Muscle and joint problems are one of the most common health problems in today’s societies. Especially with the development of health services, the incidence of skeletal system disorders has also increased as a result of the prolongation of individuals’ life span. And also; Various rheumatological diseases that develop at an earlier age due to some immune system disorders and cause permanent damage to the joints have also been described. One of these diseases is inflammatory joint rheumatism.
What is inflammatory rheumatism?
Inflammatory rheumatism or rheumatoid arthritis; It is a chronic rheumatological disease that causes damage and discomfort through auto-immune mechanisms in various organs and regions, especially in joint tissues in the body. It is recognized clinically with joint pain, limited joint movements, and deformity in the joint structure, especially due to joint inflammation. In addition, inflammatory rheumatism may cause different clinical symptoms by causing disorders in other tissues of the body as in other rheumatological diseases.
Inflammatory rheumatism is often confused with joint calcification, also known as osteoarthritis. Joint calcification is when the joint structure loses its strength over time due to the loads on the joints with advanced age and manifests itself with various symptoms. In this sense, one of the most striking points in two different diseases in terms of clinical symptoms; It is the symmetrical course of the affected joints in inflammatory rheumatism. When inflammation begins in one hand or foot joint, it can be assumed that similar problems will occur in the other hand or foot joint soon.
What are the symptoms of inflammatory rheumatism?
Although inflammatory rheumatism is prominent with joint problems in the clinical picture, it can also cause damage to the rest of the body such as the lungs, heart and vascular structures or the digestive system. The disease has a chronic course and causes permanent damage to the joint structures in the long term, while systemic symptoms may become more prominent. Again, some periods in the course of the disease may cause exacerbations that manifest themselves with the exacerbation of symptoms, and remission periods in which symptoms decrease in the period between exacerbations can be observed.
In this respect, the following clinical symptoms may be encountered in the course of the disease:
• Pain, swelling, redness in the joints, especially in the joints of the hand and ankle, first hand and toe, knee joint or shoulder joint, sensitivity with joint movements and limitation in joint movements
• Joint stiffness after rest, especially in the morning, which worsens after sleep
• Deformities in joint structures
• Weakness – fatigue and loss of appetite
• Vision loss, pain, redness, or dryness in the eyes
• Shortness of breath, cough, or chest pain
• Heart-related problems such as palpitations, chest tightness, fatigue
• Dry mouth and recurrent canker sores inside the mouth
• Pale, dry or rash on the skin
Although inflammatory rheumatism has a chronic course, if it is not controlled with appropriate treatment methods, it may result in various complications. In this sense, it is possible to develop the following health problems during the course of the disease:
• Nodule development: There is swelling and development of structures in the form of nodules, especially at the pressure points in the joints.
• Sjögren’s syndrome: Sjögren’s syndrome can occur during the course of the disease, resulting in loss of function of the glands in areas where there is continuous secretion production such as the mouth and eyes.
• Infectious diseases: Since the immune system does not work properly in inflammatory rheumatism, the patient is vulnerable to diseases developed by microorganisms such as lung infections.
• Osteoporosis: Both the inflammatory rheumatism itself and the drugs used in the treatment can cause bone resorption with damage to the bones.
• Carpal tunnel syndrome: The development of swelling as a result of inflammation in the soft tissues and ligaments together with joint problems leads to compression of the nerve tissues in the wrist and the resulting carpal tunnel syndrome.
• Coronary artery disease and hypertension: Vascular stiffness and high blood pressure may develop due to thickening of the heart vessels and damage to the vessel wall, together with inflammatory rheumatism. Atherosclerosis can result in heart attack attacks.
• Lung problems: Pulmonary diseases may occur with damage and narrowing of the lung tissue due to intense inflammatory reaction.
• Lymphoma: Problems in the immune system can trigger the immune cells to become cancerous and turn into lymphoma.
What causes inflammatory rheumatism?
Inflamed joint rheumatism basically occurs when the body’s own immune system attacks its own tissues because it perceives its own body tissues as foreign. This condition, called auto-immunity, manifests itself especially in the joint membranes and joint tissues. As a result of this mechanism, the immune system initiates inflammation in the joint tissues and over time, due to chronic inflammation, joint structures are damaged.
Studies conducted to date have not fully clarified why the immune system initiates inflammation. However, various genetic and environmental factors identified in studies have been found to facilitate or trigger auto-immune mechanisms. In this regard, the following conditions can be considered among the risk factors in terms of inflammatory rheumatism:
• Gender: Rheumatological diseases such as inflammatory rheumatism are more common in women than in men.
• Age: Although inflammatory rheumatism can be seen in any age period; It is more common in older individuals.
• Family history: People with inflammatory rheumatism in the family are likely to develop the same disease in some part of their life. This indicates that some genetic factors are important in the development of the disease.
• Obesity: Especially in women younger than 55, with excess body weight, the possibility of the immune system attacking the joint tissues and the risk of developing inflammatory rheumatism increases.
• Smoking: The substances in the cigarette that are harmful to the body increase the risk of inflammatory rheumatism in terms of both directly affecting the joint structures and disrupting the immune system functions.
• Other environmental factors: There are studies showing that rheumatological disorders such as inflammatory rheumatism can be triggered by inhaling or taking into the body harmful substances such as asbestos and silica.
What is done in the treatment of inflammatory rheumatism?
The definitive diagnosis of inflammatory rheumatism and determination of the severity of the disease can be evaluated in the light of some clinical examinations. Questioning the patient’s history and performing a detailed systemic physical examination by a specialist physician can provide useful information on this subject. After this stage, the physician benefits from some imaging and laboratory tests.
Accordingly, some blood tests for measuring the effects of disease and inflammation in the blood, as well as various immune system markers and antibody levels may be requested. Again, for detailed examination of the joints, direct X-rays can be used. In severe cases, ultrasonography, computed tomography or magnetic resonance (MR) imaging methods may be required.
Among the assays that are of particular importance in the diagnosis of inflammatory rheumatism, the presence of rheumatoid factor (RF), anti-citrulline protein antibody test (anti-CCP), anti-nuclear antibody test (ANA), erythrocyte sedimentation level (ESR) and C-reactive protein level (CRP). ) takes place. These tests are very valuable in determining the severity of the disease as well as diagnosis.
In the light of these examinations, necessary treatment plans are made depending on the severity of the disease. There is no definitive treatment for inflammatory rheumatism in the current clinical approach. The main goal of treatment is to control the symptoms of the disease, to reduce exacerbations and to prevent the development of tissue damage. With treatment, the symptoms of the patient are eliminated and the quality of life is significantly increased. Again, treatment contributes to the life span of the patient by reducing the development of complications.
In this regard, drugs such as hydroxychloroquine, methotrexate, azathioprine, anti-inflammatory drugs, corticosteroids and antibody biological agents, which are known as disease modifying drugs, are frequently used in the treatment. Again, the application of various lifestyle changes such as gaining sufficient and balanced nutrition habits, regular exercise, adequate and quality sleep, applying hot and cold to the joint area also significantly positively affects the success of the treatment.