‘t even refer tosus, a worsening can be expected, espe-
the patient to a laboratory examination or cially if the kidneys are involved.
Rheumatologist. Therefore, cooperation with organ spe-
cialists, such as for Nephrology (special-
Can children also become ill with ists for kidney, hemodialysis and organ
Rheumatism? transplantation), D ermatology (skin) or
Yes. This form of Rheumatism is called Neurology (chronic neuritis).
“Juvenile idiopathische Arthritis” (JIA).
It is an autoimmune illness and can What should an expectant mother
even affect newborns. The reasons why look out for?
the immune system fails to regulate it- In addition to the usual pregnancy pre-
self have not all been discovered at this cautions, closely-monitored rheumato-
point in time. logical examinations should be carried
out. It makes good sense for involved
Is it not advisable to carry out a preg- doctors, such as rheumatologists, gyn-
nancy with Rheumatism? ocologists and pediatricians, to discuss
As a matter or principle, a pregnancy is among themselves the best possible
always possible. However, it should re- course of action for the pregnant pa-
ally only be planned in phases of little tient.
What effect does a pregnancy have This should be discussed during prepara-
on taking medicine? tion in order to more quickly begin proper
The package insert for almost all medi- therapy.
cations contains the following advice:
“Do not take if pregnant.” This refers to Will my child also have a tendency to
the fact that no medication has been develop Rheumatism?
tested to the point of being able to be The genetic, hereditary tendency to devel-
called “harmless“ if taken during pre- op Rheumatism does exist. However, this
gancy. Experience, however, shows is only very slightly responsible for the ac-
that medication - even those for which tual breakout of the illness, as has been
a warning is printed on the package in- shown by studies on identical twins. Cur-
sert - can certainly be taken during preg- rently, the only known preventative mea-
nancy. In any case, before taking any sure for every type of rheumatic illness is
medication, it is necessary to consult to stop smoking!
with a medical doctor! In summary, one can say: A pregnancy is
Support centers are available for human a wonderful event. For women who suffer
genetics, which deal with precisely this from a rheumatic ill-
question, and also generate expert re- ness, planning
ports covering the risks of taking medi- should be carried
cations during pregnancy and breast- out together with
feeding. the rheumatolo-
A bit of advice to male Rheumatism gist so that this
patients: The subject of medication ap- special time,
plies not only to women. Men suffering which is so im-
from rheumatic illness with a desire for a portant for
child should not simply stop taking their both mother
medication, but rather discuss this sub- and child, can
ject with their doctor. also take its
course in rela-
Can complications arise during preg- tive security.
nancy?
Yes, and for this reason, regular consulta-
tion with your doctor is so important! If
problems begin to emerge, then monotir-
ing at a high-risk clinic is recommended.
Birth should be carried out in a depart-
ment with an adjacent neonatol care unit
(premature birth station). In general,
pregnancy and birth occur without any
problems. However, often enough, imme-
diately following birth a surge can occur.
Living with Rheumatism
Overview Symptoms
1. Chronic Inflammatory Illnesses
a. Rheumatoid Arthritis, RA Joint pain or swelling, pressure pain, morning stiffness
(CP; Chronic Polyarthritis) for at least half an hour
c. M
orbus Bechterew Deep back pain, morning stiffness in the spine, chest
or back pain, hip pain in der upper groin area, spine
stiffness
d. Psoriatic Arthritis Radiant inflammation of the joints of the hands and feet,
PsA; skin psoriasis with joint illness) accompanied by skin problems, tendon inflammation
with swelling
b. Fibromyalgia Pain over large areas, from head to tow, sleep or fear
(“Soft-Tissue Rheumatism”) disorders, chronic fatigue, depression, in some cases
the feeling of swelling in the hands, feet and face,
sensitivity to sounds, light and cold.
RHEUMATOID ARTHRITIS
(CHRONIC POLYARTHRITIS)
firm his suspicions. When the results their illness, up to 85% of RA patients
are in and suspiction has been con- show Rheumatoid factors in their
firmed, the patient should definitely blood serum. This does not provide
seek the advice of a Rheumatologist clear proof of the existence of RA, since
who can set the optimal therapeutic there are also patients with RA who
course of action. have no Rheuma factor (negative, sero-
negative). The converse argument is
What do the findings show? also false, because those persons who
Laboratory findings alone cannot pro- show this factor in their blood are not
vide proof of the existence of RA with necessarily ill with RA. Up to 20% of all
absolute certainty. However, in addition healthy elderly people exhibit higher
to the clinical findings (e.g., the patient Rheumatoid factor levels.
is experiencing pain and joint swelling), The most modern laboratory tech-
findings can often be confirmed. Fur- nique for certain diagnosis is the ACPA
thermore, they are useful for the current Test, which can prove the existence of
diagnosis because they can help to judge Anti–citrullinated protein antibodies
the activity of the illness. llike Anti-CCP or Anti-MCV antibodies.
During inflammation, blood tests often This is in fact very meaningful for the
show an increased erythrocyte sedi- existence of RA.
mentation rate and an increased C-re- If blood tests reveal no clear results,
active protein (CRP). The value of the but if clinical symptoms persist, then
ESR and the CRP, however, merely next steps should most certainly be
shows that an inflammation is present in taken to secure a clear diagnosis.
the body, but provides no evidence of
whether or not the issue is an inflamed What imaging methods are available,
joint and therefore definitely RA. and why are they important?
The changes typical for RA can be prov-
What are Rheumatoid factors? en and the condition of the joints can be
Rheumatoid factors (RF) are the body‘s made visible via x-ray. It is these joint
own defenses that bind to the body‘s proximity erosions (defects in the area of
own immunglobulins (antibodies), and the cartilage-bone junction). X-ray, how-
hence turn on their own kind. They can ever, can only reveal already-existing
be detected in the blood. The RF can destruction to the knee.
confirm the suspicion of the presence In the early stages of RA where no signs
of RA, but is on its own not proof of a are visible via x-ray, an MRI (magnetic
rheumatic illness. The Rheumatoid fac- resonance imaging) is very helpful. An
tor is a building block that is, in addi- MRI allows the early detection of joint
tion to the discomforts described by inflammation without radiation, and
patients and the results of bodily ex- before serious damage has been done
amination by the doctor, important for to the cartilate and bone. To this end, a
diagnosis. Throughout the course of magnetic contrast agent is injected.
What ergonomic assistance is avail- out the affected joint (see page 56). After
able for day-to-day living? only a few weeks, the synovial tissue
This is the domain of the occupational grows back (regenerates).
therapist. When day-to-day activities,
such as holding a coffee cup, cutting
bread or buttoning a shirt become im-
Tips for better living
possible, it‘s time to start looking at as-
sistive devices available in well-stocked • Carry heavier loads by backpack for
specialty shops. Finger and arm slings even weight distribution.
can be very helpful, as can so-called but-
tonhole und swan neck splints or meta- • Avoid shock to the joints (vibrating
carpal brace. Special knives (the handle machines, joint agitation).
is bent back 90 degrees from the blade) • Do not exceed your weight limit; don‘t
and bottle openers can also offer assis- overdo it.
tance.
