Osteoarthritis: is a degenerative arthritis that is the most common arthritis, and typically presents with joint pain, stiffness, and limited range of motion. (Also see: "A Closer Look At: Osteoarthritis")
Rheumatoid Arthritis (RA): is a common form of arthritis that causes inflammation of joints and that can also affect internal organ systems. (Also see: "A Closer Look At: Rheumatoid Arthritis", includes: Multiple DMARD Therapy, Biologicals Vs. Indicated Conditions)
Gout: is an inflammatory arthritis associated with elevated uric acid levels, intra-articular crystals, and sudden onset of pain and swelling of joints. Gout can affect people in different levels of intensity and frequency, sometimes consisting of one attack and no other problems. Other people may have frequent attacks, with persistent joint pain and damage in one or more joints. In some cases, the uric acid crystals can accumulate inside the joint and within the surrounding soft tissues. These deposits are called tophi and can cause significant joint damage over the years.
Although there is no cure for gout, it can be controlled with medications and with a special diet called a low purine diet. Please see this diet within our website.
Fibromyalgia Syndrome (FMS): is a common presentation of generalized muscular body pain associated with fatigue that has several signs and symptoms common to people with this diagnosis. It is not a type of arthritis nor does it have inflammation as its significant presentation.
Ankylosing Spondylitis: is a chronic, systemic type of arthritis that affects mostly the spine and sacroileac joints. Common symptoms include back pain, morning stiffness, fatigue, uveitis, and low grade anemia. There is a genetic predisposition to this arthritis, with a positive HLA B-27 in the majority of patients. This condition is most common in males, usually with onset before age 45. About 75% of patients have back pain complaints. Treatment includes range of motion and strengthening exercises, non-steroidal anti-inflammatory agents, patient education, and DMARD's (disease modifying anti-rheumatic drugs) in more aggressive cases. These agents include methotrexate, azathioprine, and sulfasalazine; further studies may support the use of leflunomide, and biological agents such as the Anti-TNF agents infliximab and etanercept.
Inflammatory Myopathies - Polymyositis & Dermatomyositis: This is a group of primary diseases that present with inflammation of the muscles. The distinct classes include polymyositis and dermatomyositis, although similar muscle inflammation can also be seen as part of any of the connective tissue diseases. The term myositis means inflammation of the muscle. The prefix ‘poly’ stands for multiple muscles and ‘dermato’ is for skin involvement in the inflammatory process. These conditions are idiopathic (no direct cause is known) and not common. There are other triggers for damaging changes of the muscles that can be linked to a specific cause, such as drugs, infections, toxins, metabolic abnormalities, endocrine or neuromuscular disorders. It is important to rule out other causes so therapy can be given appropriately.
Dermatomyositis also affects children, with a predilection for females, ages older than two years. In adults, these conditions can occur in young people, and skin changes may occur before the muscle weakness is noticeable. A mild arthritis that is not deforming can also be seen. Some features of dermatomyositis include:
Other signs and symptons common to both dermatomyositis and polymyositis include:
Treatment consists of high dose oral corticosteroids (prednisone), with about ¾ of patients responding well to steroids alone. In the rest of the cases, immunosuppressive medications are added, such as methotrexate, azathioprine, cyclophosphamide, and chlorambucil. All these medications can cause side effects, they improve survival rates for the patients, because the risks of the disease outweigh the risks of the side effects.
