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Polymyositis and Dermatomyositis Symptoms

July 3rd, 2012 No comments

Polymyositis and Dermatomyositis

Polymyositis is an unheard of wide spread disorder whose main feature is balanced muscular tissue weakness
and throwing away involving the proximal muscles of the shoulder and pelvic girdles.
Polymyositis + associated breakout = dermatomyositis

dermatomyositis heliotrope rash

Clinical components

  • any age
  • peak occurrence 40-60 years
  • female to male proportion 2:1
  • muscular tissue disadvantage and losing proximal limb muscular tissues
  • major problem is weakness
  • muscular tissue discomfort and inflammation in concerning FIFTY %
  • arthralgia or arthritis in regarding FIFTY % (resembles circulation of rheumatoid arthritis)
  • dysphagia in concerning 50 % as a result of oesophageal involvement
  • Raynaud’s phenomenon
  • think about linked malignancy: lung and ovary

The breakout

The unique rash shows attributes of photosensitivity. There is violet staining of the eyelids,.
forehead and cheeks, and possible erythema appearing like sunburn and periorbital oedema. There is a.
particular rash on the hands particularly the fingers and nail folds. The knees and elbows are.
generally included.

.

Polymiositis and dermatomyositis symptoms

 

Diagnosis
muscle enzyme studies (serum creatine kinase and aldolase)
biopsies—skin and muscle
EMG studies—show characteristic pattern

Teatment

includes corticosteroids and cytotoxic drugs. Early referral is appropriate.

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August 26th, 2011 No comments

pharmacological treatment of lupus

Pharmacological Treatment of SLE

As we have actually published on the Lupus Procedure Tips, which is mainly go over regarding Non Pharmacological Lupus Procedure. In this part The Pharmacological Procedure of Lupus will be described. Below are the Pharmacological representatives:.

Immunomodulatory therapy

1. Cyclophosphamide.

Is the primary medicine in extreme organ system conditions, especially lupus nephropathy. Therapy with Corticosteroid and cyclophosphamide (iv bolus 0.5 to 1 gram/m2) is much more effective compared to just a corticosteroid alone, in the prevention of renal system sequele, keep renal function and renal generate remission. Effective non-renal indications with cyclophosphamide is sitopenia, main nerves abnormalities, lung hemorrhage and vasculitis.

Oral administration at a dose of 1 to 1.5 mg / kilograms might be raised to 2.5 to 3 milligrams / kilograms with the disorder of neutrophils> )1000/mm3 and leukocytes> )3500/mm3. Tracking the number of leukocytes were reviewed every 2 weeks and intravenous therapy with an amount of 0.5 to 1 gram/m2 every 1-3 months.

Negative side effects that frequently happen are nausea or vomiting, vomiting, hair loss can sometimes be discovered but it disappeared when the drug is stopped.Dose-dependent leukopenia often develops after 12 days of procedure to ensure that dose change is needed with leukocytes. The danger of microbial infections, fungi and pc virus, especially herpes zoster increases. Negative effects on the gonads that is triggering the failing of ovarian feature and azospermia. Stipulation of gonadotropin hormone launching bodily hormone or oral contraceptive pills has actually not been shown reliable. In SLE people with lupus nephropathy that become pregnant this course of medicines need to be stayed away from.

2. Mycophenolate mofetil (MMF).

MMF is a relatively easy to fix prevention of inosine monophosphate dehydrogenase, an enzyme important for purine synthesis. MMF would certainly stop the expansion of B and T cells and decreased expression of adhesion molecules. MMF successfully decrease proteinuria and improve serum creatinine in people with SLE and nephritis resistant to cyclophosphamide. Negative side effects that take place are typically leukopenia, queasiness and diarrhea. The combo of MMF and Prednisone as effective as dental management cyclophosphamide and prednisone adhered to by azathioprine and prednisone. MMF is provided at a dosage of 500-1000 mg two times daily until the response to drug treatment and amount adapted to feedback. In SLE clients with lupus nephropathy that become pregnant this course of medicines must be avoided.