• Wear wrist supports when doing activities
When is an operation inevitable? involving heavy loads.
Operations are only carried out when • Pay closer attention to your posture when
other forms of therapy have not brought sitting and standing.
about the expected results. In a proce-
dure known as a Synovectomy – for pres- • Make sure to engage in fun activities to
ervation of the joint – the inflamed syno- realize happy moments.
vial membrane is removed by stripping
young patient‘s medical history and to es- avoiding lasting damage to the joints.
tablish connections with his/her current The therapy schedule differs according
affliction. In addition to the thorough ex- to patient, and is made up of a combina-
amination of the inflamed joints, another tion of pharmaceutical drugs, physio-
assessment of the illness follows using therapy, ergotherapy, psychosocial sup-
imaging procedures such as ultrasound, port and, rarely, operations.
x-ray, MRI and, rarely, CAT scan. A he-
mogram (bloodwork) is also important Which medicines are applied?
for the diagnosis. By way of the enthro- Usually, multiple kinds of pharmaceuti-
cyte sedimentation rate, the behavior of cal medicine are necessary in order to
red blood cells is observed - allowing one get control over the inflammation and
to draw conclusions concerning an infec- the pain:
tion in the body. The level of C-reactive • Non-steroidal antirheumatic drugs
proteins (CRP) – one of the proteins in are anti-inflammatory and partially re-
the blood – also rises when an infection is lieve pain.
present in the body: the higher the value, • Cortikoids inhibit the inflammation
the more active the instance of inflamma- and are administered to children and
tion. adolescents not only in tablet form or
via infusion, but also as an injection. It
How is child rheumatism treated? is carefully dosed and the duration of
The main goal of the treatment is to stop treatment is as short as possible. A sin-
the inflammation altogether, thereby gle high dose is administered only in
rare cases, such as when the inflamma- der to maintain and promote mobility, only
tion is especially strong and must be after proper instruction by a therapist.
curtailed quickly. With the help of ergotherapy, joint-
• Disease-modifying antirheumatic friendly movements are practiced which
drugs (DMARDs) are used in the case are meant to assist in day-to-day life. As-
of more severe forms of JIA. They di- sistive devices such as individually-tai-
rectly influence the process and there- lored splints, grips for pens or special
fore the progression of the illness. three wheelers can be useful. Having the
Methotrexate is one of the most com- bed at the correct sitting height eases
monly-used DMARDs. standing up, and a vertically-adjustible
• Biopharmaceuticals also directly influ- desk and an ergonomic desk chair are
ence the illness process. Biopharmaceu- also important for healthier day-to-day
ticals like Etanercept or Adalimumab living.
block the body‘s own Tumor-Necrosis- Since the bodies of children and adoles-
Factor alpha (TNF-alpha) messenger, cents are still in the growing phase, a bal-
and are then used when other medicines aced diet of fresh fruits and vegetables,
appear to have no results or have nega- milk and whole wheat products, fish and
tive side effects. Biopharmaceuticals vegetable oil are essential. Unbalanced
(e.g. Abatacept), are often combined diets are to be avoided!
with DMARDs to target and influence
the inflammation process. The Interleu- When is it time for an operation?
kin-6 inhibitor Tocilizumab is also im- If damage has already occurred to the
plemented to handle child rheumatism. musculoskeletal system, operations on
In contrast to DMARDs, the effects of rheumatically-deformed joints can help
Biopharmaceuticals are already appar- to re-establish functionality or to avoid
ent within only a few weeks. further restriction. A commonly-applied
• Pain therapy: Serious cases of JIA can invasive measure is the intra-artikular
result in severe pain. This is when, in steroid injection. This is a very effective
addition to pharmaceutical therapy, means for suppressing joint inflamma-
physical therapy can make sense. The tion by way of a one-time administra-
pharmaceutical pain therapy when ap- tion of anti-inflammatory medicine via
plied to children requires a great deal injection.
of experience in regards to proper dos-
age and tolerance. How should a family deal with such
an illness?
What supportive therapy options The first thing to do is inform everyone
exist? within the child‘s immediate circle of
Physiotherapy helps to prevent or correct family and friends - teachers, class-
malposition and stiffness of joints arising mates, playmates, etc. - about the ill-
due to protective posture. It is important to ness. Visits to the doctor and therapy
carry out exercises regularly at home in or- must be integrated into every-day life.
Apart from that, the child should main- tients themselves to get to know others
tain as normal a life as possible. It is who suffer from the same illness.
therefore important not to conceal the
illness, but rather to accept it and Is it alright if my child engages in
thereby encourage the child to make sports activities?
the best out of the situation. Don‘t al- Yes, absolutely! Sports have a positive
ways take it easy, either. Rather, be con- effect on mobility. Even if some types of
sciously aware of which hobbies or sports such as tennis or football are not
types of movements are possible de- recommended due to the severety of the
spite bodily constraints! Exchanging illness, there are alternatives which al-
experiences with other parents of afflict- low one to keep moving: swimming,
ed children via the Austrian Rheuma horseback riding, dancing, bicycling or
League or a self-help group (www. table tennis are types of sports that are
rheumaliga.at, www.rheumalis.org) can easy on the joints. Get your child to keep
be comforting and be a source of many moving, and encourage happy moments
valuable and practical tips for parents. It by engaging in fun, recreational activ-
can also be helpful to the young JIA pa- ites!
Swimming
Attention: correct water temperature! Bicycling
...depending on severity of illness:
MORBUS BECHTEREW
What is a Spondyloarthritis?
Spondyloarthritis is an inflammation of
the vertebrae and the small joints in the
spine. In its most advanced form, it is
also referred to as Morbus Bechterew
(lat.: Spondylitis ankylosans).
Neurological problems – Cauda equina What are some additional risk factors
syndrome: Following a long period of ill- for AS?
ness with severe stiffness of the spine, the The risk of illness is higher in some fam-
result can be nerve damage in the area ilies, especially for immediate blood
under the lumbar spine. The symptoms relatives (parents, sisters, brothers, chil-
are numbness, weakness, difficulty uri- dren). AS occurs more often in men
nating and involuntary defecation. It can than in women. It is commonly diag-
also lead to erectile dysfunction and im- nosed between the ages of 20 and 30.
potence in men.
Does AS affect everyday life?
Cardiovascular disease: Rarely it in- AS can affect everyday life in the fol-
volves the aortic valve, which no longer lowing areas: getting dressed, grabbing,
closes all the way, the results being heart standing up from the chair, getting up
failure, signs of leg edema and shortness from the floor, standing straight, ascend-
of breath under stress. ing stairs, looking to the side or over the
shoulder, doing household chores. These
Lung disease: Due to a stiffening of the limitations can occur due to a lessening
joints in the chest, many patients can no of joint and spinal mobility and have ef-
longer fully extend their lungs. The re- fects on the patients and their families.
sult is a change in the function of the Sometimes it is necessary to have assis-
lungs. A special form of breathing ther- tance.
apy can also help to reach the inade-
quately-ventilated areas of the lungs, How is AS treated?
thereby reducing the risk of infection. Treatment is adapted to the specific
manifestations and the severity of the ill-
Enteritis: Some patients with AS devel- ness. The following elements can/should
op infections in their intestines, which be part of the treatment:
normally do not produce any symptoms.
