Autoimmune disease: When the knee is destroyed from the inside

Ms. Dr. Schwaneck, Christian, the patient who star His story told, suffers from an autoimmune disease: At a young age, she attacked one of his knees: After ten kilometers, it became thick and immobile for the first time, then again and again. Long -treated orthopedic surgeons always unsuccessfully. Only then did it turn out that it was an autoimmune inflammation. And even more by chance.
The fact that the problem arose after a severe burden – even one -sided – understandably initially directs the suspicion to an orthopedic problem. And as a rule, you will be treated accordingly. Or you say: “Come on by itself.” But: if it doesn’t do it or if it returns, I would not simply assume that there is actually a mere orthopedic problem behind it. And then it depends on the fact that it is carefully diagnosed. As a rheumatologist, I often come into play at this moment – which means that we are by no means said that we also find one of the rheumatic diseases with everyone who comes to us. In many cases, we can then reliably rule out such a diagnosis.

How can it be clarified in one case like that of Christian?
I would recommend a magnetic resonance imaging – and then I see whether there is a meniscal tear that you should operate. But if I don’t find a so -called “inland damage” in the knee joint and the knee is still inflamed and thick, then we are asked, the rheumatology. Because the source of inflammation can be varied. There can be reactive arthritis according to an infection, a rheumatoid arthritis, known as chronic joint rheumatism, or just psoriatic arthritis that has been demonstrated by Christian and is due to the widespread psoriasis.

For a long time it was less well known that such frequent autoimmune disease often also affects the joints. However, many people still see psoriasis as a pure skin disease today and do not link them to joint problems.
Even more – some patients don’t even interfere with really striking skin findings, it seems to me. An example: a patient was recently operated on the finger – it was thick, he had it treated by a hand surgeon. The doctor expressly asked him: “Do you have psoriasis?” The patient denied it, he wanted the operation and has not been able to bend his finger since then. Some time later he came to me. And I also asked him: “Do you have psoriasis?” And again the answer was a clear no. So I look at him, go around him and see: he has a hip -sized lichen on his neck!

He didn’t notice that?
Obviously not – and therefore an extensive and complete medical examination is so important.

The story of the suffering of many patients is very long, partly associated with an odyssey by practices. The dates here in the rheumatism center, on the other hand, are obviously very quick and efficient. This is a strong contrast, how do you manage to provide the large number of those seeking help?
We actually create a patient with the same quality every ten to 15 minutes because we have organized well. We have many internal guidelines that we adhere to and on top of that extensive our own diagnostic resources in the laboratory area. If it is so obviously ahead of them, this is above all a sign of superior organization.

What in a joint like the knee is the immune system attacked?
The misguided defense reaction causes inflammation of the inner skin. It swells and pours out liquid, which is why the knee became thick in the case described. If the inflammation is untreated, it continues and can almost tumor -like attack the bone and destroy the cartilage. Then the arthritis follows the joint inflammation of a so -called secondary arthrosis, arthrosis generally goes back to the loss of the articular cartilage.

Apparently there are a variety of diseases that trigger such inflammation.
So it is, and today we can precisely distinguish the different forms of rheumatic diseases using the laboratory. They often reveal themselves through their typical patterns. We have already discussed this for psoriasis arthritis, which is very often only one-sided, while rheumatoid arthritis usually occurs on both sides. On top of that, the frequency of the diseases is distributed unevenly according to gender. Overall, autoimmune diseases are more common in women, and this also applies to rheumatoid arthritis, but the Bechterew’s disease, for example, in which the joints of the spine ignite, is mostly a disease of younger men. In this respect, we already have a good diagnostic look in rheumatology, which we should have to do with, but through the modern laboratory diagnostic methods we can secure the right finding very well and finally select the treatment very precisely.

And accordingly, do you have to treat these diseases very differently?
Her common symptom is the inflammation, and in this respect you also treat it anti -inflammatory. This is often also necessary if it is not an autoimmune disease, as is the case with the gout – because there is a basis for metabolic disease: uric acid is not sufficiently excreted, it forms crystals and the immune system tries to eliminate this crystals with inflammation. Here the acute inflammation would be treated, but in the long term the metabolic disease. In the case of autoimmune diseases, on the other hand, I have to combat the misguided reaction of the immune system. If I do not do that, the joint would be destroyed in the long run, including the cartilage, and then arthritis would have caused secondary osteoarthritis.

Anti -inflammatory drugs scare some people because they dampen the immune system – and the popular idea seems to be that it can never be “strong” enough. Even when it comes to cortisone, the speech gets very quickly on side effects.
Yes, it is also the case with the standard medication in rheumatology, for example with methotrexate, “MTX”. The patients bring the information from the net that MTX is also used in chemotherapy for some tumors and are therefore afraid of it. However, much higher doses – factor 100 – are used in tumor therapy. Just as MTX is dosed in our anti -inflammatory and long -term treatments, it is very well tolerated.

What do you do if anti -inflammatory treatment does not work?
With some patience, patients and doctors have to look at the results and weigh after a setting period whether the individually optimal strategy is found. But I always say to everyone: don’t resign when we have to start several times. As a doctor, I can be very sure today that I will find a treatment strategy. It also plays a role that there was really impressive breakthroughs in our field; Anyone who believes that there is no more progress in medicine is very wrong.

Approximately?
The antibody therapies, which were introduced for an entire spectrum of autoimmune diseases, have an extraordinarily precise effect on the respective disease. In our case, with Christian, you can see that clearly. Today he still needs an injection every two months that he can do himself. This suppresses his psoriasis, the knee is no longer damaged. He only comes into practice four times a year to check whether everything is stable.

It is said that these medicines are extremely expensive.
But the improvement for the sick is so important that it was clearly decided in Germany: statutory health insurance pays this therapy. In other countries, this is not the case in all cases, for example in Great Britain. Such progress in rheumatology means that people are no longer mutilated because of their massive symptoms, that their bones and cartilage are so destroyed that they can no longer participate in life. I am very fascinated by this enormous progress, to put it bluntly: patients come in, the joints come in a real catastrophe – and you prescribe an antibody, and it makes “puff!”, And everything is gone.