3. Azathioprine.

Azathioprine is a purine analog that inhibits nucleic acid synthesis and influences the cellular and humoral invulnerable function. In SLE this drug is used as an option to cyclophosphamide for the therapy of lupus nephritis or as a steroid sparing agent for non-renal manifestations such as myositis and refractory synovitis. Giving beginnings with a dosage of 1.5 milligrams / kg / day, if needed could be boosted with the moment interval 8-12 weeks to be 2.5 to 3 mg / kg / day supplied that the leukocyte matter>) 3500/mm3 and metrofil>) 1000. If given up combination with the allopurinol dosage ought to be decreased to 60-75 %. Negative effects that happened a lot more highly effective than cyclophosphamide, which usually happens is bone bottom reductions and food poisonings. Azathioprine is also usually related to hypersensitivity to the sign of fever, skin rashes and increased serum transaminases. Complaints are generally relatively easy to fix and vanish after the drug is stopped. Consequently metabolized in the liver and secreted in the k.idneys liver and kidney function should be checked periodically. This drug is an immunomodulatory options in patients with lupus nephropathy who become pregnant, given at a dose of 1 to 1.5 mg / kg / day because it is relatively safe.

4.Leflunomide (Arava)

Leflunomide is an inhibitor of de novo synthesis of pyrimidin approved in the treatment of rheumatoid arthritis. Several studies have reported benefits in patients with SLE which was originally given because of steroid dependence. Giving starts with a loading dose of 100 mg / day for 3 days followed by 20 mg / day.

5.Methotrexate

Methotrexate is administered at a dose of 15-20 mg orally once a week, and proved particularly effective for skin and joint complaints. Side effects that usually happens is an increase in serum transaminases, gastrointestinal disorders, infections and oral ulcers, so it needs to be monitored closely liver and kidney function. In SLE patients with lupus nephropathy who become pregnant this class of drugs should be avoided.

6.Cyclosporine

Giving a dose cyclosporine 2.5 to 5 mg / kg / day was generally well tolerated and lead to real improvements to the proteinuria, sitopenia, immunological parameters (C3, C4, anti-ds DNA) and disease activity. If creatinine increased by more than 30% or hypertension arises then the dose should be adjusted to a common side effect is hypertension, gum hyperplasia, hipertrikhosis, and increased serum creatinine. Cyclosporine is especially beneficial to membranous nephritis and nephrotic syndrome refractory to, so monitoring blood pressure and kidney function should be performed routinely. Cyclosporine A may be given to people with lupus nephropathy who become pregnant, given at a dose of 2 mg / kg / day because it is relatively safe.

Biological Agents

1.Activation of T cells, the interaction of T cells and B cells, B cell depletion

Recent developments have focused therapy of B cell function in taking autoAg and present it through the immunoglobulin-specific T cells in the cell surface, further influence T cell-dependent immune response Anti CD 20 is a monoclonal antibody against the receptor CD 20 B lymphocytes presented

2.Anti CD 20

Anti-CD 20 (Rituximab; Rituxan) has the potential of the therapy for refractory SLE. Several studies provide therapeutic efficacy in refractory lupus manifestations such as central nervous system, vasculitis and hematological disorders.

3.LJP 394

LJP 394 (Abetimus sodium; Riquent) has been designed to prevent recurrence of renal flare in nephritis patients by reducing antibody against ds-DNA through a selective antigen-specific tolerance. The substance is a synthetic compound that consists of a series of deoxyribonucleotides which bound to the triethylene glycol chains.

4.Anti-B lymphocyte stimulator

B lymphocyte stimulator (BlyS) is part of the cytokine TNF (tumor necrosis factor), which presented the B cellsLymphoStatB a monoclonal antibod against BlyS.

5.Cytokine inhibitors

Although there have been studies showing decreased secretion of TNF alpha and melioration leukopenia, proteinuria and immune complex deposition in experimental animals, but no clinical studies that administered anti-TNF agents in patients with SLE.

6.Anti-malarial

Antimalarial drugs used in SLE is hydroxychloroquine, chloroquine, and quinakrin. Used to constitutional complaints, manifestations in the skin, musculoskeletal and serositis. Antimalarial drug combinations have a synergistic effect and is used when the use of one drug is not effective. Hidroksiklotokuin (200-400 mg / day) and Quinakrin (100 mg / day) as a steroid sparing agents have side effects are mild and reversible, ie the skin becomes yellowish discoloration.

The mechanism of how hydroxychloroquine to prevent organ damage is unclear. Hydroxychloroquine lowering lipid levels and possible anti-thrombotic. Noteworthy are the side effects on the eye although it is relatively safe when used at low dois (<6.5 mg / kg / day). However, the current recommendation is to perform eye examinations before starting treatment and every 6-12 months later. Antimalarial rarely cause congenital abnormalities in the fetus. Therefore direkomendasaikan to be given also in patients with lupus nephropathy of pregnancy and lactation can be given up. Incidence of IUGR was also reduced by administering hydroxychloroquine.