Remedial gymnastics exercises:
What is HLA-B27? “Bechterew Gymnastics“ should be part
The HLA-B27 antigen is an innate char- of the treatment for all patients with AS.
acteristic of white blood cells. It does not The exercises are comprised of daily
change throughout one’s lifetime. Proof home exercises, single or group therapy
that one carries this characteristic means with a physiotherapist or even physio-
a higher chance that a Spondyloarthritis therapeutic applications such as heat/
diagnosis can be reached, but only when electricity/ultrasound/massages. The
pain is clearly present. The HLA-B27 an- home exercises should include posture
tigen can also occur in totally healthy per- training, breathing exercises, back
sons – in which case it means nothing. strength training and stretching.
1A 1B 2A
2B 3 4
2. S
trengthening the upper back
muscles
Lay on your stomach and fold both hands
in front of your head, with the palms of
your hands on the floor, supporting your
forehead. Now, slowly raise the elbows
and pull your head up. Hold this posi-
tion. Then, lay yourself down flat on the
mat and relax, before repeating the exer-
cise again.
3. S
trengthening the stomach and
backside muscles
Get down on all fours and raise your left
arm and right leg horizontally. In the
process, strain your stomach and back-
side muscles without leaning out with
the hip (in other words, the hip should
remain positioned over the knee). After
you have returned to all fours, repeat the 5
motion, but this time with the right arm
and left leg. Strengthening the shoulder muscles
PSORIATIC ARTHRITIS
How does the illness progress? How can I recognize Psoriatic Arthritis
As a rule, Psoriasis as well as Psoriatic in my child?
Arthritis progresses in chronic phases. Psoriatic Arthritis in infancy is rare and
This means that phases of decline switch does not follow a uniform pattern. Re-
with phases of improvement or even free search shows that children are affected
of pain. Though the skin affliction in ev- mainly between the ages of 2 and 5 years
ery illness phase can be brought into full old. The little patients usually have to
remission, the joint inflammations lead deal with painful inflammation of the
to permanent damage, resulting in lim- finger or toe joints. The children wish to
ited movement of the affected joint. keep their weight off of the afflicted joint
and want to be carried. Older children
suffer from inflammationo of th liga-
ments and/or the spinal joints, which can
result in pain in the lumbar area. Also,
fever which appears with or without a
rash over a longer period of time, or an
inflammation of the iris can be a first in-
dication.
GOUT
Biopharmaceuticals
TNF-alpha Infliximab intravenous infusion, initially at chimeric human- rheumatoid arthritis, psoriatic
Blockers weeks 0, 2 and 6, every four to murine monoclonal arthritis, ankylosing spondylitis,
eight weeks later, depending on antibody Crohn‘s disease, ulcerative coli-
the disease tis, Crohn‘s disease with fistula
formation, pediatric Crohn‘s
disease
Adalimumab subcutaneously: pre-filled syringe monoclonal human rheumatoid arthritis, psoriatic
or pen; vial exclusively for kids, antibodies arthritis, ankylosing spondylitis,
every two weeks Crohn‘s disease, juvenile idiopa-
thic arthritis, ulcerative colitis
Etanercept vial; subcutaneously: pre-filled sy- human TNF recep- rheumatoid arthritis, psoriatic
ringe or pen, once or twice a week tor p75 Fc fusion arthritis, ankylosing spondylitis,
protein juvenile idiopathic arthritis
about storing their medication, for ex- flammation in the joints diminishes,
ample, on vacation; nor do they have to and the changes to the bone can be
be concerned about any issues during slowed or stopped. The way in which
self-administration. the patient realizes successful treat-
ment is by feeling less pain and the
Biopharmaceuticals in the form of joint swelling either fades or stops alto-
pre-filled syringes or pens – what are gether. The main disadvantage is the
the advantages? high cost.
The first time a patient administers a Important: Before taking the substance,
drug using pre-filled syringes or pens, it the existance of a serious infection, espe-
should be done under the supervision of cially tuberculosis, must be excluded!
their doctor. The drug is administered,
for example, as a ready solution in the What is the importance of the B -cell
pre-dosed pen with built-in needle, with therapy?
no additional preparation needed. If the In contrast to the TNF alpha blockers,
patient has gained enough confidence in which focus mainly on the regulation of
handling it alone, then he can administer Zytokines, this therapy targets the B-cells,
the drug to himself at home. For many or B-Lymphocytes, a subclass of the white
patients this constitutes an advantage, blood cells. An important task of the B-
since this makes them independent of cells is form abtibodies. In the case of
the hospital or their doctor. It is impor- rheumatoid arthritis, however, the B-cells
tant, however, to note that the patient are called up to attack the body‘s own
must ensure that the substance is kept joints. In B-cell therapy, B-cells - which
cool in the refrigerator - at between 2 carry a special marker (CD20) on their sur-
and 8 degrees Celcius. face - are greatly reduced. Thereby, the
illness activity and the radiologically veri-
TNF-alpha blockers are also Biophar- fiable destruction of the joints can be re-
maceuticals. What can they do? duced.
The substances that are used – Adalim- Rituximab is a substance that was origi-
umab, Certolizumab, Etanercept, Goli- nally developed as a therapy for malicious
mumab und Infliximab – block the illnesses of the lymphatic system. Cells
body‘s own inflammation-causing such as plasma cells, which do not carry
messenger known as TNF alpha. In this the CD20 marker, are not eliminated, al-
way they inhibit the further progres- lowing part of the body‘s own immune
sion of joint inflammation, stopping system to remain intact. As a general rule,
the destruction of the joint. The mobil- two infusions at intervals of 14 days are
ity of the joint is preserved. The advan- administered – if this shows no effects,
tages over and above conventional then the administration of Rituximab is
NSAIDs: Many patients react quickly ceased. If it is shown to have a positive ef-
and well to TNF alpha blockers, the in- fect, then continuation for between six
months and one year is allowed. Usually, What other pharmaceutical options
Rituximab is administered in combina- are available?
tion with an NSAID. An additional therapeutic option for rheu-
matoid arthritis is the IL-1 receptor in-
How can blocking the activation of hibitor Anakinra, which is also used for
T-cells help? adult patients who have been shown to
When a patient does not react satisfactorily react unsatisfactorily to NSAIDs. This
to therapy with NSAIDs, then the Bio- substance arrests the inflammation-
pharmaceutical Abatacept can be ad- promoting messenger Interleukin-1. In
ministered. This substance is admitted its effectiveness, however, Anakinra is
for use by patients with moderate to se- inferior to the other Biopharmaceuticals
vere rheumatoid arthritis (RA) and Juve- and therefore does not represent a pri-
nile Idiopathic Arthritis, and is usually mary form of treatment.
taken together with Methotrexat. Its im- When it comes to Psoriatic Arthritis, the
munomodulating effect is due to the Interleukin-12/23 blocker known as
blocking of the activation of T-cells. The Ustekinumab is available. This drug
active ingredient impedes the activation fixes itself to the inflammatory messen-
of T-Lymphocytes (T-cells) which play a gers Interleukin-12 and 23, and can
role in the regulation of the immune sys- thereby reduce inflammation.
