Rheumatism: Causes, Risk Factors, and the Path to an Accurate Diagnosis
- Markus Hentschel
- May 6
- 6 min read
Dr. med. Lioba Pieterse
Specialist in Rheumatology & Nephrology
Private Practice in Heidelberg-Neuenheim
Joint pain that won’t go away in the morning, swelling with no apparent cause, persistent fatigue—these are symptoms that unsettle many people. Rheumatism may be the underlying cause of these symptoms. But what actually triggers the condition, and why is early diagnosis so important? Here you’ll find the answers—explained in simple terms.
What is rheumatism—and why is the term so multifaceted?
“Rheumatism” is not the name of a single disease, but rather a collective term for more than 100 different conditions. What they all have in common is that they affect the musculoskeletal system—that is, the joints, muscles, tendons, and bones. Some forms can also affect internal organs, the skin, and blood vessels.
The best-known and most common form is rheumatoid arthritis (also known as chronic polyarthritis). It affects an estimated 1 in 100 adults in Germany and is classified as an inflammatory rheumatic disease. Other forms include ankylosing spondylitis, psoriatic arthritis, and systemic lupus erythematosus.
What all inflammatory forms have in common is that the immune system plays a central role—and this is precisely where the causes lie.
How does rheumatism develop? The main causes
Most rheumatic diseases do not have a single, clearly defined cause. Current research suggests that several factors interact—genetic predisposition, environmental influences, and an immune system dysfunction.
The immune system as a central starting point
Inflammatory rheumatic diseases are what are known as autoimmune diseases. This means that the immune system, which is supposed to fight off foreign invaders such as bacteria or viruses, mistakenly attacks the body’s own tissues. In the case of rheumatoid arthritis, it attacks the inner lining of the joints (synovial membrane). This results in a chronic inflammatory reaction—painful, swollen, and potentially damaging in the long term if left untreated.
The exact cause of this malfunction has not yet been conclusively determined by science. However, it is known that various factors significantly increase the risk.
Genetic predisposition
Rheumatic diseases tend to run in some families. A family history of the condition increases the risk of developing it—for example, the risk of rheumatoid arthritis is about three times higher if one parent has the disease. Certain genetic markers, such as the HLA-B27 protein, are detectable in several rheumatic diseases and are considered risk factors. However, a genetic predisposition does not necessarily mean that the disease will develop—other triggers almost always play a role.
Environmental factors and lifestyle
Some risk factors can be actively influenced. This is where the research evidence is most clear:
Smoking increases the risk of developing rheumatoid arthritis by up to 40 percent—and also worsens the course of the disease.
Being overweight increases the risk of developing inflammatory rheumatic diseases and reduces the effectiveness of certain treatments.
A lack of exercise weakens the immune system and can contribute to inflammatory processes.
Chronic stress is considered a possible trigger that disrupts immune regulation.
Infections as possible triggers
A harmless respiratory infection can—in individuals with a genetic predisposition—trigger an autoimmune reaction that then targets the body’s own tissues rather than the pathogen. This mechanism explains why rheumatic conditions sometimes appear to develop “suddenly” following an illness. This link has been established for several types of rheumatic diseases, even though the exact mechanism is still being studied.
Who is particularly at risk? An overview of known risk factors
Gender
Women are about three times more likely to develop rheumatoid arthritis than men—hormonal factors play a role in this. In other rheumatic diseases, such as spondyloarthropathy (a subtype of which is ankylosing spondylitis), men are more commonly affected.
Age
Rheumatism can occur at any age, but it is most common among people aged 40 to 60. It is not simply a sign of aging.
Family history
If parents or siblings are affected, your own risk is higher—though not all relatives will automatically develop the condition.
Smoking
The only risk factor that can be clearly influenced and has been shown to affect the development and severity of the disease.
Important to know: None of these factors alone causes rheumatism. In most cases, it is a combination of genetic predisposition and triggers.
Early Signs: When Should You Take Notice?
Rheumatic diseases often develop gradually. Typical early signs include:
Morning joint stiffness that lasts longer than 30 minutes
Swelling and warmth in the joints of the fingers or toes
Joint pain occurring symmetrically (on both sides at the same time)
Persistent fatigue and a general feeling of being unwell
Pain that occurs at rest or worsens at night
These symptoms do not all have to be present at the same time. Even a single symptom lasting more than six weeks is a reason to see a rheumatologist.