Sex Hormones

Bromocriptine which selectively inhibits the anterior pituitary to secrete prolactin prove useful to reduce SLE disease activity. Dehydroepiandrosterone (DHEA) is useful for SLE with mild to moderate activity. Danazole (synthetic steroids) with doses of 400-1200 mg / day to control cytopenia especially thrombocytopenia and autoimmune hemolytic anemia. Estrogen replacement therapy (ERT) may be considered in patients with SLE who experience menopause, but there is still debate about the ability of oral contraceptives or ERT in the cause of SLE flares. For that this therapy should be postponed in patients with a history of thrombosis.
Corticosteroids

Corticosteroids are effective in treating a variety of clinical manifestations of SLE. Topical or intralesional dosage used for skin lesions, intra-articular preparations used for arthritis, while preparations for oral or parenteral systemic abnormalities. Giving oral dose varied from 50-30 mg of prednisone (methylprednisolone) per day in single or divided doses, is effective for treating the constitutional complaints, skin disorders, arthritis and serositis. Often given concurrently with corticosteroids or immunomodulatory antimalarials in order to get a quick induction then lowered the dose.The involvement of vital organs such as nephritis, cerebritis, hematological abnormalities or systemic vasculitis, generally require high doses of prednisone (1-2 mg / kg / day). Parenteral Corticosteroids can also be used in cases of very severe, life-threatening, with a bolus dose of 1000 mg methylprednisolone for 3 consecutive days.

Undesirable effects of glucocorticoids on long including cushingoid habitus, weight gain, hypertension, infection, capillary fragility, acne, hirsutism, accelerated osteoporosis, ischemic bone necrosis, cataract, glaucoma, diabetes mellitus, myopati, hypokalemia, irregular periods, irritability, insomnia, and psychosis. Therefore after a controlled disease activity, corticosteroid dose should be lowered or discontinued if possible or given in daily doses of the smallest interval.

To minimize osteoporosis, calcium supplements can be given 1000 mg / day in patients with 24-hour urinary calcium excretion over 120 mg. Given 50,000 units of vitamin D is also 1-3 times a week (monitor hypercalcaemia). In preventing osteoporosis can also be given calcitonin and bisphosphonates (alendronate, Didronel or Actonel). Corticosteroids are generally well tolerated during pregnancy although it can cause exacerbation of diabetes and hypertension. There is no evidence that corticosteroids cause congenital defect but may cause low birth weight babies and premature rupture of membranes.

NSAIDs (Non Steroid Anti Inflammatory Drug)

NSAIDs are used to deal with complaints of musculoskeletal pain, pleurisy, pericarditis, and headache. Side effects of NSAIDs on the kidneys, liver, central nervous system should be distinguished from the intense activity of lupus. The presence of proteinuria is an emerging or worsening renal function may be caused by SLE activity or effects of NSAIDs. NSAIDs can also cause aseptic meningitis, headache, psychosis and cognitive impairment, increased serum transaminase reversibly. Gastrointestinal disorders are the most frequent side effects caused by non-selective COX inhibitor. COX-2 selective inhibitors fewer gastrointestinal side effects. In SLE patients with lupus nephropathy who become pregnant this class of drugs should be avoided because it can lead to congenital abnormalities and is excreted in breast milk.

Plasmapheresis

The role of plasmapheresis in lupus nephropathy remains controversial. The indication is a case of lupus with cryoglobulinaemia, hyperviscosity syndrome and TTP (Thrombotyc Thrombocytopenic Purpura).

Intravenous immunoglobulin

Intravenous immunoglobulin (IV Ig) are immunomodulators with a wide working mechanism, including Fc receptor blockade, complement regulation and T cellUnlike immunosuppressant, IV Ig has no effect to increase the risk of infection. Dose of 400 mg / kg / day for 5 consecutive days provide improvements to the thrombocytopenia, arthritis, nephritis, fever, skin manifestations and parameters of immunologically. Side effects that occur are fever, myalgia, headache and arthralgia, and occasionally aseptic meningitis. Contraindications given to patients with SLE with IgA deficiency.