tem‘s defense processes, thereby sup- The BLyS-Inhibitor Belimumab is a bio-
pressing the inflammation process. pharmaceutical prescribed to patients
with systemic Lupus erythematodes (see
When is an Interleukin-6 Receptor page 87) who still display high illness ac-
Inhibitor used? tivity following standard therapy. Its ef-
The IL-6 Receptor Inhibitor is a humanised fectiveness is based on its bonding to the
monoclonal antibody against the Interleu- soluble B-Lymphocytes stimulator hu-
kin-6 Receptor (IL-6), which suppresses man protein BLyS, which shortens the
the activity of IL-6, another important trig- lifetime of B-Lymphocytes.
ger of the inflammation process. The sub-
stance Tocilizumab, employed here, is ap- What types of monitoring are impor-
proved for use by patients with tant for long-term therapy?
moderately to severely active RA, or with In order to identify damage early on
polyarticular Juveniler Idiopathic Arthritis, which is not subjectively recognizable,
and who have not reacted satisfactorily to the following should be monitored:
an NSAID therapy. The mechanism of ac- blood count, liver function, kidney
tion reduces the inflammation of the function, CRP and urine. Some com-
joints and mitigates the systemic symp- pounds or a combination of multiple
toms. The onset of action is, as a rule, to be substances require additional monitor-
expected quickly. ing.
When does it make sense to have an In the case of pre-emptive surgery, the
operation? operation takes place early on, when the
An operation is carried out with the in- cartilage tissue and ligaments are still in-
tention of improving the functionality tact, with the goal of stopping or delaying
of the joint and reducing pain. Opera- irreversible damage to joints and liga-
tions are never a replacement for medi- ments. Functionality should remain in-
cal therapy, but are rather resorted to tact.
when all conventional methods (such as Reconstructive surgery, on the other
physical therapy, drugs, assistive devic- hand, is when the fuctionality of the
es, etc.) have been exhausted, yet the joint has been compromised. It should
pain in a joint remains. An operation be restored and pain should thereby be
can be either a preventive or a rehabili- reduced.
tative measure.
What operations or methods exist? rect Cortisone injections have not been
• Synovectomy: This is a surgical proce- adequately successful.
dure whereby the synovial membrane -
the soft tissue between the joint capsule When should a joint be surgically
and joint cavity - is removed. The re- replaced?
quirement is that the weight-bearing If damage has reached a certain point,
area is still intact. With the help of this then the only alternative is joint replace-
operation, the progression of destruc- ment made of materials such as metal,
tion to the joint can be delayed and, in ceramics, polyethylene or silastic. In the
some cases, even brought to a standstill. case of a total endoprosthetic, the ball of
Today, with the benefit of so-called key- the joint as well as the socket are re-
hole surgery by means of arthroscopy, placed, whereby for a partial prosthetic
surgery can be performed - mainly out only the joint ball is replaced, and not the
on the knee or shoulder - with only very socket. This procedure can be applied to
small incisions. Arthroscopic surgery almost all joints - shoulder, elbow, hand,
can often not be carried out on hand and finger, hip, knee, upper ankle or toe
finger joints, however, since tendons joints. The most common are knee and
and ligaments must be treated simulta- hip replacement.
neously. This is when an “open” syno- In general, it can be said that the imple-
vectomy is performed which requires mentation of artificial joints can lead to
larger incisions. Following the surgery, great improvements in pain reduction
the synovium grows back within only a and almost normal mobility. 90–95% of
few weeks. all implants last at least 15 years,
• Corrective Surgery in the case of joint through for very active young patients
malposition or functional restrictions this can be somewhat shorter. Certain
(preventative and reconstructive proce- materials match to enable extremely
dures) low friction, such as ceramic on ceram-
• Joint replacement (partial or total en- ic, whereby even high loads exerted
doprosthetics) during athletic activity are supported.
• Arthrodeses, Spondylodeses (stabilis-
ing Albee‘s operation) What is an Albee‘s Operation?
This is the surgical stiffening of a joint,
What is Radiosynoviorthesis? for example in the case of a very severe
Radiosynoviorthesis is a procedure rheumatic illness (often used for small-
wherein a weak radioactive liquid is in- er joints in the feet and vertebrae) and
jected into a chronically inflamed joint, mainly serves to reduce pain. The mo-
thereby cauterising the surface of the bility of the joint is disabled, the parts
inflamed synovium. This form of treat- of the bone of the stiffened joint grow
ment should only be implemented together.
when treatment with NSAIDs and di-
What types of operations are until a bony bridge can be formed that
available? stops the progession of the illness.
• Rheumatoid Arthritis (RA): Depend- • Psoriatic Arthritis: Depending on the
ing on the phase of the illness, the in- stage of the disease, the inflamed joint
flammably changed articular capsule or capsule or oder tendon sheath is re-
synovial sheath is removed (synovecto- moved (synovectomy), damaged ten-
my), damaged ligaments are recon- dons are restored and a partial joint re-
structed, a partial joint removal (resec- moval ( resection arthroplasty) is carried
tion arthroplasty) is carried out, a joint out, a joint stiffening (Arthrodesis) is
stiffening (arthrodesis) is performed or performed or an artificial joint is im-
an artificial joint is implemented. Artifi- planted.
cal joints are usually implemented in the
hips, knees or shoulders, and more rare-
ly in the elbows or ankles. In the case of
smaller joints, a stiffening operation is
carried out. For patients with rheuma-
toid arthritis, inflammatory changes are
often apparent in the second vertebral
body, which can lead to neurological de-
ficiencies in later stages. The initial
damage to spinal marrow is apparent
due to pain in the neck and back of the
head, and a weakening of the extremi-
ties and uncertainty while walking. A
stiffening operation can protect the spi-
nal marrow and additional damage can
be avoided. The choice of the correct
point in time for the operation is deci-
sive.
• For Morbus Bechterew: Primarily,
life-long gymnastics is necessary to
strengthen the spinal erector. When the
course of the disease, however, is so
strongly progressive that the curvature
of the spine is exaggerated, then a stiff-
ening operation can be carried out on
the spine. Screws are inserted into the
vertebrae and linked in series with rods
in order to achieve stability. These im-
plants are only temporary stabilisors, Neck pain due to RA is often very distressing.
GENDER-
SPECIFIC
DIFFERENCES
From which rheumatic illnesses are Do any rheumatic illnesses exist that
women more likely to be affected affect more men than women?
than men? • Morbus Bechterew: Around twice as
• Rheumatoid Arthritis (RA): Two to many men are affected by this disease
three times more women become ill than women. In addition, the symp-
with RA than men. Hormones like Pro- toms of Morbus Bechterew in women
lactin and Estrogen have a good deal of are usually considerably less pro-
influence. nounced than in men.
