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Rheumatologic and Connective Tissue Disorders (Osteoarthritis (Clinical…
Rheumatologic and Connective Tissue Disorders
Rheumatoid Arthritis
Facts
Autoimmune disease
Unknown origin
Severity varies
More prevalent in women (35-50)
Etiology / Pathophysiology
Cause is unknown; Genetic, environmental, hormonal, immunological, and infectious factors
An external trigger elicits an autoimmune response
Edema of synovium occurs, followed by formation of excess granulation tissue. Granulation tissue covers the articular surfaces
Complications
Digital gangrene
Skin ulcers
Muscle atrophy
Keratoconjunctivitis
Sicca Sjogrens syndrome
TMJ involvement
Clinical Presentation
Onset is gradual and subtle
Multiple, symmetric joint involvement
Significant joint inflammation
Morning joint stiffness lasting longer than 1 hour
Symmetric, spindle shaped swelling of inter phalangeal joints
Systemic manifestations (fatigue, weakness)
Medical Management
No cure exists
Goal is to reach remission, although difficult
More practical goals are to reduce swelling, inflammation, relieve pain, stop damage, and facilitate normal function
Drug groups
NSAIDs to reduce pain and swelling
DMARDs to limit joint damage and improve long term outcomes
Osteoarthritis
Most common form of arthritis
Non-inflammative, degenerative disease
Leading cause of disability among older people
Regional, not systemic
Etiology
Cause is unknown
"wear and tear" on joints
Pathophysiology and Complications
Articular cartilage becomes thicker, erosion of subchondral bones, new bone forms at the margin of cartilage in non-weight baring part of joint
Clinical Presentation
Primary symptom is pain limited to one or two joints
Pain is described as a dull ache, accompanied by morning stiffness
Pain and symptoms lasts no longer than 15 minutes
Joint noises with movement
Painless bony growths
Systemic Lupus Erythematosus
Incidence and Prevalence
SLE is the prototypical autoimmune disease
Affects mainly women of childbearing age, more common in women
More common and severe in African American and Hispanic
Defining feature is presence of anti-nucleus antibodies in blood
Etiology and Physiology
Etiology is unknown
May be triggered by stress, infectious agents, diet, toxins, drugs, and sunlight
Pathophysiology and Complications
Involves production of antibodies, resulting in inflammation and vascular changes
Antibodies are formed in response to stimulation
Leading cause of death are infectious complications and clinical complications related to Lupas
Clinical Presentations
Most common is arthritis
Butterfly shaped rash across nose and cheek
Fatigue, fever, and weight change
Renal abnormalities
Neuropsychiatric, cardiac, and pulmonary complications
Sjogren syndrome
Definition
Chronic, autoimmune, inflammatory disorder characterized by lymphatic infiltration of the exocrine glands
May occur alone or with another autoimmune disorder
Etiology not well understood
Incidence and Prevalence
Second most common rheumatologic disorder in the US
Manifest in the 5th or 6th decade of life
Pathophysiology and Complications
Antigens trigger the immune response
As inflammatory process progresses, fibrosis and atrophy of salivary glands
Clinical Presentation
Eye dryness
Hyposalivation
Enlargement of parotid gland
Lyme Disease
Caused by the tickborne spirochete Borrelia burgdorferi
Macular skin rash that appears within one month of tick bite
Signs include fatigue, malaise, neuritis, facial palsy
Fibromyalgia
The most common cause of pain in the US
Difficult to diagnose
Signs are chronic, diffuse muscle pain accompanied by fatigue, sleep disturbances, and neuropathies