Summary :

To be able to diagnose lupus required a good understanding of Lupus pathophysiology. In addition to symptoms and signs listed in the ACR criteria we need to know that many variations of other manifestations, especially in the skin and the central and peripheral nervous system. More often handling must be carried out in patients who do not fully meet the ACR criteria but suffered life-threatening condition, such as CNS lupus, hemolytic crisis, severe nephritis and poliserositis that does not prove there are other causes. On the other hand we too are required not to overdiagnostic for cases not yet clear. Handling of lupus often require cooperation intra-and inter-disciplinary branch of medicine. It is wise if the doctors who deal with lupus we include peer group or support group in providing education to patients with lupus. Lupus Treatment requires comprehensive understanding as well as astute skills.

A comprehensive treatment plan for lupus may include a range of complementary and alternative therapies (Natural remedies for lupus).

Nutrition and Supplements

Eating a healthy diet with plenty of fruits, vegetables, and whole grains is important for anyone with a chronic disease. People with lupus may also benefit from the following strategies:

Eat more antioxidant-rich foods (such as green, leafy vegetables) and fruits (such as blueberries, pomegranates, and cherries).
Avoid refined foods, such as white breads, pastas, and sugar.
Eat fewer red meats and more lean meats, cold-water fish, or beans for protein.
Use healthy cooking oils, such as olive oil or vegetable oil.
Avoid coffee and other stimulants, alcohol, and tobacco.
Drink plenty of fluids.
Exercise moderately at least 30 minutes daily, 5 days a week.

The following supplements may also help:

Flaxseed (30 g per day) contains omega-3 fatty acids and alpha-linolenic acid, which may help decrease inflammation. One preliminary study suggested that people with lupus who took flaxseed had better kidney function — important because kidney disease (lupus nephritis) is a major complication of lupus.
Fish oil, which also contains omega-3 fatty acids, may help decrease inflammation. Although evidence is mixed about taking a fish oil supplement, doctors do suggest that people with lupus eat more fish. Cold-water fish, such as salmon or halibut, are good sources. Talk to your doctor before taking a fish oil supplement if you also take anticoagulants (blood-thinners), such as warfarin (Coumadin). Eating fish doesn’ t cause the same risk.
Dehydroepiandrosterone (DHEA), start at 5 mg three times a day and work up to 100 – 200 mg per day for 7 – 12 months. Do not take DHEA without your doctor’ s supervision. DHEA is a precursor to the hormones estrogen and testosterone in the body, and several clinical trials show that it may help improve symptoms of lupus. However, side effects — including acne, increased facial hair, and excessive sweating — were common. DHEA may also lower HDL (good) cholesterol, which could contribute to heart disease. Because of DHEA’ s hormone-like effects, people with a history or higher risk of breast, uterine, ovarian, or prostate cancer should not take DHEA.
Calcium and vitamin D supplement, 1 – 2 tablets daily if taking corticosteroids. Corticosteroids can raise the risk of osteoporosis, and calcium and vitamin D can help keep bones strong.
Methylsulfonylmethane (MSM), 3,000 mg two times per day, may help prevent joint and connective tissue breakdown.

Herbs – Natural Remedies For Lupus

Herbs are generally available as standardized, dried extracts (pills, capsules, or tablets), teas, or tinctures/liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage. Dose for teas is 1 – 2 heaping teaspoonfuls per cup of water steeped for 10 – 15 minutes (roots need longer).

Astragalus (Astragalus membranaceus) appeared to reduce overactive immune function in people with lupus in one study. However, the study was preliminary; more research is needed to know whether astragalus works. Do not take astragalus without talking to your doctor first, especially if you already take medications to suppress your immune system.

Tripterygium wilfordii, 30 – 45 mg daily, a Chinese herb. You may also prepare teas from the root of this herb. Two preliminary studies suggest that this herb may help suppress the immune system and reduce joint pain and inflammation. However, not much is known about its safety, and one report suggests that using it long-term may reduce bone density in women. Low bone density is a risk factor for osteoporosis. There are other reports of possibly more serious side effects. Do not take this herb without your doctor’ s supervision. Do not take tripterygium if you are pregnant.

People with lupus should avoid alfalfa supplements, and should talk to their doctor before taking any herb that is used to strengthen the immune system, such as echinacea or gingko.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for lupus based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person’s constitutional type – your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

Apis mellifica
Arsenicum album
Calcarea carbonica
Causticum
Rhus toxicodendron
Ruta graveolens
Thuja occidentalis
Acute dose is 3 – 5 pellets of 12X to 30C every 1 – 4 hours until symptoms are relieved.

