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Rheumatoid Arthritis Manifestations and Diagnosis

May 23rd, 2011 No comments

Rheumatoid Arthritis

Exactly what is Rheumatoid arthritis – Rheumatoid arthritis (RA) is among autoimmune ailments which is a chronic or long-term inflammatory problem. RA is the commonest chronic inflammatory polyarthritis and affects about 3 % of the populace. The symptoms create slowly, and could differ from a mild to a most extreme debilitating expression. It might consist of joint pain, tightness, and swelling. The condition can influence numerous cells throughout the body, yet the joints are typically most severely impacted. The cause of rheumatoid arthritis is unknown.

RHEUMATOID ARTHRITIS DANGER ELEMENTS – The particular reason for rheumatoid arthritis is still not understood yet. Sensitivity aspects and Launching elements, nonetheless, have been presumed as elements that can affect an individual’s danger.

Susceptibility factors— RA more than likely creates when a prone person is subjected to factors that begin the inflammatory process. Heredity, gender, and genes mostly figure out an individual’s possibility of developing rheumatoid arthritis. Around 1 per 100 individuals has actually rheumatoid arthritis.

  • Heredity – RA is not a received disease. Genes do not trigger rheumatoid arthritis, they just affect the risk of illness’ advancement.
  • Gender – Gender appears to take part in a major duty in an individual’s susceptibility to rheumatoid arthritis. Ladies are about 3 times more likely than males.
  • Specific genes – Person with specific variants of human leukocyte antigen (HLA) genes are most likely to get rheumatoid arthritis.

Starting aspects – Many individuals who have HLA genes never ever create the condition. As a matter of fact, when one identical twin has rheumatoid arthritis signs, the probability that the other individual will certainly establish illness is just approximately 1 in 3. This shows that aspects must be essential for a person to establish RA.

  • Infection – Bacteria or viruses could be just one of the elements that start rheumatoid arthritis.
  • Smoking – Smoking might raise the risk of creating RA and also could enhance the probability the intensity need to it happens.
  • Anxiety – Taxing occasions such as mishaps, separation and sorrow are more common in individuals with RA in the 6 months prior their diagnosis.

RHEUMATOID ARTHRITIS SYMPTOMS— In the majority of people RA starts with the perilous start of discomfort and stiffness of the little joints of the hands and feet which is on-going as opposed to short lived and mostly has an effect on the fingers where symmetrical participation of the PIP joints produces spindling while the metacarpophalangeal joints (joints in the center of the fingers) establish diffuse thickening as does the arm. Early symptoms could feature tiredness, muscle pain, a low-grade fever, fat burning, and numbness and tingling in the hands. Sometimes, these signs take place prior to joint discomfort or stiffness is obvious. In 25 % of cases Rheumatoid arthritis signs present as arthritis of a solitary joint such as the knee, a circumstance causing complication with Lyme illness or a spondyloarthropathy.

rheumatoid arthritis pictures, rheumatoid arthritis symptoms,

Joi.nts involved

  • Hands : MCP and PIP joints, DIP joints (30%)
  • Wrist and elbows
  • Feet : MTP joints, tarsal joints (not IP joints), ankle
  • Knees (common) and hip (delayed—up to 50%)
  • Shoulder (glenohumeral) joints
  • Temporomandibular joints
  • Cervical spine

Joint symptoms – These Rheumatoid Arthritis symptoms Usually begin gradually and include pain and stiffness, redness, warmth to the touch, and joint swelling. The joint stiffness is most bothersome in the morning and after sitting still for a period of time. The stiffness can persist for more than one hour.

rheumatoid arthritis symptoms

  • Hands – The joints of the hands are often the very first joints affected by rheumatoid arthritis. Between 1 and 5 % of people with rheumatoid arthritis develop carpal tunnel syndrome because swelling compresses a nerve that runs through the wrist which is characterized by weakness, tingling, and numbness of certain areas of the hand.

Rheumatoid Arthritis SymptomsCertain characteristic hand deformities can occur with long-standing rheumatoid arthritis. swan neck deformities and boutonniere deformities, and may drift together in the direction of the small finger. The tendons on the back of the hand may become very prominent and tight, called the bow string sign.

