RCS 6080 Medical and Psychosocial Aspects of Rehabilitation Counseling. Rheumatic Diseases. Rheumatoid Arthritis.
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Rheumatoid arthritis is an autoimmune disease in which the normal immune response is directed against an individual's own tissue, including the joints, tendons, and bones, resulting in inflammation and destruction of these tissues
The cause of rheumatoid arthritis is not known
Investigating possibilities of a foreign antigen, such as a virus
NSAIDS - Usually, only one such NSAID should be given at a time. Can be titrated every two weeks until max dosage or response is obtained. Should try for at least 2 to 3 wk before assuming inefficacy.
Slow acting - Generally, if pain and swelling persist after 2 to 4 mo of disease despite treatment with aspirin or other NSAIDs, can add a slow-acting or potentially disease-modifying drug (eg, gold, hydroxychloroquine, sulfasalazine, penicillamine) Methotrexate, an immunosuppressive drug is now increasingly also used very early as one of the second-line potentially disease-modifying drugs.
Corticosteroids – offer the most effective short-term relief as an anti-inflammatory drugs. Long-term though improvement diminishes. Corticosteroids do not predictably prevent the progression of joint destruction, although a recent report suggested that they may slow erosions. Severe rebound follows the withdrawal of corticosteroids in active disease.
Immunosuppressive drugs These drugs (eg, methotrexate, azathioprine, cyclosporine) are increasingly used in management of severe, active RA. They can suppress inflammation and may allow reduction of corticosteroid doses. Major side effects can occur, including liver disease, pneumonitis, bone marrow suppression, and, after long-term use of azathioprine, malignancy.
Systemic lupus erythematosus (also called SLE, or lupus) is an autoimmune disease of the body's connective tissues. Autoimmune means that the immune system attacks the tissues of the body. In SLE, the immune system primarily attacks parts of the cell nucleus.
SLE affects tissues throughout the body. Five times as many women as men get SLE. Most people develop the disease between the ages of 15 and 40, although it can show up at any age.
SLE causes tissue inflammation and blood vessel problems pretty much anywhere in the body. SLE particularly affects the kidneys. The tissues of the kidneys, including the blood vessels and the surrounding membrane, become inflamed (swollen), and deposits of chemicals produced by the body form in the kidneys. These changes make it impossible for the kidneys to function normally.
Note the granular appearance of the cortex of these lupus affected kidneys – it’s across the entire surface of both kidneys suggesting a chronic condition.
The inflammation of SLE can be seen in the lining, covering, and muscles of the heart. The heart can be affected even if you are not feeling any heart symptoms. The most common problem is bumps and swelling of the endocardium, which is the lining membrane of the heart chambers and valves.
SLE also causes inflammation and breakdown in the skin. Rashes can appear anywhere, but the most common spot is across the cheeks and nose.
People with SLE are very sensitive to sunlight. Being in the sun for even a short time can cause a painful rash. Some people with SLE can even get a rash from fluorescent lights.
Rashes caused by SLE are red, itchy, and painful. The most typical SLE rash is called the butterfly rash, which appears on the face – particularly the cheeks and across the nose. SLE can also causes hair loss. The hair usually grows back once the disease is under control.
Almost everyone with SLE has joint pain or inflammation. Any joint can be affected, but the most common spots are the hands, wrists, and knees. Usually the same joints on both sides of the body are affected. The pain can come and go, or it can be long lasting. The soft tissues around the joints are often swollen, but there is usually no excess fluid in the joint. Many SLE patients describe muscle pain and weakness, and the muscle tissue can swell.
The spondyloarthropathies share certain common features, including the absence of serum rheumatoid factor, an oligoarthritis commonly involving large joints in the lower extremities, frequent involvement of the axial skeleton, familial clustering, and linkage to HLA-B27
These disorders are characterized by inflammation at sites of attachment of ligament, tendon, fascia, or joint capsule to bone (enthesopathy)
Sacroiliitis is an inflammation of the sacroiliac joint.
Symptoms usually include a fever and reduced range of motion.
Picture on the bottom right shows an individual with – sacroiliitis and Ankylosing Spondylitis. The arrows point to the inflamed and narrowed SI joints. They are white due to bony sclerosis around the joints
Chronic disease that primarily affects the spine and may lead to stiffness of the back. The joints and ligaments that normally permit the back to move become inflamed. The joints and bones may grow (fuse) together.
The effects are inflammation and chronic pain and stiffness in the lower back that usually starts where the lower spine is joined to the pelvis or hip.
Diagnosis is made through: (a) medical history including symptoms, (b) X-rays, and possibly (c) blood tests for HLA-B27 gene
Arthritis that produces pain, swelling, redness and heat in the joints. It can affect the spine and commonly involves the joints of the spine and sacroiliac joints. It can also affect many other parts of the body such as arms and legs. Main characteristic features are inflammation of the joints, urinary tract, eyes, and ulceration of skin and mouth.
The symptoms are fever, weight loss, skin rash, inflammation, sores, and pain.
Reiter's often begins following inflammation of the intestinal or urinary tract. It sets off a disease process involving the joints, eyes, urinary tract, and skin. Many people have periodic attacks that last from three to six months. Some people have repeated attacks, which are usually followed by symptom-free periods.
Diagnosis is made through a physical exam, skin lesions, and a test for the HLA-B27 gene
Causes pain and swelling in some joints and scaly skin patches on some areas of the body.
The symptoms are:
About 95% of those with psoriatic arthritis have swelling in joints outside the spine, and more than 80% of people with psoriatic arthritis have nail lesions. The course of psoriatic arthritis varies, with most doing reasonably well.
Silver or grey scaly spots on the scalp, elbows, knees and/or lower end of the spine.
Pitting of fingernails/toenails
Pain and swelling in one or more joints
Swelling of fingers/toes that gives them a "sausage" appearance.
The amount of the bowel disease usually influences the severity of arthritis symptoms. Other areas of the body affected by inflammatory bowel disease include ankles, knees, bowel, liver, digestive tract, skin, eyes, spine, and hips.
When the axial skeleton is involved, the initial symptom is morning stiffness and lower back pain
As the disease worsens, there is progressive diminution of motion of the spine
Eventually, the sacroiliac joints, lumbar, thoracic, and cervical spine become fused
At this stage, the spine is no longer painful, but the person has lost all ability to flex or rotate the spine and generally develops a hunched-over posture with fused flexion of the cervical spine and flexion contracture of the hips to compensate for the loss of the lordosis curvature in the lumbar spine