• Osteoarthritis: Women are clearly at
more risk to fall ill to knee joint arthro- Do women who suffer from rheumatic
sis or finger polyarthrosis. In addition, illnesses sense more pain than do
women also suffer more from joint men?
pain and related physical burden than Research has shown that, when it comes
do men with the same illness. to rheumatoid arthritis, the pain thresh-
• Systemic Lupus Erythematosus hold is considerably lower for women
(SLE): SLE is present in about 1 per- than for men. The functional restrictions
cent of the population, and occurs 10 for women are also more pronounced for
times more often in women than in women and become more severe for
men. This ratio is stacked even higher women as they get older. Associated ill-
against females when it comes to nesses such as depression and anxiety
young adults – though this does not ap- disorders are also more frequent and can
ply to children. Irrespective of genetic amplify the symptoms of pain. On the
factors, hormonal factors also play a other hand, moreso than men, women
large role in the development of this ill- tend to develop very good strategies for
ness. dealing with pain.
ARTHROSIS
stage whereby swelling of the joints, • When swelling of the joints occurs,
overheating, contusion (bruising) and joint fluid is extracted via puncture and
pain are apparent, and which leads to an examined in the laboratory. Draining
inability to move the joint. the fluid from the knee releases the
joint from painful pressure, and it is
What type of pain is characteristic? possible to confine different joint ill-
The typical kind of pain suffered by Ar- ness from one another - such as bacte-
throsis patients is, for example, when rial infections or crystal deposition dis-
they start to move, and which decreas- ease (Chondrocalcinosis).
es after a few steps. Another type of • Magnetic Resonance Imaging (MRI)
pain is due to loads on the joint, appar- or Ultrasound examinations provide a
ent on longer walks or when going higher level of certainty. Ultrasound is
down steps. Pain rarely occurs when at best for evaluating tendons, muscles,
rest or during sleep. Over time, joint bursitis, cysts and joint swelling. The
deformation can occur, resulting in ac- MRI - Magnetic Resonance Imaging,
cumulation of fluid and redness. The an imaging method that shows tissue
affected joints are hard and bony, be- structures inside the body - has proven
come knotty and scalloped, swell and highly useful in the examination of car-
“grate, grind or pop“ when performing tilage. In the case of bone necrosis (the
certain movements. The joint is sensi- death of some or all of the cells in an
tive to touch, and movement is restrict- organ or tissue, in this case bone),
ed. which can cause afflictions similar to
those causes by Arthrosis, an MRI can
What examinations are necessary? produce diagnostic proof of ailment at
The examination of movement restric- an earlier stage than can an x-ray.
tion, functionality, ligament stability,
joint shape, pain tests and identifica- What are the laboratory findings that
tion of defective position (such as the can indicate the presence of Arthro-
legs) reveal an initial, tentative diagno- sis?
sis. It is also important to note when A laboratory procedure for detecting the
and during which activities the pain presence of Arthrosis does not exist.
occurs. However, clinical and laboratory testing
can be used to exclude the existence of
Which imaging methods can reveal Arthrosis-causing illnesses, as well as
the presence of Arthrosis? other ailments which cause discomforts
• Structural changes such as the reduction similar to those caused by Arthrosis.
in joint space, defective and degraded • Rheumatoid factor: normal
joint cartilage and bones, hardening of • Erythrocyte sedimentation rate (ESR):
tissue and the buildup of cysts can be re- normal or only slightly above-normal
vealed with the help of an x-ray examina- • ACPA: negative (Anti–citrullinated
tion. protein antibodies such as Anti-CCP or
Anti-MCV antibodies, are used to dis- spite joint deterioration, with the help
gnose the early stages of rheumatoid of therapy the resilience and mobility
arthritis.) of the joint should preserved for as
long as possible. If the damage is too
How is the illness treated? great and the pain is unbearable, then
The goal of Arthrosis therapy is to re- the only remaining option is to have
lieve pain and to slow down the develop- the joint replaced.
mental progression of the various ail-
ments. It is important that patients get What non-pharmaceutical options are
enough exercise without overloading available to Arthrosis patients?
joints, to protect their joint injuries, to Physiotherapeutic remedies like heat,
avoid gaining or to lose excess body mechanics (such as sports therapy, reme-
weight, and to take the right drugs. De- dial gymnastics, occupational therapy
and massage) and electrotherapeutics
should be applied regularly for Arthrosis
Healthy versus diseased joint patients.
Remedial gymnastics are carried out
with the help of items like elastic straps,
balls and even elaborate machines that
target the root causes of reduced mo-
tion, muscle contraction and muscle
weakness.
Special support devices for daily use
support the joints and delay the advance-
ment of the ailment. Splints, sturdy
shoes or the use of a cane can relieve the
joint of undue pressure.
One very helpful and effective form of
Intact cartilage treatment is therapy in water, known as
aqua training.
tilage metabolism. The following are • Cortisone: If the synovium (layer of in-
used to alleviate pain: ner skin) of an individual joint has un-
• Pain creams: These are available for dergone strong patholocial change or
topical application as anti-inflammato- has developed an inflammatory pro-
ry ointments or gels. The application of gression, Cortisone can be injected di-
compresses soaked with ointment is rectly into the joint for a short period of
advantageous since the active ingredi- days or weeks. It has strong anti-in-
ent is not applied directly into the af- flammatory properties.
flicted area right away, but rather an • Diacerein: This is a slow-acting medi-
adequate amount remains in the dress- cine which inhibits special semio-
ing and can be absorbed later. chemicals (such as Interleukin-1, Inter-
• Non-steroidal anti-inflammatory leukin-6 and Tumor necrosis factor
drugs (NSAIDs): In contrast to other alpha) that are involved in inflamma-
pain relievers, these anti-inflammatory tion and the destruction of cartilage.
drugs do not act on the brain, but rather • Injecting Hyaluronan directly into the
the affected tissue itself. There they knee joint: The goal is pain relief, be-
block the tissue hormones (pros cause a diseased joint cannot produce
taglandins) which transmit the pain. In anymore Hyaluronan, which works to
addition to the pain-relieving effect, reduce the abrasion of cartilage tissue.
the anti-inflammatory aspect reduces • Protective or regenerative substances:
swelling. NSAIDs should only ever be Glucosamine (sulfate) or chondroitin
taken on the advice of your doctor. sulfate can block the breakdown of car-
• Systemic analgesics such as tilage tissue.
Paracetamol
• schmerzlindernd
end
• entzündungshemm
• abschwellend
Mach mit
®
bei den Kytta
Wandertagen:
C
www.kytta.at
M
CM
MY
everyday life.
CMY
OSTEOPOROSE
What screening examinations are Milk delivers calcium which is important to counter
recommended? the loss of bone mass.
An important preventive measure is
bone density scanning, which - depend-
ing on what risk factors are present - 1500 mg daily) and vitamin D (800
should be carried out between the ages units daily), whose dosage is deter-
of 50 and 60 in consultation with a doc- mined by the physician.
tor. Basically, the first bone density test
is given to women not at risk of fractures Important sources of calcium are milk
at the age of 65; earlier for women who and milk products, also spinach, broc-
are at risk. For men not at risk, the first coli, hazelnuts and calcium-rich min-
measurement is advised at the age of 70; eral water. However, the total calcium
for at-risk men regardless of age. intake should be taken into account, as
it is now well established that an excess
Blood tests provide information about of calcium, especially if it is adminis-
bone metabolism and hormone levels. tered with medications, can also cause
Also, X-ray, CAT scan or MRI examina- damage to the organism. Large quanti-
tions are important for detecting sig- ties of alcohol and excessive smoking
nificant changes in the spine. can have negative influence on calcium
levels.