  • Wrist – The wrist is the most commonly affected joint of the arm in people with rheumatoid arthritis. In the early stages of RA, it might be not easy to bend the wrist backward.
  • Elbow – Rheumatoid arthritis may cause inflammation of the elbow. Swelling of this joint may compress nerves that travel through the arm and cause numbness or tingling in the fingers.
  • Shoulder – The shoulder may be inflamed in the later stages of rheumatoid arthritis, causing pain and limited motion.
  • Foot – The joints of the feet are often affected in the early stages of rheumatoid arthritis symptoms, especially the joints at the base of the toes.
  • Ankle – Rheumatoid arthritis may cause inflammation of the ankle. Inflammation of this joint may cause nerve damage, leading to numbness and tingling in the foot.
  • Knee – Rheumatoid arthritis may cause swelling of the knee, difficulty bending the knee, excessive looseness of the ligaments that surround and support the knee, and damage of the ends of the bones that meet at the knee. RA may cause the formation of a Baker’s cyst (a cyst filled with joint fluid and located in the hollow space at the back of the knee).
  • Hips – The hips may become inflamed in the later stages of rheumatoid arthritis symptoms. Pain in the hips may make it difficult to walk.
  • Cervical spine – Rheumatoid arthritis symptoms may present as an inflammation of the cervical spine, which is the area between the shoulders and the base of the head.
  • Cricoarytenoid joint -In about 30 % of people with rheumatoid arthritis symptoms, there is inflammation of a joint near the windpipe called the cricoarytenoid joint. Inflammation of this joint can cause hoarseness and difficulty breathing.

Other Rheumatoid Arthritis Symptoms  – Although joint problems are the most commonly known issues in rheumatoid arthritis, the condition can be associated with a variety of other problems.

  • Rheumatoid nodule – Rheumatoid nodule is painless lumps that appear beneath the skin. The nodule may move easily when touched or they may be fixed to deeper tissues.
  • Felty’s Syndrome : Characterized by an abnormally enlarged spleen (splenomegaly).
  • Amyloidosis : Infiltration of the liver, kidneys, spleen and other tissues with amyloid (starch like substance).
  • Inflammatory conditions – Rheumatoid arthritis may produce a variety of other symptoms, depending on which tissues are inflamed.
  • Pericarditis : Inflammation of the pericardium, tissue lining the chest cavity and surrounding the heart that may cause chest pain and difficulty breathing.
  • Fibrosing Alveolitis : Inflammation of the lung that is not due to infection may cause shortness of breath and a dry cough.
  • Peripheral sensory neuropathy, mononeuritis multiplex : Abnormal nerve function may cause numbness, tingling, or weakness.
  • Sjögren’s syndrome : Dry eyes and dry mouth. women may develop vaginal dryness due to Sjögren’s syndrome, which can cause pain with sexual intercourse.
  • Inflammation of the white part of the eye may cause pain or vision problems.
  • Vasculitis – Inflammation of the blood vessels, may cause a wide variety of symptoms, depends on the location.

RHEUMATOID ARTHRITIS DIAGNOSIS – There is no single test used to diagnose rheumatoid arthritis. Instead, the diagnosis is based upon many factors, including the characteristic signs and symptoms, the results of laboratory tests, and the results of x-rays.

American Rheumatism Association: criteria for the diagnosis of rheumatoid arthritis

  1. Morning stiffness
  2. Pain on motion or tenderness in at least one joint
  3. Swelling of one joint, representing soft tissue or fluid
  4. Swelling of at least one other joint (soft tissue or fluid) with an interval free of symptoms no longer than three (3) months
  5. Symmetrical joint swelling (simultaneous involvement of the same joint, right and left)
  6. Subcutaneous nodules over bony prominences, extensor surfaces or near joints
  7. Typical X-ray changes that must include demineralisation in periarticular bone as an index of inflammation
  8. Positive test for rheumatoid factor in the serum
  9. Synovial fluid – a poor mucin clot formation on adding synovial fluid to dilute acetic acid
  10. Characteristic histopathology of rheumatoid nodules biopsied from any site
  11. Synovial histopathology consistent with RA:

(a)    marked villous hypertrophy

(b)   proliferation of synovial cells

(c)    lymphocyte plus plasma cell infiltration in subsynovium

(d)   fibrin deposition within or upon microvilli

• For classical RA 7 criteria needed

• For definite RA 5 criteria needed

• For probable RA 3 criteria needed

 

Autoimmune disease – Diagnosis, Symptoms, Investigation, Definition,

May 17th, 2011 No comments

Autoimmune disease

Autoimmune diseaseAutoimmune disease is a pathological condition which is caused by an adaptive autoimmune response directed against an antigen within the body of the host. In other words, the body mistakenly attacks its own cells. The disease can affect every part of the human body. It may be systemic, affect single organs or organ systems or attacking several organ systems simultaneously. Thus, the symptoms are vary correspondingly depend on which parts of the body are attacked by the immune system and on the development of the disease. However, these definitions can be unclear since it is often difficult to differentiate the causality when dealing with a human disease. It is very beneficial to consider the evidence of an autoimmune etiology of a human disease with three degrees of stringency.

