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Rheumatic diseases are manifested in all ages. First manifestations of gout are frequent between the ages of 40-60 years. Furthermore, the incidence of rheumatoid arthritis increases as well as anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitides. Recently new treatment options for gout were established but colchicine, which has been used to treat gout for a long time was also further optimized in its use. Remarkable advantages in the treatment of rheumatoid arthritis towards remission have been made by the introduction of biological agents 10 years ago. In granulomatosis with polyangiitis (formerly Wegener's disease) therapeutic optimization has led to a reduction in toxicity and rituximab has proven to be an effective treatment option.

Systemic lupus erythematosus (SLE) is a chronic autoinflammatory disease of unknown etiology with predominance of the female sex. Clinical criteria as well as immunological characteristics, e. g. autoantibodies, are necessary for diagnosis. The clinical course of SLE is variable and may be characterized by periods of remissions and chronic or acute relapses. New symptoms are often challenging regarding differential diagnosis. This review will discuss symptoms with a problem based approach. Parameters of activity are helpful to differentiate between disease activity and associated problems, e. g. infections. Lupus patients have a 5 times increased mortality compared to the normal population. The main reasons for mortality are infections and cardiovascular events, rather than disease manifestations. Therefore, besides the fast and precise use of immunosuppressants the consequent therapy of co-morbidities is a major issue in dealing with these patients. Cardiovascular risk factors need to be controlled, life style modifications should be started early, and diagnosis and therapy of osteoporosis should not be neglected.

Systemic sclerosis (SSc; syn. systemic scleroderma) is a rare autoimmune disorder with characteristic cutaneous manifestations. Prevalence in women is fivefold higher than in men. The course of the disease is slowly progressive with a variable degree of internal organ involvement due to fibrosis and obliteration of small vessels. The diffuse form shows more frequent and severe organ manifestations compared to the limited form. Increased mortality is particularly related to a cardiopulmonary involvement leading to a 5-year survival of around 75%. Treatment indications are dependent on the severity of the disease. In the acute state, immunosuppressive agents are needed in case of significant organ involvement. Vasodilative drugs are often used for the symptomatic treatment of Raynaud's phenomenon.