What is treatment like?
The basis of any osteoporosis treatment Tip: Calcium should be taken with a lot
is the adequate intake of calcium (1000- of water!
The bone vitamin D can only be devel- As a third pillar supporting the treat-
oped in meaningful amounts via sun- ment, classes of active pharmaceutical
light. Therefore, you should spend at ingredients can be implemented to
least 30 minutes a day outdoors. A lower the risk of a fracture, to minimize
smaller proportion may also be includ- the loss of bone mass, and to promote
ed in the diet; plenty of vitamin D can bone mass buildup and therefore the
gotten from fatty fish and egg yolks, for bone stability. In any case, this medica-
example. tion should be taken according to pre-
scription, since die danger of bone
The second important pillar of treat- fracture increases again.
ment is regular exercise. with the assis-
tance of a therapist, risk patients should Which medications help with Osteo-
carry out special exercises for muscle porosis?
and bone strengthening. Using a tar-
geted pain therapy is again possible 1. Bone resorption-inhibiting substances
and necessary for osteoporosis patient These are substances that inhibit bone re-
fitness. sorption in the first place. They increase
What is Polymyalgia rheumatica? tory disease that usually occurs after the
Polymyalgia rheumatica (PMR; Greek/ age of 50. Women are much more fre-
Latin) is a member of the vascular in- quently affected than men. Every year,
flammation family. It manifests itself around 2000 to 4000 Austrians are af-
mainly with an acute onset and severe fected.
pain in the shoulder and pelvic girdle
muscles. It is clear that it has to do with What are the symptoms?
an overactivity of the immune system, Typical symptoms include severe pain in
which in turn attacks the body. the shoulder muscles on both sides, par-
Polymyalgia rheumatica can be treated tial lifting of the arms is hardly possible.
very well. It is one of the best prognostic Pain also appears in the pelvic girdle and
rheumatic diseases. However, here as thighs; the hands lose power. Pain is of-
well, early diagnosis is of great impor- ten particularly strong during the night
tance, so that you can start quickly with and early morning hours. The upper
the appropriate treatment. arms and thighs are often very sensitive
to pressure. In the morning the arms and
Who is affected? legs feel stiff, with mobility improving
PMR is a relatively common inflamma- throughout the day.
Where does the discomfort originate? ed, the lower the risk of permanent
An inflammation of the synovial mem- damage.
branes, especially of the shoulder and
hip joints, visible on ultrasound, is re- What causes GCA?
sponsible for these pains. Depending Patients with giant cell arteritis suffer
on the inflammatory activity it leads to from general malaise. It feels like the
weight loss, increased body tempera- flu, possibly associated with fever,
ture and general malaise. In approxi- weight loss, night-time sweating, loss
mately 50% of all cases, a giant-cell ar- of appetite and general weakness. The
teritis occurs together with the PMR, other symptoms are variable, depend-
especially the temporal artery near the ing on which vessel area is affected.
temples (Morbus Horton). Arteritis temporalis Horton, for exam-
ple, causes throbbing, one-sided
What is a Giant-Cell Arteriris (GCA)? headaches in the temple region, which
The giant-cell arteriris is also one of the
inflammatory diseases of the blood ves-
sels. Mainly found in women over 50
years of age, peaking around the age of
70. When the large arteries of the circu-
latory system are affected, mostly in the
coverage area of the external carotid ar-
tery (Arteria carotis externa) above the
aorta. In the case of Arteriitis temporalis
Horton, the affected temporal artery on
the temple is clearly visible from the
outside - therefore the name.
The persistent inflammatory activity
results in a narrowing of the affected
vessels up to the occlusion, whereby
the organs behind the damaged area
receive less blood. This may result in
pain when chewing, for example. With-
out treatment, the result could be inju-
ry to the eye - in the worst case, blind-
ness. However, there are treatments
available with which almost all patients
can achieve and maintain freedom
from pain. Again, the earlier the dis- Without treatment, the eye is in danger of damage
ease is detected and treatment is start- - even blindness.
PMR most often begins with strong neck pains and headaches.
are aggravated by coughing or moving tion rate and other inflammation pa-
of the head. Some patients experience rameters are strongly to very strongly
visual disturbances (diplopia), pain increased. Typical of Polymyalgia Rheu-
when moving the eye or impaired vi- matica is also the lack of laboratory val-
sion. ues that show damage to the muscles
(e.g. no increase in the so-called cre-
How does the doctor diagnose PMR? atine kinase).
There are no typical findings which can
be regarded as positive evidence of the How is PMR treated?
existence of Polymyalgia Rheumatica. PMR can be treated quite well with glu-
If the symptoms raise suspicion that cocorticoids (Cortisone). Characteristic
the illness is PMR, then at diagnosis of PMR is the almost immediate re-
other diseases must be excluded that sponse of the patient to the treatment.
display similar symptoms. Certain crite- The effect of the therapy is checked by
ria (see box) are then used to confirm monitoring the symptoms and the in-
the diagnosis of Polymyalgia Rheumat- flammation parameters - best summed
ica. Thus, for example, in laboratory up as PMR-AS (“Polymyalgia rheumati-
findings the erythrocyte sedimenta- ca activity score“). Accordingly, the
SYSTEMIC LUPUS
INCLUDING DRUG THERAPY
What does the term “Systemic Lupus male hormones (estrogens) have an in-
erythematosus“ mean? fluence on the development of the dis-
Systemic lupus erythematosus (SLE) is ease.
an autoimmune disease in which there is Systemic lupus erythematosus is rare
chronic inflammation of the skin, joints, with approximately 50 sufferers per
nervous system, and internal organs. The 100,000 people.
disease usually comes and goes in phases
for years: High disease activity alternat- What causes systemic Lupus erythe-
ing with periods of improvement. The ill- matosus?
nees got its name due to the typical le- The exact causes of SLE are not (yet)
sions on the face since scarring, redness known. What is certain is that, antibodies
and furrows look like a “wolf rash“ (Latin are formed in the blood against cell compo-
lupus. Wolf; Greek erythematosus: red.). nents, often against the nucleus. These so-
However, such severe skin afflictions oc- called auto-antibodies attach themselves to
cur rarely anymore due to much better the body’s own healthy tissue and trigger
treatment options. inflammation from them. It then occurs
“Systemic“ means that internal organs that structures of autoantibodies, cellular
are affected by the disease. When only debris and immune
the skin is affected, the diagnosis is cells collect in the
“chronic discoid lupus“ (CDLE) or “sub- walls of small
acute cutaneous lupus“ (SCLE). Systemic blood vessels.
lupus erythematosus is one of the rheu-
matic and collagen (connective tissue)
diseases. However, in reality the disease
has nothing to do with the collagen in
our bodies.
