Rheumatoid arthritis and other diseases

Question 1

What are inflammatory rheumatic diseases?

Answer 1

· These are conditions related to inflamed joints, muscles, and tissues that connect or support your organs and other internal body parts
· Manyrheumatic disordersare autoimmunedisorders
· It results in characteristic connective tissue and internal organ damage

Question 2

List the acute and chronic forms of rheumatoid diseases.

Answer 2

Acute forms:
· Gout

Chronic forms:
· Rheumatoid arthritis
· Sjogren disease
· Systemic lupus erythematosis (SLE)

Question 3

For Gout, list:
· causes
· risk factors
· signs and symptoms

Answer 3

Causes
• Gout occurs when uric acid, a normal waste product, builds up in your bloodstream and forms urate crystals in a joint
• Uric acid is produced when the body breakdown purines, a substance found in food
• Uric acid is normally dissolved in blood and processed by kidney
• May be episodic

Risk factors
• Male
• Drinking too much (beer)
• Elevated uric acid in blood
• Diet high in purines (meat, sweetbreads, offal, shellfish, fructose)
• Overweight
• Using diuretics
• Type 2 diabetes, HBP, high cholesterol
• Kidney disease

Signs and symptoms
• intense joint pain
• joint swelling
• skin over the joint may look red and shiny
• affected joint may be hot to touch
• tophi (lumps of crystals that form under the skin) may occur in people who have repeated attacks.

Question 4

For Rheumatoid arthritis, list:
· causes
· risk factors
· signs and symptoms

Answer 4

Causes
• In RA, the immune system targets the lining of the synovial joints, causing inflammation and joint damage
• Usually affects smaller joints like hands and feet
• It can affect non- joints like eyes, lungs, kidneys, digestive tract, heart
• In RA; white blood cells release cytokines which attack cells of synovial membrane. It causes synovial cells to release destructive substances, and results in the synovial membrane growing new blood vessels that form a thickened area called a pannus. Overtime, as the pannus grows, it invades and destroy’ bone/ cartilage within the joint. Consequently, inflammation causes fluid build up and results in the joint swelling. Eventually, the joint space narrows and ankylosis occurs; the two bones in the joint fuse.

Risk factors
• Women
• Middle age
• Smoking
• Environmental exposures
• Obesity 

Signs and symptoms
• Joint pain, swelling, and tenderness to touch
• RF autoantibody
• Commonly raised ESR and CRP
• stiffness in the joints, especially in the morning
• symmetrical (the same joints on both sides of the body are affected)
• Systemic signs/symptoms: weight loss, anorexia, low grade fever and fatigue; generalised osteoporosis and muscle wasting due to chronic inflammation. Can also have anaemia.

Question 5

For Systemic Lupus Erythematosis list:
· causes
· risk factors
· signs and symptoms

Answer 5

Causes
• Immune system attacks healthy tissues
• For some people lupus may just affect the skin and/or joints
• In other people the lungs, kidneys, blood vessels, brain or other parts of the body are affected.

Risk factors
• Genetic factors, (such as deficiencies in complement pathways)
• Environmental factors (viruses, drugs)

Signs and symptoms
• Arthritis: in 90% of patients with SLE. Symmetrical pattern
• Skin: many SLE-specific rashes (eg ‘butterfly’ rash on face), alopecia
• General: Fatigue, headache, poor concentration
• Lung: Pleural disease (common)
• Kidney: Renal disease
• Cardiovascular: several types eg Pericarditis, increased risk of CVD
• Neurological: eg seizures, other brain diseases
• Haematological disorders: eg haemolytic anaemia, thrombocytopaenia
• Reynaud’s phenomenon: discoloration of the fingers and/or the toes after exposure to changes in temperature
• Oral ulceration

Question 6

For Sjogern disease list:
· causes
· risk factors
· signs and symptoms

Answer 6

Causes
• An autoimmune disease that mainly affects the eyes and salivary glands, but can also affect other parts of the body
• Immune system cells attack the tear (lachrymal) and salivary glands. They accumulate, attack and lead to fibrosis = failure to produce secretions
• Can occur own its own, or with other diseases

Risk factors
• Women
• Having an autoimmune disease before hand

Signs and symptoms
• Dry eyes (including irritation, gritty feeling or painful burning in the eyes)
• Dry mouth (or difficulty eating dry foods)
• Swelling of the glands around the face and neck.