Systemic Lupus Erythematosus (SLE): is an inflammatory disease that can affect joints, skin, muscles, and other internal organs. Variants of this condition include discoid lupus, drug-induced lupus, limited cutaneous LE, and mixed or overlap syndromes. (Also see: "A Closer Look At: Lupus")
Osteoporosis: is a condition that causes weakening of the bridges that keep the bones strong. These bridges are called trabeculae. Some of these bridges break microscopically and makes the bones more susceptible to fractures. The most commonly known osteoporosis is post-menopausal, in which the balance between breakdown of bone and new bone formation (remodeling) favors loss of bone. There is a precursor to osteoporosis called osteopenia. There are secondary causes of bone loss, such as use of prednisone or other corticosteroids, other drugs (heparin, high thyroid hormone replacement, phenytoin), alcoholism, low testosterone, gastrectomy, hypogonadism, hyperthyroidism, or osteogenesis imperfecta. Risk factors are:
The diagnosis of osteoporosis usually requires some basic laboratory tests. A specialized x-ray called a Bone Density Study may be helpful in the diagnosis as well as to follow up on the progress of the therapy. After the diagnosis is made, treatment includes biphosphonates (alendronate, risedronate) or calcitonin, calcium and vitamin D supplementation, and hormonal replacement therapy when appropriate. Sometimes treatment is started as a preventive measure in cases of osteopenia or when the persons is at high risk for osteoporosis, such as in chronic prednisone use.
Scleroderma:Scleroderma means "hard skin" and is rare. There are two forms of this disease, 1.) Localized, and 2.) Generalized, the first one being the most common form. Generalized scleroderma is referred to medically as progressive systemic sclerosis (PSSc), and has two subtypes, a.) Limited cutaneous systemic sclerosis, and b.) Diffuse systemic sclerosis.
Sjogren’s Syndrome: Sjogren’s syndrome is a complex of signs and symptoms that include dryness of the eyes, mouth, and skin, and inflammatory arthritis.
Raynaud's Phenomenon: This condition is seen in several connective tissue diseases, such as systemic lupus erythematosus and scleroderma. This is a vasospasm or clamping down of the vessels of fingertips and toes. Cold exposure and emotional stress can trigger this reaction. The color changes with cold make the fingers or toes turn white and blue-purple. In some cases, the lack of circulation to the tissues from sustained vasospasms can cause infarction (skin death), digital scars, infections, and true gangrene. Treatment involves avoidance of injury or any triggering factors, keeping hands and feet warm and covered, and careful local care of any cut or ulcer that occurs (including antibiotics, if needed). Nifedipine, blood thinners, topical nitroglycerin paste, and other medications to improve circulation can be helpful. Smoking is very harmful for patients with Raynaud’s phenomenon, and can cause severe vasospasms.
Vasculitis: Vasculitis is a group of diseases for which the etiology is generally unknown. There is a theory that states that these vasculitides are immune-complex mediated. To support this, there is some evidence for circulating immune complexes , decrease of serum complements, and findings of immunoglobulin deposits in the tissues involved. Another theory suggests an infectious cause for these conditions, such as Hepatitis A, B and C, cytomegalovirus (CMV), human T cell lymphoma virus, human parvovirus B-19, herpes zoster, Lyme disease & HIV infection. Another possible explanation is malignancy, such as hairy cell leukemia.
The classification of vasculitis is quite complex, and involves different parameters. These include vessel size, location of vessels, type of vessel involved, histologic or microscopical picture, response to medications, and specific clinical characteristics. The major vasculitic classes are as follows:
- Classic polyarteritis nodosa
- Allergic granulomatosis
- Overlap
- Serum sickness
- Henoch-Schonlein purpura
- Essential mixed cryoglobulinemia
- In relation to malignancies
- In relation to other primary diseases
- Temporal arteritis
- Takayasu’s arteritis
- Thromboangiitis obliterans
- Mucocutaneous lymph node syndrome
- Behcet’s disease
- Weber-Christian disease
- Relapsing polychondritis
Therapy is tailored to each individual disease and can be quite complicated. Sometimes anti-inflammatory agents can help (NSAID’s), but in most cases prednisone or corticosteroids are needed. In Wegener’s Granulomatosis, cyclophosphamide has been instrumental in prolonging the life of patients. Other cytotoxics, such as methotrexate, cyclosporine A, and azathioprine , as well as gamma globulin can also be useful in the treatment of vasculitis.
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