The result is inflammation in various or- exhausted, many suffer fever, weak-
gans, whereby primarily blood vessels in ness and weight loss. The lymph nodes
the skin, kidney and joints are affected. are usually enlarged. Which organs are
An accumulation of the disease in some affected and to what extent the symp-
families suggests a genetic predisposi- toms may occur, is very individual.
tion. Scientists suspect a hereditary error In very rare cases, SLE spreads to the
of programmed cell death of certain im- nerves, leading to numbness, pain, in-
mune cells. The risk of passing on the creased sensitivity and a reduced tem-
disease to one’s own children is still con- perature sensitivity. This numbness usu-
sidered low, because even in genetically- ally occurs on both sides of the hands and
identical twins the disease affects both feet. Also, headache, seizures, visual dis-
siblings only in a quarter of cases. Vari- turbances, confusion and depression can
ous environmental factors may play a occur in systemic Lupus erythematosus.
role as a trigger in the pathogenesis of
SLE, such as infections with viruses or
bacteria, intense sunlight, extreme cli- Tips on SLE
mate changes, major mental stress and
hormonal changes such as can occur in
puberty, pregnancy and menopause.
An extremely rare special form of the The presence of SLE is likely if at least four of
disease is the so-called drug-induced the following are true (criteria of the American
Lupus erythematosus: In certain indi- College of Rheumatology - ACR):
viduals, some drugs (eg, antiepileptics,
blood pressure medications, antibiot- • butterfly rash
ics, hormones) can trigger SLE. The • disk-shaped raised exanthema/skin rash
symptoms usually disappear entirely • sensitivity to light
once the drug has been discontinued. • tissue defects of the mouth and nose
• inflammation of two or more joints
What are the symptoms of SLE? • pleura or pericarditis
A systemic Lupus erythematosus mani- • afflicted kidneys (protein in urine)
fests itself in many different symptoms. • infection of nerves and brain
A well-known, but not always present,
• typical blood findings (specific form of ane-
indicator of the disease is a butterfly- mia, decreased platelets [thrombocytopenia]
shaped redness (erythema) of the face and/or white blood cells [leucopenia])
on both cheeks and on the bridge of
• typical immunological findings: autoantibo-
the nose, which is more pronounced in
dies vs. endogenous DNA
sunlight. Other symptoms include joint
• antibodies directed against components of
pain, circulatory disorders of the fin-
the cell nucleus
gers and organs are affected (eg, kid-
ney inflammation, pleurisy or pericar-
ditis). Most patients feel tired and
The aim of the treatment of SLE is to calm the body‘s immune response.
gists. The close cooperation between suppressive and cytotoxic drugs are used
specialist and family physician is par- in more severe phases of the disease.
ticularly important in SLE.
What side-effects can occur?
How is systemic Lupus erythemato- As with all medications, DMARDs can
sus treated? cause side effects even in the case of sys-
The aim of the treatment of SLE is the temic Lupus erythematosus. They are
defensive reaction of the body to calm each different. Therefore, regular blood
down (immune modulation) or to sup- tests are essential. Furthermore, suffer-
press (so-called immunosuppression). ers should note that the long-term use of
Different groups of drugs are used.The immunosuppressants can lead to infec-
first step is to relieve the symptoms tions, such as colds, due to the immune
with rheumatoid painkillers. Although system being weakened by drugs. Pa-
systemic Lupus erythematosus is not tients should therefore pay attention to
curable, the disease is still treatable. the first signs of infection and intervene
What treatment is used is determined quickly.
by the severity of the disease and the
organs affected by a specialist (rheu- Are complementary medicinal SLE
matologist). therapies useful?
A variety of complementary medical ther-
For the treatment of Lupus erythema- apies exist that can be applied for SLE,
tosus the following steps are valid such as homeopathy, traditional Chinese
(from lighter to heavier drugs): medicine (TCM) and acupuncture - just to
• Painkillers name a few. The choice of the method de-
• Antimalarials (chloroquine, for example) pends on the individual patient’s situation.
• Cortisone
• Immunosuppressants (medicines that slow
down the work of the immune system such as
azathioprine, cyclosporine A, mycophenolate
mofetil)
• Biologicals (belimumab)
• Cytotoxic drugs (eg, methotrexate, cyclophos-
phamide)
In controlled studies, the effects of com- ries”), therefore nicotine must be avoi-
plementary medicine have not been prov- ded!
en. It is important to ensure that the basic
treatment is continued, because the com- •
Contraception and pregnancy should
plementary measures should be consid- be discussed with the Lupus rheumato-
ered only as a supplement and the different logist specialist.
approaches are complementary and not
exclusive. Therefore, you should consult • Immunizations (e.g. influenza vaccina-
with your Rheumatologist on all forms of tion) should be discussed by SLE pati-
treatment that you wish to use! ents in advance with their doctor. Some
live vaccines can trigger a disease flare.
What else should SLE sufferers watch
out for? • Exercise and sports in moderation are
• Sunlight and UV light may enhance di- recommended because movement sup-
sease progression. Therefore, sufferers ports the function of the immune sys-
should avoid direct sunlight and always tem and the psyche.
use sunscreen. Above all, they should
steer clear of the tanning salon! • On long car rides or flights, SLE pati-
ents should consider a thrombosis pro-
• SLE patients have an increased risk of phylaxis, because they are particularly
atherosclerosis (“hardening of the arte- vulnerable to vascular complications.
Those with Lupus erythematosus should find out more before getting pregnant.
Una hän
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Herz und
Gefäße
Älterwerden verstehen
verstehen • Prävention: So beugen Sie Herz-
und Gefäßerkrankungen vor
• Anti-Aging durch Nährstoffe • Therapie der Risikofaktoren wie
• Wohnen und Reisen im reifen Alter Bluthochdruck, Durchblutungsstörungen etc.
• Gesundheitsprobleme ab der Lebensmitte • Therapie bestehender Herz-Kreislauferkrankungen
• Pflege im höheren Alter inkl. Ernährungs- und Bewegungstipps!
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G E S U N D H E I T S R AT G E B E R g b g
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Lunge und
Bewegungsapparat Atemwege
verstehen verstehen
• Gelenke: Aufbau und Funktion • Hochleistungsorgan LUNGE
• So hält Sport gesund • Aufbau und Funktion der Atemwege
• Was tun bei Verletzungen und Schmerzen? • Asthma bronchiale
• Rheuma und Arthrose • COPD
Bücherserie
„Gesundheit
verstehen“
Auch wenn sich Ärzte alle Mühe geben,
ihren Patienten gute und verständliche Er-
klärungen zu liefern, bleiben dennoch nach
dem Gespräch oft noch viele Fragen offen.
Die Bücherserie „Gesundheit verstehen“
bietet Patienten zum Nachlesen zu Hause
von hochkarätigen Experten gut verständ-
lich aufbereitete, zusätzliche Informationen
rund um ihre Krankheit und wertvolle Tipps
er
ie R atgeber d e in für die Bewältigung des Alltags.
D
e rhalten Si
Serie
pot heke.
Ihrer A
Rheuma verstehen 2014 101
SUPPORT FROM
YOUR PHARMACY
Complementing your
basic therapy
www.dr-boehm.at
!
