More than 200 different pathologies are grouped under the term “rheumatic diseases” which can affect not only the joints, but also the muscles, blood vessels, skin and vital organs. In many of them, the immune system becomes deregulated and causes persistent inflammation which, if uncontrolled, ends up damaging tissues and compromising quality of life. Today, rheumatological medicine tries to intervene before this happens: identify the first warning signs, stop the inflammation at the root and achieve what a few decades ago seemed an unattainable challenge: early and lasting remission of the disease.
Dr. Álvaro García Martos, rheumatologist at the Tajo University Hospital (Aranjuez, Madrid), summarizes this change in perspective well: “Today we know that controlling inflammation is the key to changing the natural history of these diseases.”
“The current therapeutic objective is not limited to relieving pain, but to intervene on the origin of the problem and prevent this inflammatory process from perpetuating”
Research has revealed that prolonged inflammation not only damages joints, but “can also alter the balance of the entire body: increasing cardiovascular risk, influencing metabolism and impacting psychological well-being.” For this reason, he adds, “the current therapeutic objective is not limited to relieving pain, but to intervene on the origin of the problem and prevent this inflammatory process from perpetuating”.
TREAT FIRST, BETTER QUALITY OF LIFE
Early control of inflammation doesn’t just treat the symptoms: it changes the course of the disease. The earlier intervention is performed, the greater the likelihood of achieving long-lasting remission and improving the patient’s quality of life.
Early diagnosis
The first step is to identify the disease and start treatment as soon as possible.
Early control → Less pain
Less rigidity, more mobility and autonomy in daily life.
Reduced inflammation → Better function
Less rigidity, more mobility and autonomy in daily life.
Maintained remission → Better quality of life
When inflammation is stably under control, the patient can regain their physical and emotional well-being.
Sources: European League against Rheumatism (EULAR); American College of Rheumatology (ACR); “Rheumatoid arthritis”, by Smolen JS, Aletaha D and McInnes IB., “Lancet”, 2016; World Health Organization
To illustrate what happens when the immune system remains on constant alert, García Martos uses a simple metaphor: “Just as if you do squats with the wrong posture and end up injuring yourself, the immune system that works on constant alert gets used to that pattern. The later you correct it, the harder it will be to regain balance.”
The specialist insists that the impact goes far beyond the physical aspect: “These diseases affect all aspects of a person’s life. Not being able to move, not being able to do one’s job or enjoy time with loved ones has a huge emotional impact,” he explains. Controlling inflammation, he adds, means restoring balance and autonomy, but also hope.
Early diagnosis changes history
The starting point is an early diagnosis, which not only prevents structural damage, but also opens the door to remission, the ideal state in which the disease is no longer active. García Martos insists that “the sooner you act, the better your chances of achieving lasting remission.”
However, achieving this goal remains a challenge. “There are advanced treatments, but not all patients achieve complete absence of inflammation. There are still those who depend on corticosteroids or live with recurrent epidemics,” he acknowledges. Hence the need for a personalized and multidisciplinary approach, in which collaboration between specialties – and the involvement of the patient himself – is fundamental.
WHEN INFLAMMATION AFFECTS THE WHOLE BODY
Early control of inflammation doesn’t just treat the symptoms: it changes the course of the disease. The earlier intervention is performed, the greater the likelihood of achieving long-lasting remission and improving the patient’s quality of life.
- Heart Increased cardiovascular risk (atherosclerosis, hypertension)
- Bone Bone loss and osteoporosis
- Metabolism Metabolic syndrome, increased cholesterol and glucose
- emotional state Depression, anxiety and chronic fatigue
- immune system Increased susceptibility to infections
- Dream Disturbances in rest and worsening of physical recovery
Sources: ‘Prevention of atherosclerotic cardiovascular disease in rheumatoid arthritis, by Semb AG et al. in Nature Reviews Rheumatology (2020); “Pathogenetic mechanisms of bone loss in rheumatoid arthritis,” in Frontiers in Medicine; “The impact of rheumatoid arthritis on quality of life and mental health: a systematic review and meta-analysis.” Rheumatology, 2014; “Comorbidities in Rheumatoid Arthritis: RBSMR.” International Journal of Clinical Rheumatology.