  • Direct evidence
  • Indirect evidence
  • Circumstantial evidence

AUTOIMMUNE DISEASE – CRITERIA

How to determine if autoimmunity is the cause of the disease rather than an accompanying feature or an outcome? The demonstration of auto-antibodies is the first step in the diagnosis of these diseases, however the antibodies might not be the actual pathogens of the disease. Autoantibodies can occur naturally and are common in all immunologically competent person and might even increase nonspecifically while in the course of disease or injury. Hence, the miniscule presence of autoantibodies does not automatically determine a cause-and-effect relationship, because the autoantibodies might be the result, not the cause, of the disease process. However it is important to emphasize, that the presence of autoantibody responses has great value in diagnosing and prognosing numerous human diseases.

Autoantibodies may be present many years before the diagnosis of diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Type 1 diabetes mellitus (DM) and antiphospholipid syndrome. Combined with genetic information or family history, the presence of autoantibodies may be highly predictive of the later onset of an autoimmune disorder.

Direct evidence – The disease can be produced by showing autoimmune response. Direct evidence usually involves transfer of autoantibody from a patient to a healthy recipient, either an animal or a human. A few instances of such transfers have been successfully performed.

  • Reproduction of pemphigus by injection of patient serum into a neonatal mouse.
  • Maternal-fetal transmission (transplacental transmission) of myastenia gravis, Graves’ disease, and the complete heart block associated with lupus and Sjögren’s disease. The clinical manifestations in the offspring are temporary, because the autoantibody in these cases is provided through passive transfer of serum from the mother.

Indirect evidence – The second level of proof of causality is indirect evidence which requires the availability of an appropriate animal model where the necessary transfer studies can be carried out. Different animal models are implemented :

  • Reproduction of disease in animals via immunization with the appropriate antigen.
  • Autoimmune thyroiditis in the mouse after immunization with thyroglobulin – Hashimoto’s thyroiditis (chronic autoimmune thyroiditis).
  • Myocarditis after immunization of susceptible mice with murine myosin.
  • Naturally occurring disease in animals that resembles its human counterpart.
  • Many aspects that resemble human SLE (Systemic Lupus Erythematosus) have been found in particular genetic strains of mice.
  • A disease closely resembling Type 1 (autoimmune) diabetes.
  • Disease resulting from manipulation of the immune system.
  • Models of inflammatory bowel disease have been described in animals in which particular cytokines such as interleukin (IL)-2 and IL-10 have been eliminated.
  • Autoimmune dilated cardiomyopathy develop in mice which are deficient in programmed cell death-1 (PD-) immuno-inhibitory coreceptor.

Circumstantial evidence – This is the lowest level of proof, which is the one most commonly available to connect a mysterious human disease to autoimmunity.

  • The hazards of using this kind of evidence as the basis for concluding that a disease is caused by autoimmunity have been previously described. Natural autoantibodies are common and might rise nonspecifically in the course of a disease process.
  • Autoimmune diseases tend to cluster, maybe simply because they share a number of genetic susceptibility traits. For examples, a single person will have more than one autoimmune disease, and family members share the very same or even other autoimmune diseases.
  • Most, but not all, autoimmune diseases are more common in women than men. Therefore, a sex bias provides increased circumstantial evidence of an autoimmune etiology. In addition, new information on the differing pathogenic mechanisms involved in men and women has been provided by comparing of the sex-based differences in autoimmune diseases.
  • A disease’s response to immunosuppressive therapy is usually an important clinical indicator of autoimmune etiology. If effective symptomatic therapy can be obtained by immunosuppression, therefore, demonstrating the etiologic agent of the disease may seem less essential.
  • A particular bias to certain HLA haplotypes is shown by most of the autoimmune diseases, usually the Class II category. Because genes that are important in regulating the immune response are encoded by the Class II Major Histocompability Complex (MHC), some rational association may exist between the genetic constitution and susceptibility to a specific autoimmune disease.