Prognosis/Possible Complications :

The prognosis for people with lupus is mixed. Half of people who go into remission stay in remission for decades, but 90% of people with lupus have complications. For women, symptoms tend to get better after menopause. 90% of people with lupus have a survival rate of 10 years, and 63 – 75% have a survival rate of 20 years. People with certain complications from lupus tend to have a poor prognosis.

Follow Up :

Your doctor should monitor you closely during a flare to make sure you get the right treatment, and should watch your condition long-term to spot any complications with your lungs, kidneys, or other organs.

Lupus Symptoms: How to Identify

August 3rd, 2011 No comments

Lupus Symptoms– The best ways to Determine

Symptoms of Lupus

Systemic lupus erythematosus (SLE) is a chronic inflamed problem of unidentified cause that could have an effect on the joints, skin, heart, renal systems, nerves, lungs, serous membranes and/or other organs of the body, therefore, lupus symptoms are differ. SLE is characterized by cells and cell damages from pathogenic autoantibodies and immune complexes. Ninety percent of patients are women in childbearing years and the illness is a lot more common in African Americans. Multiple body organ system indications can take place, including musculoskeletal (arthralgias, myalgias), cutaneous (malar breakout, photosensitivity, hair loss), renal (nephritis, nephritic disorder), stressed (seizures, hassles), cardiopulmonary (pericarditis, pleuritis), hematologic (anemia, leukopenia). Immunologic problems, in particular the generation of a quantity of antinuclear antibodies, are another noteworthy attribute of the disorder. There are many kinds of lupus, Systemic lupus erythematosus which influences different physical body parts is the most typical kind, the others are Subacute Cutaneous lupus erythematosus – generates skin sores on components of the body subjected to the sunlight, Discoid lupus erythematosus – causes a skin rash that doesn’t go away entirely, Drug-induced lupus – could be induced by medications, Neonatal lupus – an uncommon type of lupus that impacts newborn babies.

The medical advancement of Wide spread lupus erythematosus is varied and can be represented by patterns of remissions and lasting or severe relapses. Ladies, primarily in their 20s and 30s, are had an effect on much more frequently than guys.

People with SLE are subject to a lot of symptoms, troubles, as well as inflamed participation that might have an impact on virtually every body organ. The most frequent pattern is a mix of constitutional problems with skin, medium hematologic, serologic involvement, in addition to musculoskeletal. On the other individual hand, a number of people have mainly kidney, hematologic, or central nerve fibers manifestations. The particular pattern that dominates through first couple of years of the disease is likely to control later.

Lupus Symptoms, Constitusional – 50 – 100 % of clients has fever, fatigue, and fat burning. Over 50 percent of lupus symptoms is fever that is believed to be because of active illness. 60 % of the fevers were thought to be due to lupus, 23 % to infection, and 17 % to various other reasons. Threat elements for infection: long-lasting disease damage, neutropenia, hypocomplementemia, lymphopenia, energetic lupus disease, renal participation, neuropsychiatric signs, and using glucocorticoids and other immunosuppressive drugs. A lot of fevers as a result of energetic SLE will certainly transmit with usage of acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and/or low to medium dosages of corticosteroids, if it does not, the suspicion of a contagious or medicine associated etiology is risen.

Lupus symptoms in women

Low Energy or tiredness happens in 80 – 100 % of lupus symptoms, and often the most debilitating. Its existence in not obviously correlated with other measures of disease activity. Hence fatigue is highly correlated with reduced physical exercise tolerance. However, fatigue might not be caused by active SLE, yet to one or more of the following: depression, increased work load, poor habits (smoking, less active living, substance abuse), stress or anxiety, hypothyroidism, anemia, use of specific medications (such as beta-blockers, prednisone), any inflammatory and/or contagious disease, coexistent fibromyalgia, sleeping disturbances and/or deconditioning, or a perception of inadequate social support. Fatigue caused by SLE may respond to antimalarials and glucocorticoids.Weight gain in lupus is commonly caused by one of two factors: salt and water retention associated with hypoalbuminemia, or increased appetite associated with the use of glucocorticoids.Weight loss often occurs before the diagnosis of SLE. Unwilled weight loss could be because of decreased appetite, the side effects of drugs (especially diuretics or antimalarials), and gastrointestinal disease such as (GERD) gastroesophageal reflux disease, abdominal pain, pancreatitis, or peptic ulcer disease.

