Rheumatoid arthritis can be categorized based on progression, severity, and affected organs:

1. Seropositive rheumatoid arthritis: The presence of rheumatoid factors or anti-CCP antibodies is typical and indicates a more aggressive form.
2. Seronegative rheumatoid arthritis: Rheumatoid factors and anti-CCP antibodies are absent, yet the clinical symptoms are clear.
3. Juvenile idiopathic arthritis (JIA): A form of rheumatoid arthritis that occurs in children under 16 years of age.
4. Systemic rheumatoid arthritis: In addition to the joints, other organs such as the heart, lungs, or eyes are affected.
5. Advanced rheumatoid arthritis: Chronically destructive form with irreversible joint damage and deformities.

The exact causes of rheumatoid arthritis are not yet fully understood. It is suspected to be a combination of genetic, immunological, and environmental factors:

- Genetic predisposition:

- HLA-DR4 and HLA-DR1 are associated with an increased risk.

- Autoimmune reactions:

- Misguided immune cells attack the body's own tissue, particularly the joint lining (synovium).

- Environmental factors:

- Smoking, infections, and stress can act as triggers or enhancers of the disease.

- Hormonal influences:

- The higher proportion of affected women suggests hormonal involvement.

The symptoms vary depending on the severity and phase of the disease, but often include:

- Joint pain and swelling: Particularly affected are the small joints of the hands and feet.

- Morning stiffness: Characteristic is stiffness lasting longer than 30 minutes.

- Symmetrical patterns of involvement: The same joints are affected on both sides of the body.

- Systemic complaints: Fatigue, fever, loss of appetite, and weight loss.

- Progressive joint deformities: In chronic cases, there are misalignments and deformations.

The diagnosis is made through a combination of medical history, clinical examination, and specific tests:

• Medical History:
  • The doctor inquires about the duration of the illness, the nature of the symptoms, and family history.
• Physical Examination:
  • Examination for swelling, tenderness, and movement restrictions.
• Laboratory Tests:
  • Rheumatoid factor and anti-CCP antibodies as specific markers.
  • Increased inflammatory markers such as CRP and ESR.
• Imaging:
  • X-ray: Detection of joint changes or erosions.
  • MRI: Detailed depiction of soft tissue and joint damage.
  • Ultrasound: For assessing joint effusions and inflammation.

Conservative Therapy

The treatment aims to relieve pain, control inflammation, and preserve joint function:

• Medication Therapy:
  • NSAIDs: Reduce pain and inflammation.
  • DMARDs: Methotrexate, leflunomide, or sulfasalazine slow the progression of the disease.
  • Biologics: TNF-α inhibitors, IL-6 inhibitors, or JAK inhibitors like tofacitinib.
  • Corticosteroids: For acute flares to quickly reduce inflammation.
• Physiotherapy:
  • Improvement of mobility and prevention of joint stiffness.
• Occupational Therapy:
  • Support in daily life through ergonomic adjustments.
• Pain Management:
  • Heat and cold applications as well as alternative approaches like acupuncture.

Surgical Therapy

In advanced cases with severe joint damage:

• Synovectomy: Removal of the inflamed joint lining.
• Joint Replacement: Implantation of prostheses in cases of irreparable joint damage.
• Corrective Surgeries: Restoration of joint function and correction of deformities.

To prevent and avoid a severe course of the disease, the following measures are recommended:

1. Smoking cessation: Smoking is a significant risk factor for the development and worsening of the disease.
2. Early detection: Regular check-ups and early treatment at the first symptoms.
3. Exercise: Joint-friendly activities like swimming or cycling strengthen the muscles.
4. Healthy diet: An anti-inflammatory diet with omega-3 fatty acids can help alleviate symptoms.
5. Stress management: Techniques like yoga or meditation can positively influence disease activity.