Do you recognize these symptoms in yourself? Schedule an appointment now at our private practice in Heidelberg—it’s easy to do online, with no long wait.
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When is it the right time to see a rheumatologist?
Many people wait too long before seeing a specialist—often because their symptoms initially seem nonspecific or because they hope the pain will subside on its own. This is understandable, but it can have serious consequences: the earlier rheumatism is diagnosed and treated, the better the chances of preventing permanent joint damage.
Experts recommend scheduling a rheumatology evaluation within the first three months of symptom onset, if possible. Starting treatment early can significantly improve the course of the disease.
A specialist can:
use blood tests, inflammatory markers (CRP, ESR), and specific antibodies (rheumatoid factor, anti-CCP) to identify initial signs,
make targeted use of imaging techniques (ultrasound, X-ray, MRI),
make an individualized diagnosis—and distinguish between different forms of rheumatism as well as similar conditions such as osteoarthritis.
Holistic Rheumatology at my Private Practise in Heidelberg
As an internist specializing in rheumatology and nephrology, I do not view rheumatic diseases in isolation. This is because rheumatic conditions can also affect the kidneys and blood vessels—and conversely, kidney dysfunction and high blood pressure can contribute to inflammatory processes in the body.
In my private practice, I take the time you deserve to investigate unclear symptoms: a detailed medical history, a structured diagnostic consultation, and a treatment recommendation that suits you as a person—not just your lab results.
Are you looking for a rheumatology evaluation in Heidelberg? We're here to help.
Private practise Dr. Pieterse · Heidelberg Handschuhsheim · Bookable online
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Frequently Asked Questions About the Causes of Rheumatism
Is rheumatism hereditary?
Genetic predisposition plays a role in rheumatic diseases—but it does not determine one’s fate. If one parent has the condition, your own risk increases, but you will not necessarily develop it. It is always a combination of multiple factors.
Can you develop rheumatism without a family history of the condition?
Yes. Many people with the condition do not have any relatives who have it. Environmental factors such as smoking, infections, and hormonal influences can trigger a rheumatic disease even in the absence of a family history.
What is the difference between rheumatism and osteoarthritis?
Osteoarthritis is a degenerative joint disease—without an inflammatory cause. Rheumatism (especially rheumatoid arthritis), on the other hand, is an autoimmune disease: the immune system attacks the body’s own tissues. It is important to distinguish between the two, as they are treated differently.
Which blood test results indicate rheumatism?
Key laboratory test results include the rheumatoid factor (RF), anti-CCP antibodies, and inflammatory markers such as CRP and ESR. These results alone are not conclusive—only when combined with physical examination findings and imaging do they provide a complete picture.
Can stress cause rheumatism?
Chronic stress is considered a possible contributing factor, as it can affect immune regulation. While it has not been definitively proven to be the sole cause, it is one of the factors that can trigger disease flare-ups.
When should I see a rheumatologist for joint pain?
Spätestens dann, wenn Gelenkschmerzen oder -schwellungen länger als sechs Wochen anhalten, morgens eine ausgeprägte Steifigkeit besteht oder mehrere Gelenke gleichzeitig betroffen sind. Frühzeitige Abklärung kann dauerhafte Schäden verhindern.
ABOUT TTHE AUTHOR
Dr. med. Lioba Pieterse
As a board-certified specialist in internal medicine with a focus on rheumatology and nephrology, I offer comprehensive rheumatological diagnostics and consultations at my private practice in Heidelberg.
Training at Charité – Universitätsmedizin Berlin
Specializing in autoimmune diseases, joint disorders, and their connection to kidney and blood pressure conditions
Private patients and self-pay patients – short wait times, in-depth appointments
Do you have questions about your symptoms—or would you like to schedule an appointment at our private practice for rheumatology and nephrology in Heidelberg?
Private Practise Dr. Pieterse · Heidelberg Handschuhsheim · Bookable online
Charité Berlin
UKE Hamburg-Eppendorf
Uniklinik Heidelberg
Private ptactise since 2020
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