Here is a list of Lupus Symptoms 

General Symptoms : Photosensitivity (sensitive to the sun light), Fatigue, Malaise, Hair Loss, Weight gain or loss, Fever
Central Nervous System : Lupus Headaches, Fibromyalgia, CNS Vasculitis
Cardio-Vascular System : Antiphospolipid Syndrome, Anemia, Chest Pain when taking a deep breath, Myocarditis, Endocarditis
Gastrointestinal Tract : Gastroesophageal Reflux Disease, Lupus Hepatitis, Chronic Diarrhoea, Nausea and Vomitting, Ascites
Musculoskletal System : Arthritis, Muscle Pain, Fibromyalgia
Reproductive System : Lesion(s) in genital area, Loss of Libido, Increase Miscarriage rate
Kidney : Lupus Nephritis
Skin : Discoid Lupus Erytemathosus, Malar Rash / Butterfly Rash, Tumid Lupus Erythematosus, Raynaud’s Phenomenon, Lupus Panniculitis, Purpura, Subacute Cutaneus Lupus
Mouth and Nose : Mucosal Discoid Lupus, Mouth and Nose Ulcers, Bullous Systemic Lupus Erythematosus
Lungs : Pleuritis, Shortness of breath, Chest Pain
Other Organs : Eye Problem, Lupus Thyroiditis, Swollen Glands, Rhinitis nonallergica

Should you like to know Norton Protocol for Lupus and Natural Remedies for Lupus Click Here!

How Is Lupus Diagnosed?

Lupus is not diagnosed with single test only. The diagnosis might take several months or years, as your doctor has to piece together the puzzle of symptoms of this complex disease in order to be diagnosed accurately. Knowledge and awareness of  the doctor and also good communication from the patient are important so that the correct diagnosis can be made. Some test for lupus or tools may be required by your doctor to make the diagnosis of lupus, such as :

  • Medical history
  • Complete physical examination
  • Complete blood count (CBC)
  • Blood chemistries
  • Erythrocyte sedimentation rate (ESR)
  • Urinalysis
  • Complement levels
  • Antinuclear antibody test (ANA)
  • Other autoantibody tests (anti-DNA, anti-Sm, anti-RNP, anti-Ro [SSA], anti‑La [SSB])
  • Anticardiolipin antibody test
  • Skin biopsy (looking at skin samples under a microscope)
  • Kidney biopsy (looking at tissue from your kidney under a microscope).
  • X rays and other imaging tests can help doctors see the organs affected lupus

Criteria for classification of SLE
(SLE = 4 or more of these 11 criteria)

  • Malar (butterfly) rash
  • Discoid rash
  • Photosensitivity
  • Arthritis
  • Oraulcers
  • Serositis (pleurisy or pericarditis)
  • Renadisorders (proteinuria or casts)
  • Neurologicadisorders (intractable headache, seizures or psychosis)
  • Haematologicadisorders (haemolytic anaemia, leucopenia, lymphopenia or thrombocytopenia)
  • Immunologicadisorders (positive LE cells, anti-DNA, anti-Sm or false positive syphilis serology)
  • Positive antinuclear antibody

Diagnostic tests

  • ESR—elevated in proportion to disease activity
  • antinuclear antibodies (ANA)—positive in 95% (key test)
  • double stranded DNA antibodies—90% specific for SLE but present in only 60% (key test)
  • rheumatoid factor—positive in 50%
  • LE test—inefficient and not used

The diagnosis cannot be made on blood tests alone. Supportive clinicaevidence is necessary.

Management

Appropriate explanation, support and reassurance, use of sunscreens
Refer to consultant for shared care
Drug treatments

  • mild: NSAIDs (for arthralgia)
  • moderate (esp. skin, joint serosa involved): low-dose antimalarials, e.g.
  • hydroxychloroquine up to 6 mg/kg once daily
  • severe: corticosteroids are the mainstay immunosuppressive drugs, e.g. azathioprine

Avoid drugs in those in clinicaremission and with normacomplement levels
Other treatments such as plasma exchange and immunosuppressive regimens available for severe disease

 

Related Article you might like Lupus symptoms in women, Rheumatoid Arthritis Symptoms and Diagnosis

Recommended Books for Lupus

Rheumatoid Arthritis Diet– The Simple Fact

August 1st, 2011 No comments

Rheumatoid Arthritis Diet regimen

Rheumatoid Arthritis DietThe Simple Reality regarding Rheumatoid Arthritis Diet regimen— For long times, special diet regimens for patients with Rheumatoid Arthritis were delegated to phoniness. It was lately that the Arthritis Structure presented “The Reality regarding Diet regimen and Arthritis,” stating “if there was a partnership in between arthritis and diet, it would have been uncovered long ago. The reality is simple, that there is no clinical proof that any type of diet plan or meals has anything to do with causing arthritis and no evidence that any type of food works in managing or ‘curing’ it.”.

