Berlin (dpa) - The pain will usually start in the fingers and toes. They hurt early in the morning and the joints feel hot and swollen. Movement is difficult. Exhaustion and a lack of energy are also common. The pain typically occurs symmetrically.

"It hurts in both hands or feet, at the same spot," explains Erica Gromnica-Ihle, a Berlin-based rheumatologist, describing the typical symptoms of polyarthritis, a rheumatoid arthritis. It is chronic and irreversible, but manageable if arrested early enough.

"Rheumatoid arthritis is the most common and worst of the inflammatory diseases of the joints," says Gerd-Ruediger Burmester, a rheumatologist at Berlin's Charite University Clinic. About 1 per cent of the population is affected. Of those, 70 to 80 per cent are women.

Many seem to be about 50 when the disease strikes, though it can strike anyone anywhere. "Whether you're a child, a teen or a retiree, the disease is not a question of age."

There are serious problems if the disease is left untreated.

"The joint infections spread, attacking, for example, the elbows, knees, jaw or neck," explains Gromnica-Ihle, who is also president of the German Rheuma Association. Internal organs might also be affected, with rheumatic knots building up in the heart or lungs. In the long run, joints will be destroyed.

In earlier times, patients would reach a point where they simply could not move any more and become invalids. "Generally, we can prevent that today," says Burmester. All the same the earlier a person gets a proper diagnosis from a doctor, the higher the chances of arresting the disease.

"If the described symptoms last for more than six weeks, then make sure you get to a rheumatologist."

Diagnoses are difficult. "There are countless other diseases that have similar symptoms to polyarthritis," says Ulf Mueller-Ladner of the German Association for Rheumatology. A blood test usually helps because it shows factors associated with rheumatism. New tests for special antibodies should provide even more precise results.

Beginning the use of medication as early as possible can render a patient nearly symptom-free and stop the spread of the disease.

"We've already had a few patients upon whom, by virtue of early treatment, we've been able to stop the medicinal treatments," says Burmester.

At the same time, there are no long-term studies on the disease available. "The malady is chronic and the current scientific understanding indicates that it cannot be healed, meaning it could break out again at any time."

Methotrexat (MTX) is the most common therapy for polyarthritis. "The anti-rheumatoid reduces inflammation and regulates the immune system," explains Burmester. That's important, because the disease is caused by cells incorrectly guided to the joints, where they begin to produce inflammatory agents.

"Why that happens, we don't know," says Mueller-Ladner. But genetics seems to play a role. Whatever reason, the problem attacks the joints. "The process is similar to the destructive ability of cancer cells."

Since MTX takes about six weeks to reach its full potential, initial therapy is usually supported with cortisone. "We use it as a bridge medicine to take some pain away."

Other alternative treatments include treatment with biopharmaceuticals, or natural antibodies. "They fight the inflammatory agents that the rheumatism takes further into the body," explains Gromnica-Ihle. But the treatment is expensive and comes with multiple side effects.

Along with medicinal therapies, which can usually be given on an outpatient basis, movement and physical therapy are also important. To prevent a stiffening of the joints, Mueller Ladner recommends physical therapy. Swelling is best treated with cooling and light massage.

"Anyone who already has joint problems should use ergotherapy to learn relief strategies for everyday life," recommends Gromnica-Ihle.