RACE (Rheumatology & Arthritis Center Of Excellence) UNIT
Joint & Bone Care Hospital is one of the best Rheumatology Hospitals in Salt Lake, Kolkata. Diseases treated by JBCH rheumatologists include Rheumatoid arthritis, Systemic lupus erythematous, Spondyloarthropathies, Vacuities, Scleroderma etc. Book an appointment for Rheumatology Arthritis Treatment at a highly experienced Rheumatologist.
What is arthritis?
Arthritis is generally used to denote inflammation of joints. There are more than 100 different types of arthritis, with different causes and treatment options. In inflammatory arthritis, the affected joint could be painful along with swelling, stiffness or warmth. If not treated adequately they can lead to significant disability deformity at a later stage.
What are the common symptoms of arthritis ?
Joint pain, stiffness and swelling are the most common symptoms of arthritis. Depending on the type of arthritis you have, your signs and symptoms may include:
- Joint swelling, redness and warmth
- Back pain and stiffness
- Skin rash
- Recurrent mouth ulcers
- Skin rash when exposed to sunlight ( especially face)
- Dry eyes and mouth
- Heel pain
- Red eyes
- Ulcers in the legs
- Unexplained clot in the leg veins
What are the different forms of arthritis?
There are many types of arthritis (over 100 identified). The types of arthritis range from those related to wear and tear of joint cartilage (such as osteoarthritis) to those associated with inflammation of the joints and soft tissues resulting from a confused immune system (such as rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus etc). The different forms of arthritis may co-exist.
What is an autoimmune disease?
An autoimmune disease is a condition in which your immune system mistakenly attacks your own body or cells. The immune system in entrusted to guard against germs like bacteria and viruses. When it senses these foreign invaders, it sends out an army of fighter cells to attack them and contain the infection. Normally, the immune system is able to differentiate between foreign cells and your own cells. In an autoimmune disease, the immune system becomes confused and mistakes part of your body, like your joints or skin, as foreign. It releases abnormal proteins called autoantibodies that attack and destroy healthy cells.
What are the common autoimmune rheumatic diseases?
There are several autoimmune rheumatic diseases as discussed below
Rheumatoid arthritis: Rheumatoid arthritis is a chronic progressive inflammatory disorder that can affect more than just your joints. The condition usually shows up between the ages of 30 to 50, but can also be found in younger or older individuals. It commonly affects joints in the hands, wrists, shoulders and knees. Inflammation can also affect other body parts such as eyes, heart and lungs. Disease attacks could be periodical, or continuous in some people leading to the significant damage and deformity of the affected joints.
Ankylosing spondylitis: Ankylosing spondylitis causes inflammation of the spine and often other joints such as hips, knees and wrists. This is a disease of a younger age group (male predominant). The spine becomes painful and stiff. Inflammation can also affect other body parts such as eyes (red eyes), rib cage ( costochondritis) and heels. If left untreated it can lead to progressive spinal fusion( loss of spinal movements), restricted chest expansion and joint damage ( especially hip joints).
Psoriatic arthritis: Psoriasis is an inflammatory skin condition causing a red rash on the scalp, back of neck and back, elbows and knees etc. About 10-20% of patients with skin psoriasis can also have inflammatory arthritis affecting several joints such as fingers, wrists, toes, knees and spine.
Systemic Lupus Erythematosus (SLE): SLE is an autoimmune condition affecting multiple systems in the body where the patient might experience joint pains, skin rash, facial rash on exposure to the sun, recurrent mouth ulcers, hair loss etc. This condition may also affect the heart, lungs, kidneys, brain, nerves etc. Leakage of protein through kidneys, deranged kidney function and involvement of the brain are considered serious complications. Lupus can also affect the blood system resulting in low hemoglobin, white cells and platelets.
Sjogren’s syndrome: Patients with Sjogren’s Syndrome usually present with dryness of the eyes and the mouth. They may also experience joint and muscle pains, tiredness, dry cough, acid reflux etc.
Scleroderma (Systemic sclerosis): This is a rare autoimmune condition where the skin becomes thick, tight and shiny. They may experience Raynaud’s phenomenon (fingers becoming blue and painful in the cold environment), difficulty in swallowing of food, painful ulcers at fingertips. Other organs such as lungs, heart & kidneys may be affected as well.