Just how could perhaps diet have a result on arthritis? Initially, some individuals with rheumatic disease might be adverse certain foods and have sign and symptoms that could be a symptom of food allergy. Second, particular kinds of diet plans with specific quantities of protein, calories, and greasy acids may have a result on the immunologically-mediated inflammation that accompanies arthritis.

Exists any Rheumatoid Arthritis Diet plan!.?. !? There is no effective evidence at this moment that any type of diet plan aside from a well balanced, healthy one is constantly beneficial to individuals with Rheumatoid Arthritis. One study of a popular diet regimen (the removal of ingredients, red meat, chemicals, fruit, herbs and spices, dairy items, and liquor) for clients with Rheumatoid Arthritis discovered no consistent salutary outcome on condition activity.

Is Rheumatoid Arthritis signs prompted by meals hypersensitivity in some patients? Physicians and people continue being interested that arthritis might often be the outcome of irritation to meals. As instances: Behçet’s syndrome has been connected with black walnuts; Palindromic rheumatism with sodium nitrate; Systemic Lupus Erythematosus (SLE) with hydrazine and with canavanine in alfalfa (which might cross-react with native DNA or turn on B lymphocytes), and Rheumatoid Arthritis (RA) presumably with many substances featuring smoke, tobacco, home dirt, tartrazine, petrochemicals, wheat or grain, corn, dairy items, and beef. Furthermore, rheumatoid-like synovitis in bunnies has been generated by cows’ milk.

Inflamed arthritis could possibly be connected with foods has actually been confirmed (for picked patients) by complete, potential, placebo-controlled, double-blind researches. One person, as an example, had 30 minutes of morning rigidity, 3 inflamed joints and 9 tender joints on her normal diet. Nearly all of these seekings vanished after a three day quick. After that they can be reproduced by milk challenge yet not with various other foods.

The role of plant or fish oils or diet regimens? Nutritional condition placed a regulation a deep influence on immune cooperation and illness sign. For example, mice with SLE or rodents with arthritis who are fed diets rich in EPA (eicosapentaenoic acid – polyunsaturated fatty acid analog) ended up much better as compared to manage pets.

Clinical tests of plant seed oils and fish oils have shown a modest decrease particularly signs with procedure in people with Rheumatoid Arthritis (RA) but not Systemic Lupus Erythematosus (SLE). Helpful effects of fish oil supplements could be improved by limiting the nutritional usage of polyunsaturated oils (eg, soybean, corn, sunflower) to less compared to 10 grams per day. Nevertheless, fish oil pills are beneficial, the amount of omega 3 had in every capsule is.equal to that found in 1 mL of cod liver oil.

Compared to a typical “Western” diet, a Mediterranean diet in general obtains much less calories from animal fat and more from vegetable oils and cereals, especially olive oil. Liberal consumption of beans and fresh fruits in addition to a small daily consumption of wine. The possible effects of a Mediterranean diet (MD) was the topic of a research in which 51 individuals with Rheumatoid Arthritis (RA) were randomly given to an omnivorous or to a MD cuisine for 12 weeks. There was little change spotted in patient general assessments in the omnivorous subjects nor in their scores of the disease activity. While those patients who ate a MD had more development in some disease activity scores, other indicators were not changed.  Considering that the assessment and intervention were not “blinded”, a considerable placebo effect in the group given to the MD can’t be excluded.

These findings on Rheumatoid Arthritis Diet suggest that dietary components that transform arachidonic acid-derived prostaglandin or leukotriene generation have an effect on immunologic responses and inflammatory and may as a result ameliorate symptoms of rheumatic disorder.

The nutritional supplements’ role? A number of elements, including zinc, copper, and vitamin B, have been documented to be beneficial for individuals with arthritis. Generally, however, the proof in support of such statements is short. For instance, even though copper salts have been anti rheumatic in clinical trials, many adverse effects were associated with the usage, consequently, copper salts have not progressed as an important therapeutic agent. In a different study, some patients with Rheumatoid Arthritis benefited from oral zinc, however, the improvement was inconsistent and modest, and there was no confirmation in other studies. Additionally, although the administration of L-histidine has aided a small set of Rheumatoid Arthritis patients, it has not blossomed as an important agent. There is also lack of evidence to support the efficacy of vitamin C for arthritis patients.