Living with an invisible illness
For Elisenda de la Torre, president of the Reu+ association and patient suffering from psoriatic arthritis, the diagnosis marked a before and an after. “I was diagnosed when I was 20, and then living with arthritis meant moving from the sofa to the bed. Today the reality is very different: we have effective treatments and we can lead an almost normal life. But there are still many things to improve.”
These include practical information and support. “Sometimes they tell you to maintain your weight, but they don’t explain how to do it. There is a lack of nutritional, physiotherapeutic or psychological support,” he points out. His experience reflects the need for a comprehensive approach, in which body and mind go hand in hand: “Autoimmune diseases have a lot to do with the emotional state. An epidemic can be triggered by stress, which is why psychological support should be part of the treatment.”
De la Torre also claims the patient’s proactive role: “Knowing yourself, knowing when to rest, accepting your limits and asking for help when you need it. All this is part of controlling the disease.” Even so, she acknowledges that it’s not easy: “There are days when you need help even going to the bathroom, and it’s very difficult to ask for it. It’s difficult to accept that you need support without feeling like a burden.”
“We must not resign ourselves: living with pain is not normal. There are treatments to alleviate it and improve life. It’s about learning to live with the disease from another place”
His message, however, is one of hope. “Early diagnosis has changed our lives. Previously all patients ended up with prostheses, now they don’t. And we shouldn’t give up: living with pain is not normal. There are treatments to alleviate it and improve your life. It’s not a question of giving up, but of learning to live with the disease from another place.”
When the body hurts and the waist shrinks
As a spokesperson for patients, De la Torre talks about the importance of psychological assistance. Because the emotional impact of rheumatic diseases is profound and often invisible. Doctor Rosa Molina, psychiatrist at the San Carlos Clinical Hospital (Madrid), explains it with a powerful image: “The diagnosis does not only fall on the body, but forces us to reorganize the entire map, to study again the territory of the new body we inhabit”.
According to the specialist, receiving a diagnosis of this type “can awaken contradictory emotions: fear, anger, disbelief, even relief. Sometimes, giving a name to what happens gives meaning, but also forces us to take on a new identity”. For this reason, he insists that the role of the professional “is not only to calm, but to accompany, validate and offer spaces in which to navigate the process”.
Physical pain, he explains, is amplified when it mixes with anguish, guilt or desperation. “The body becomes an unpredictable meteorologist and warns of thunderstorms without warning. The fear of pain appears, the anticipation that it will get worse, and this hurts more.” To break this cycle, Molina recommends building a “psychological emergency kit” that can include mindful breathing, short writing, mindfulness, or short pauses to reconnect with the present.
“Asking for help is not a sign of weakness. Stopping saying ‘there’s nothing’ and starting asking ‘what’s wrong’ is an act of courage.”
He also highlights the importance of asking for help: “It’s not a sign of weakness. Sharing what we feel changes our narrative. Stopping saying ‘there’s nothing wrong’ and starting asking ourselves ‘what’s wrong with me’ is an act of courage.” The support network, he adds, is fundamental: “It must be called resilience redsilence. “We are stronger when we support each other.”
Towards a more humane medicine
All three agree that controlling inflammation is only part of the challenge. The other great challenge is to bring people back to their physical and emotional balance. “It’s not enough to silence the pain,” says García Martos. “It’s about helping the patient recover their life plan.”
Early control of inflammation has therefore become the compass of modern rheumatology medicine. Not only does it prevent damage, but it opens the possibility of lasting remission, of a fuller and more active life. Because living with a rheumatic disease, as Rosa Molina reminds us, “does not just mean managing medical symptoms, but learning to relate to oneself again, with one’s limits and with one’s small victories”.
And in this process, concludes Elisenda de la Torre, attitude makes the difference: “Not everything depends on the treatment. It also depends on you, on putting yourself out there and not giving up on living with dignity, even if some days it hurts a little more”.