NEUh
Hoc
rt!
dosie
Omega-3 in Bestform
Neben den bewährten Omega-3-forte Kapseln gibt es jetzt neu
die speziell entwickelten Omega-3-complex Kapseln:
aus hoch gereinigtem, schadstofffreiem Kaltwasserfischöl
geruchlos und geschmacksfrei
zusätzlich mit 30 mg Coenzym Q10 plus wertvolles Vitamin D und E
pathic remedies should only be used as Which medicinal plants are available,
a supplement, and under no circum- especially to help with rheumatic ail-
stances as a replacement for basic ments?
pharmaceutical therapy! For the additional treatment of chronic
joint ailments, extracts of devil‘s claw
What natural remedies are used for (Harpagophytum procumbens), cat
rheumatic ailments? claw (Uncaria tomentosa) or frankin-
Even some natural products are assigned cense are available in the pharmacy.
certain positive effects. These include Other extracts such as poplar, willow
so-called phytopharmaceuticals, or stan- bark and nettle are said to have an in-
dardized remedies, created from plants. hibitive effect on the immune system,
These are available as plants and plant which can alleviate pain under certain
parts rendered non-perishable through circumstances. The external applica-
drying, or extracts processed into tab- tion of cayenne pepper, eucalyptus oil,
lets, capsules, etc. In order to achieve a spruce or pine-needle oil have also
therapeutic effect, then – as with all been said to work.
medications – precise dosage is required.
If the dose is too small, there will be no What can one expect of the Devil‘s
effect; if the dose is far too high, then Claw?
unwanted side effects can occur. In ethnic medicine in Africa, Devil‘s
Therefore, be sure to consult your phar- Claw has been used for hundreds of
macist and always discuss the taking of years to reduce pain and swelling. In
additional compounds with your pri- Western medicine, Devil‘s Claw ex-
mary care provider! tracts have been used as so-called “tra-
ditional herbal remedies“ (available in
the pharmacy without a prescription).
Important Note
s
Da che
n z li -
www.dr-boehm.at
pfla merz
Sch ittel
m
2. Have you suffered from joint pain for more than 6 months, which you
do not believe is the result of an injury?
yes no
3. Are your hands so stiff in the morning that you have problems making
a fist for longer than an hour?
yes no
6. Can you feel knots under the skin near joints or bone protrusions?
yes no
7. Have you had afflictions in joint regions on both sides of the body
(both hands, both shoulders, both feet, etc.) for longer than six weeks?
yes no
8. Has a doctor recently informed you following a blood test that your
inflammation factor is elevated?
yes no
Meine Medizin
Die neue Patienten-App für einen besseren
Therapieerfolg!
Ihre Vorteile:
Speicherung der Gesundheits- und Medikamentendaten –
nur für Ihren persönlichen Zugriff!
Erinnerungsfunktion
Nützliche Infos und Tipps Jetzt Code
einscannen und
App starten!
Ein gemeinsames Projekt von
Pharmig und der Ärztekammer für Wien
Hergestellt von
Rheuma verstehen 2014 109
KAPITEL 7
PHYSICAL
ACTIVITY
& SPORTS
Choose activities that are easy
on the joints.
Physical activity without too much What other types of movement are
strain - is it possible? recommended?
Regular exercise is a key factor in the The Feldenkrais Method is a somatic edu-
fight against pain and stiffness of the cational method focused on the individu-
joints, especially in rheumatic pa- al‘s quality of movement and the personal
tients. Achieving sporting excellence movement learning process.
does not matter; rather, the goal is to Pilates is a gentle but very effective
make the muscles strong in a gentle workout that utilises the entire body.
way. Physical exercise can relieve joint The muscles are trained to elongate
pain, promote mobility and increase from the stricken rheumatism muscle
muscle strength. In addition, physical knots into smooth muscle strands.
activity helps with weight loss, be-
cause, remember: Every kilogram of Does pain make sports exercise
excess weight represents that much impossible?
more load on your joints and unnec- If you hardly get up the stairs due to
essarily exacerbates your symptoms! rheumatic pain, you will probably be
able to imagine just hard it is to engage
Important Note: Before each exercise, in sports. However, there is a variety of
a new sport consultation should be held workouts for the home, and beginners
with the doctor. as well as older persons may find the
exercise program that can do their
What types of sports are very stress- body some good and have fun doing it.
ful on the joints? Many rheumatism sufferers report that
Suitable sports in the case of arthrosis of only the first few steps (walking, jog-
the hip, knee or ankle are cycling, swim- ging) or swings (tennis, table tennis,
ming, water aerobics and (Nordic) walk- golf) are anywhere from very uncom-
ing. When cycling, you should, however, fortable to painful, but this pain will
avoid steep slopes because of the in- disappear after a short warm-up.
creased pressure on the knee and hip.
Many rheumatism sufferers also like to Should strength training be given up?
do gymnastic exercises in a group, No. Strength training is the counterpart
since one thereby learns how to prop- to endurance training and aims to get the
erly execute useful movements. Poor muscles strong and healthy. Especially
posture can be corrected quickly and when afflited with a rheumatic disease, a
the motivation is often much greater. healthy muscle system plays a very im-
4. D
o you have an occupation in which you must often carry heavy things or work
on your knees?
yes no
6. D
o you suffer from “startup pain,“ pressure pain or abrupt immobility?
yes no
7. D
o you have the feeling that your joints grind on one another or “pop“?
yes no
8. D
o your knee or hip joints hurt when you take your first steps, before
the pain then dissipates?
yes no
9. Do your ailments also occur at times of rest, when you are not moving?
yes no
If you have answered more than three of the obove questions with “yes,“ then you should visit a
specialist (Rheumatologist) as soon as possible.
Your contact:
• Bundessozialamt:
1010 Wien, Babenbergerstraße 5
Tel.: 05 99 88
Fax: 05 99 88-2131
bundessozialamt@basb.gv.at
www.sozialministeriumservice.at/
• Bundesministerium für Finanzen:
1030 Wien, Hintere Zollamtsstraße 2b
Bürgerservice: Tel.: 0810 001 228 Self-help groups:
www.bmf.gv.at • Österreichische Rheumaliga (ÖRL):
Gertraud Schaffer (Chairperson)
5762 Maria Alm, Dorfstraße 4
Tel.: 0699/155 41 679
www.rheumaliga.at
• Österreichische Vereinigung
Morbus Bechterew (ÖVMB):
Ing. Paul Pocek (President)
1020 Wien, Obere Augartenstraße 26-28
Tel.: 01/332 28 10
www.bechterew.at
• Fonds Soziales Wien: • PsO Austria
Pflege und Betreuung (Psoriasis association):
Tel.: 01/24 524 Friederike Schönauer (Obfrau)
www.fsw.at 1020 Wien,
• Bundesministerium für Arbeit, Obere Augartenstraße 26-28
Soziales und Konsumentenschutz Tel.: 01/350 12 86
(BMASK): www.psoriasis-hilfe.at
1010 Wien, Stubenring 1 • Rheumalis (SHG for parents of
Tel.: 01/711 00-0 rheumatic children & adolescents):
www.bmask.gv.at Karin Formanek
Tel.: 0699/19 74 88 11
www.rheumalis.org
Additional links:
www.rheumatologie.at
www.rheuma-online.at
www.netdoktor.at
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