Whilst vitamin B6 concentrations are reduced in the serum of patients with Rheumatoid Arthritis and levels of the active metabolite of Vit B6 (pyridoxal 5′ phosphate), are inversely correlated with disease activity, there is currently no convincing evidence on Vitamin B6 supplementation in the diet has any valuable effect on associated disorders or disease activity.

RHEUMATOID ARTHRITIS THERAPIES

May 27th, 2011 No comments

RHEUMATOID ARTHRITIS TREATMENTS

rheumatoid arthritis treatment algorithmRheumatoid arthritis procedures take part in a necessary duty in controlling the irritation of the condition and lessening joint destruction. The procedure integrates a mix of medicine treatment and other individual non-drug therapies, and sometimes it include surgical treatment. The procedure of Rheumatoid Arthritis Symptoms should be personalized to each client’s particular instance, that includes the seriousness of the ailment, the negative effects and the effectiveness of particular therapies.

The therapies variety may be various for an individual with RA who has other individual illnesses, such as liver or renal systems ailment. In order to make an efficient and acceptable plan for managing rheumatoid arthritis, it is essential to collaborate with a healthcare carrier.

RHEUMATOID ARTHRITIS THERAPY – GENERAL BASICS

The function of rheumatoid arthritis treatment is to manage a person’s signs and symptoms, to prevent joint damage, and to keep high quality of life and ability to feature of the client. The preliminary therapy of RA intends to minimize or to get rid of swelling. Lots of drugs for managing rheumatoid arthritis have possibly major negative side effects. Physicians Typically prescribe medications with the least negative effects initially, or the threat of side effects from therapy must be considered versus the advantages.

Long-lasting healthcare with routinly planned gos to is important for the effective procedure of rheumatoid arthritis. This treatment incorporates medical gos to and examinations to examine the effectiveness of treatment and check for negative side effects.

Nonpharmacologic therapies are treatments other than medications and are the fundamental foundation of procedure for all person suffering RA. There are a vast assortment of non-medication treatments offered.

Education and learning and advising can help you to much better comprehend the quality of rheumatoid arthritis and take care of the challenges of this condition.

Biofeedback and Cognitive Behavioural Therapymight assist powerful Rheumatoid Arthritis symptoms.

Relax – Swollen joints need to be relaxed, as fatigue is a common symptom of rheumatoid arthritis yet physical fitness must be maintained. If joint discomfort or minimal joint movement disrupts working out, the physical and physical therapists must be searched for assistance with health and fitness curricula,.

Workout is important as stagnation could cause a loss of joint motion, contractions, and a loss of muscle strength. Person with rheumatoid arthritis oftens become less active as the ache and rigidity prompted. Therefore, weakness decreases joint security and boosts weary over the time.

Physical therapy could minimize pain, assistance maintain joint structure and function and lessen irritation for clients with RA. Certain types of bodily treatment are accustomed to attend to particular results of RA such as the application of heat or cool to reduce pain or stiffness, an assessment with a podiatrist that could make foo.t orthotics (equipments that make sure correct position of the foot) and supportive footwear. Reduce inflammation of the sheaths surrounding tendons (tenosynovitis) by Ultrasound.

Nutrition and dietary therapy – Dietary therapy helps to make sure that the patient eat a sufficient amount of calories and nutrients. Weight reduction might be advised for over weight and obese people to minimise pressure on swollen joints. Persons with rheumatoid arthritis possess a higher risk of getting coronary artery disease. Hypercholesterolaemia is one risk factor for coronary disease that can respond to modifications in diet. Arthritis pain and joint swelling have been modestly improved by fish oils and some plant oils, such as borage seed oil. However, there is no diet that can cure rheumatoid arthritis, neither herbal nor nutritional supplements, such as collagen or cartilage; these treatments can be harmful and are not generally recommended.

Smoking and alcohol – Studies have shown that smoking is a risk factor for rheumatoid arthritis and smoking cessation can improve disease. Smokers need to quit totally. Moderation of alcohol consumption is not hazardous to rheumatoid arthritis, event hough it might rise the chance of liver destruction from some drugs such as methotrexate.

Measures to minimise bone loss – Rheumatoid arthritis causes bone loss, that can lead to osteoporosis. The likelihood of bone loss is increase in persons who are inactive, and persons who are taking glucocorticoids, such as prednisone.

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.