Our services

Diagnostics and treatment at our rheumatology practice

Doctor discussing findings with a patient at the desk

Rheumatic diseases

“Rheumatism” is not a single disease but an umbrella term for around 400 different conditions. The age range of patients is wide, and rheumatic diseases can occur at any age.
There are inflammatory and non-inflammatory rheumatic diseases. Joints, tendons and muscles are frequently affected. Because rheumatic diseases are systemic, other organs such as the kidneys, heart, lungs, gastrointestinal tract, eyes, skin, blood vessels and nervous system are often involved as well. Working up these systemic diseases requires a high level of expertise, which the Centre for Rheumatology at the ATOS Clinic Heidelberg provides.

Because the complaints are so varied, it is often hard to interpret one’s own symptoms correctly and to see a doctor early. On the following pages we would like to give you a closer look at how these diseases present. Please note that this information can only offer a brief insight into the conditions and does not replace a specialist examination.

Rheumatoid
arthritis

Spondyloarthritis

Connective tissue diseases

Vasculitis

Other diseases

Paediatric rheumatology
Doctor showing a patient ultrasound images of the joints

Diagnostic procedures for rheumatic diseases

Every diagnosis naturally begins with a detailed history, in which we ask about your medical history, your current complaints and any concomitant diseases. The physical examination includes a general internal medicine status (heart, lungs, lymph nodes and more). All joints, the tendons and the spine are assessed, and we look for further clues such as changes to the skin or nails or neurological signs, which can also develop in connection with an inflammatory rheumatic disease. Depending on your symptoms, this is supplemented by ultrasound examinations of joints, internal organs and blood vessels. Our own autoimmune laboratory allows specialised rheumatological testing to be carried out promptly on site. In the case of joint swelling, a joint aspiration can be performed with immediate examination of the synovial fluid under the practice’s own polarising microscope.

Immunology laboratory

Laboratory diagnostics in the work-up of inflammatory rheumatic diseases are extensive and include important routine internal medicine tests. Depending on your complaints, we order additional differentiated immunological tests, which are performed in the Centre for Rheumatology’s own immunology laboratory.
Importantly, normal “rheumatism values” do not rule out a rheumatic disease.

Ultrasound

Ultrasound examinations are an important diagnostic building block in inflammatory rheumatic diseases. The Centre for Rheumatology has a high-quality ultrasound system with colour duplex and power Doppler, ideally suited to the varied requirements of internal medicine rheumatology. We scan affected joints as well as the abdominal organs, the thyroid and the heart (echocardiography).

Joint aspiration and synovial fluid analysis

In the case of joint swelling, a joint aspiration can be performed to relieve pressure and for specific diagnostics. The synovial fluid is assessed under a polarising microscope immediately after it is taken. Counting the leukocytes (white blood cells) allows, among other things, a distinction between inflammatory rheumatic and degenerative (osteoarthritis) causes. Gout or pseudogout can also be diagnosed by polarising microscopy. Take a look through our microscope!
We also analyse synovial fluid for our orthopaedic, surgical and radiological colleagues at the ATOS Clinic and for cooperating physicians.

Radiological and nuclear medicine diagnostics
Supplementary radiological and nuclear medicine diagnostics (conventional X-ray, MRI, bone scintigraphy, CT, PET-CT, dual-energy CT) are provided in cooperation with the radiology and nuclear medicine practice at the ATOS Clinic Heidelberg and other practices and hospitals.

Rheumascan/Xiralite®

We can offer you a fast, radiation-free examination to visualise inflammatory changes in the hands. Xiralite® is an innovative imaging technique for diagnosing inflammatory joint disease of the hands. A dye widely used in medicine (indocyanine green) and a special camera system make inflammation visible. In an examination time of just six minutes, all 32 joints of both hands can be assessed simultaneously. The specific distribution pattern provides information about the underlying disease. This novel method allows rheumatic inflammation to be detected at an early stage and treatment to be monitored in unclear cases.

Capillaroscopy

The smallest blood vessels at the nail fold are assessed under a microscope. The procedure is painless and has no side effects, and it is particularly helpful for diagnosing and monitoring inflammatory connective tissue diseases.

ECG

An electrocardiogram (ECG) is part of the basic work-up for rheumatic diseases.

