Serie English for PTA: Rheumatism

Rheumatic disorders consist of more than a hundred disease forms. They often cause chronic pain which affects the joints and muscles. During recent years there has been a lot of progress in treating rheumatic diseases.

von Jane Funke and Hannelore Gießen

© Foto: RFBSIP / (Symbolbild mit Fotomodell)

The most common inflammatory joint disease is rheumatoid arthritis. However, rheumatic inflammation can also affect other organs such as the skin, the vessels , the connective tissue or the eyes. Women are affected by rheumatic diseases slightly more often than men.

Rheumatic diseases, including most forms of arthritis and inflammatory spinal conditions , are usually painful, chronic, and progressive, which means they get worse as time goes on. Early diagnosis and treatment are essential because then the progression of many rheumatic diseases can be slowed down.

Signs and Symptoms

The following are some of the most common symptoms of arthritis and rheumatic diseases:

  • joint pain
  • swelling of one or more joints
  • joint stiffness that lasts for at least one hour in the early morning
  • chronic pain or tenderness in one or more joints
  • warmth or redness in the area of a joint
  • limited movement in an affected joint
  • fatigue.

Diagnosing a rheumatic disease is not often easy, as generally, no single test can reveal the precise disorder. After a thorough examination to check for visible signs of swelling, stiffness, or redness in the joints, lab tests will usually follow to help rule out other potential causes of the symptoms.

Blood and urine tests can amongst other things, help to detect inflammation markers , certain rheumatoid factors and abnormal organ function. Imaging tests, such as X-rays, computerized tomography (CT) scans, magnetic resonance imaging (MRI) scans, or ultrasound scans of joints and bones can help to reveal inflammation and fluid build-up and to discover changes that may have taken place. In many cases there may be no specific test, and it is often a case of eliminating other conditions before reaching the correct diagnosis.

Treatment and Medication Options

Various types of medication are prescribed to treat rheumatic diseases, along with drugs used to relieve the symptoms includ- ing pain and inflammation. The most important ones include


Disease-modifying anti-rheumatic drugs (DMARDs), which can slow the progression of rheumatic diseases by affecting the body’s immune reactions and inflammatory processes DMARDs, such as leflunomide or methotrexate, have greatly improved the quality of life for many people with rheumatoid arthritis. While DMARDs target the immune system, they can also weaken its ability to fight infections.

Biologics, a subclass of DMARDs that target specific steps in the body’s inflammatory processes. The most important ones are adalimumab, etanercept, infliximab and anakinra.

Janus kinase (JAK) inhibitors, a DMARD subclass that target Janus kinase (JAK) pathways which are involved in the body’s immune system response. Baricitinib, tofacitinib and filgotinib are JAK inhibitors available for oral use.

Drugs that help to deal with pain and discomfort are comprised of oral analgesics such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and naprox- en sodium and the COX-2 inhibitors. In more severe cases opioids may be applied.

Patients often don’t take just one but several drugs over a long period of time. Most drugs administered for rheumatic disord- ers have a high interaction potential. It is therefore not only important for the pharmaceutical staff to keep an eye on the patient’s adherence to their doctor’s orders but also to be aware of the risk of possible drug-drug-interaction.

Jane Funke ist geborene Britin und erstellt als Native Speaker gemeinsam mit Apothekerin Hannelore Gießen seit vielen Jahren die Serie „English for PTA“, die sich mit klassischen OTC-Themen befasst.








connective tissue


spinal conditions

Erkrankungen der Wirbelsäule


hier: Empfindlichkeit

inflammation marker


fluid build-up





hier: Beschwerden

to keep an eye on

etw. im Auge behalten


hier: Adhärenz, Therapietreue

grain pillow




to be imperative

unbedingt notwendig sein



Lyme disease






residual waste


to dispose of

etw. entsorgen


PTA: Good morning, what can I do for you?

Customer: I’d like something for the pain in my knee.

PTA: How long have you had it?

Customer: It’s been this bad for about a week.

PTA: Have you injured it in any way?

Customer: No, it just seemed to appear from nowhere.

PTA: Can you describe how it feels?

Customer: Well to begin with, the knee was just a bit stiff in the morning. Then it started hurting as I was hurrying to the bus stop on my way to work. The more I move, the worse it gets.

PTA: Is it swollen?

Customer: Yes, and tender.

PTA: What have you done so far?

Customer: I’ve been putting my feet up in the evenings with a cold compress on my knee and I’ve taken a painkiller once or twice this week. It hasn’t really helped though.

PTA: A hot water bottle or a grain pillow may be better to relax the muscles but whether hot or cold is better, is often a case of trial and error! Is there anyone in your family with similar problems? A genetic disposition is not unusual

C ustomer: My mother had to have a knee replacement in her seventies but she had rheuma- toid arthritis. I hope I don’t have the same.

PTA: Well, in that case, you should definitely see your healthcare provider as soon as possible. Early diagnosis is imperative in order to prevent damage to the joint. You may even be referred to a specialist for tests.

Customer: Oh dear. What kind of tests would that involve?

PTA: Blood tests to determine inflammatory pro-cesses in the body and if you’ve been bitten by a tick , to eliminate Lyme disease . There will be X-rays and possibly MRI scanning.

Customer: Is the damage to the joint reversible?

PTA: Well, currently we don’t really know what it is. In any case, early diagnosis is important as in many cases it’s possible to achieve clinical remission.

Customer: Can I do anything to reduce the pain?

PTA: I can recommend external treatment with pain ointment containing diclofenac for example. If you prefer a natural product, you could choose an ointment with comfrey . If you use the diclofenac formula, you should remove any superfluous cream with a tissue and dispose of it in the residual household waste instead of washing it off.

Diclofenac has been found in lakes and rivers and it harms the fish population. That should be avoided whenever possible.

Customer: How awful! I don’t want that! What else can I do?

PTA: An appointment with your doctor should have top priority. Would you like me to show you the applications?

Customer: Yes please. Do you stock grain pillows too?

PTA: We do.

Customer: You’ve been very helpful. Thank you.

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