Polymyositis/Dermatomyositis: In this, an autoimmune condition inflammation of the muscles, causing pain, stiffness and weakness in the muscles. This might present as difficulty in getting up from chair or climbing stairs, difficulty in swallowing of food or shortness of breath. It may also be accompanied by red spots in the skin, Raynaud’s phenomenon (fingers becoming blue and painful in the cold environment), inflammatory changes in the lung etc.
Antiphospholipid antibody syndrome (APS): In this condition, the blood becomes” sticky” resulting in clots in the arteries and veins. It can cause recurrent abortions, very high blood pressure during pregnancy, heart valve diseases. It might present as a stroke in a younger age group.
Behcet’s syndrome: They may present as recurrent ulcers in the mouth and genitalia, red eyes and inflammatory arthritis.
Vasculitis: They encompass a group of autoimmune conditions affecting multiple systems leading to the disease-specific serious organ or life-threatening complications. In these conditions the wall of the blood vessels becomes inflamed and the vessel may become blocked.
- Takayasu’s arteritis or aortoarteritis attacks the large blood vessels leaving the heart – the aorta and the vessels coming off the aorta. This causes pain in the legs; the pulses in the arm may become weak.
- Polyarteritis nodosa (weight loss, muscle pain, nerve problems and high blood pressure),
- Wegener’s granulomatosis or Granumolatosis with polyangitis (affecting lungs causing breathing problems, ulcers in the nose or mouth, bleeding from the nose, blood in the urine and kidney problems),
- Churg Strauss syndrome or Eosinophillic granulomatosis with polyangitis(causing asthma, nerve, kidneys and lung damage ),
- Microscopic polyangiitis (causing skin rash, kidney and nerve damage).
Other Non-inflammatory conditions:
Gout: This is a kind of arthritis caused by an accumulation of uric acid crystals in the joints. Uric acid is a breakdown product of purines that are components of many foods we eat. Gout is characterized by sudden, severe attacks of pain, swelling, redness and tenderness in the joints. Toes, ankles, knees and wrists are commonly affected. A similar arthritis is called “pseudogout” where crystals of a different type are responsible for the joint inflammation.
Osteoarthritis: Osteoarthritis is the most common chronic (long lasting) joint condition resulting from wear and tear of the cartilage of the joints. It occurs most often in older people above 55 years of age, although it can occur in adults of any age. Any joint can be affected but knees and hips are most commonly affected.
Osteoporosis: Osteoporosis is a silent disease where bones gradually become weak and brittle. This makes them susceptible to low impact fractures. Osteoporosis affects men and women of all races. Osteoporosis-related fractures most commonly occur in the hip, wrist or spine. Early detection and appropriate treatment, healthy diet and weight-bearing exercise can help prevent bone loss and reduces the risk of fractures.
How autoimmune rheumatic conditions diagnosed?
Early diagnosis and initiation of appropriate treatment are essential to achieve optimum control of disease activity, thereby avoiding significant disability or joint deformities. Assessment and treatment of autoimmune rheumatic diseases come under the specialist Rheumatology team. The successful diagnosis could be reached through thorough history taking and clinical examinations, specific immunological blood tests to identify the underlying autoimmune process, relevant imaging techniques where indicated (Xray, Ultrasound, Ct or MRI scan) to assess the severity of affected body parts. Presenting symptoms of autoimmune disease can be non-specific in the beginning. Therefore, patient awareness can be helpful in the early diagnosis of these conditions.
How to treat arthritis and autoimmune rheumatic diseases?
Modern medical research and technologies have offered several treatment strategies to control these autoimmune rheumatic conditions effectively. Early treatment with “disease-modifying agents” often can bring the disease under control. Sometimes it becomes difficult to control the disease with a standard regime of medicines when rheumatologists can use a special class of medicines called “biological agents”. These newer generation of medicines are capable of bringing about a dramatic improvement of symptoms and help patients maintain their economic productivity and quality of life.
All these medicines have their side effects ( could be serious) and therefore need regular monitoring. The rheumatologist closely supervises the treatment which includes periodic systematic assessments of the disease process. Non-compliance to treatment or stopping the treatment against the advice may lead to severe recurrence and progression of the disease.
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