Doctor talking with an elderly patient, a member of the practice team standing next to him

Treatments – help for rheumatic diseases

Every inflammatory rheumatic disease has its own constellation of symptoms and laboratory findings; severity and course vary greatly. Treatment must therefore be tailored to each individual’s situation and adjusted regularly. Fortunately, there are numerous treatment options today. Alongside long-established standard drugs such as anti-inflammatory painkillers (non-steroidal anti-inflammatory drugs, NSAIDs) and glucocorticoids (cortisone), many specific medications are now available for the various rheumatic diseases, including the newly developed biologics. In many cases these are antibodies that block a key inflammatory mechanism at a decisive point. These targeted therapies are often very successful and have few side effects.

Acute treatment
The first goal of treatment is rapid relief of symptoms. This can often be achieved most quickly with a time-limited course of glucocorticoids (“cortisone”). Anti-inflammatory painkillers (NSAIDs) are also used.

Maintenance treatment
To control an inflammatory rheumatic disease in the long term, specific antirheumatic drugs – DMARDs (disease-modifying antirheumatic drugs) – are usually prescribed. The so-called conventional DMARDs include methotrexate, sulfasalazine, hydroxychloroquine, leflunomide, ciclosporin and azathioprine. They have been used for many decades, so knowledge and experience with these drugs are extensive. Methotrexate is one of the most frequently used antirheumatic drugs and remains the “gold standard” in the treatment of many rheumatic diseases. It originally comes from cancer therapy and is used at much lower doses in rheumatic diseases.

Over the past 20 years, the treatment options for inflammatory rheumatic diseases have advanced considerably. Biological DMARDs – biologics – can now help in particular those patients in whom conventional DMARDs did not bring the disease to a standstill.

Biologics are biotechnologically produced proteins that intervene in the regulation of the immune response and thus specifically in the rheumatic disease process. These antibody therapies, which block inflammatory messengers and pathways in a targeted way, are given as an infusion or as an injection under the skin. More recently, a further group of drugs has become available: the Janus kinase inhibitors (JAK inhibitors), which are taken as tablets.

Individual treatment of symptoms and concomitant diseases
Every treatment decision must take concomitant diseases into account – such as diabetes, liver or kidney disease. Therapy has to be tailored to each patient. Before starting treatment, we always explain the benefits and possible risks in detail. In the hands of experienced rheumatologists, the treatment of inflammatory rheumatic diseases is safe and success rates are high. The many modern drugs approved in recent years in particular have brought a substantial improvement in treatment.

Complementary measures
Alongside drug treatment, complementary measures such as physiotherapy (individual and group exercise), occupational therapy and physical therapy (heat, cold, massage, electrotherapy) are very important for restoring and maintaining joint mobility. Patient education is essential for understanding the disease, and contact with self-help groups can also be helpful. Psychological support is added where needed.

This multimodal approach shows the need for interdisciplinary cooperation between treating physicians and therapists, as practised for many years at the Centre for Rheumatology at the ATOS Clinic Heidelberg, today by Dr Dornacher, Dr Schmitt, Dr Max, Dr Lutz, Dr Kihm and Dr Tuleweit. If you have questions about rheumatic treatment, you are welcome to make an appointment at the Centre for Rheumatology.

With time, personal commitment and a wide range of diagnostic and therapeutic services, we take care of your health – competently and with trust – as your rheumatology practice in Heidelberg.

+49 6221 9832980

For patients with statutory health insurance

Dear patient,

Despite our best efforts we have not been granted a statutory health insurance licence. Patients with statutory health insurance (GKV) can therefore only be seen in our practice as self-paying patients. A rheumatological work-up is best arranged in consultation and cooperation with your general practitioner. For cost reasons, the necessary laboratory diagnostics should, for example, be ordered through your GP, who is also welcome to contact one of our physicians in advance. A list of the required rheumatological laboratory values is available from the practice on request. The cost of an initial rheumatological consultation as a self-paying patient is between 150 and 200 euros. We do our best to offer every patient an appointment at short notice, particularly in the case of acute illness, joint swelling or elevated inflammatory markers. We see ourselves as a “signpost” for statutory-insured patients: once a rheumatic disease has been confirmed, we help you find a path within the statutory health care system and stay in close contact with your treating doctors.
We are happy to answer further questions by phone.

If you are interested in an examination, please send an e-mail to rheumatologie-hd@atos.de with the subject line “Laborwerte Kassenpatient” so that we can send you the laboratory sheet.