Summary systemic lupus Rheumatoid arthritis (RA) is an Osteoarthritis is a joint
erythematosus -- is a disease inflammatory disease that inflammation that of the immune system. causes pain, swelling, stiffness, results from cartilage Normally, the immune and loss of function in the joints. degeneration, can be system protects the body It occurs when the immune caused by aging, from infection. In lupus, system, which normally defends heredity, and injury however, the immune system the body from invading from trauma or inappropriately attacks organisms, turns its attack disease. tissues in various parts of the against the membrane lining the body. joints. The most common symptom of approximately 1.5 million rheumatoid arthritis generally osteoarthritis is pain people in the U.S. have lupus. occurs in a symmetrical pattern, in the affected joint(s) People of African, Asian, and meaning that if one knee or after repetitive use. Native American descent are hand is involved, the other one Other osteoarthritis more likely to develop lupus also is. symptoms and signs than are Caucasians. include The disease often affects the The cause(s) of SLE is (are) wrist joints and the finger joints swollen joints, unknown, however, heredity, closest to the hand. It can also joint stiffness, viruses, ultraviolet light, and affect other parts of the body joint creaking, and drugs all may play some role. besides the joints. In addition, loss of range of Female hormones are people with rheumatoid arthritis motion. believed to play a role in the may have fatigue, occasional development of lupus fevers, and a general sense of There is no blood test because women are affected not feeling well. for the diagnosis of by lupus much more often osteoarthritis. than men. This is especially about 1.3 million people, or true of women during their about 0.6 percent of the U.S. Before age 45, reproductive years, a time adult population, have osteoarthritis occurs when hormone levels are rheumatoid arthritis. more frequently in highest. males. After 55 years Factors that may contribute Like some other forms of of age, it occurs more to the development of lupus arthritis, rheumatoid arthritis frequently in females. include viruses, occurs much more frequently in environmental chemicals and women than in men. About two Osteoarthritis a person's genetic makeup. to three times as many women commonly affects the as men have the disease. hands, feet, spine, and Drug-induced lupus can occur large weight-bearing after the use of some Rheumatoid arthritis is also a joints, such as the hips prescription medications systemic disease and knees (such as hydralazine and procainamide). These It is not a systemic symptoms generally improve disease.. after the drug is discontinued. Sign and Lupus symptoms and Rheumatoid arthritis is a Osteoarthritis is a non- Symptomps signs include destructive joint disease that is autoimmune- caused by inflammation in the inflammatory joint butterfly rash on the tissue that normally produces disease whereby the face, lubrication fluid for joints. When cartilage of the joint appetite loss, this tissue remains inflamed, it thins, typically hair loss, leads to deformity by loosening asymmetrically -- so fever, joint ligaments and to joint only one knee or hand fatigue, destruction by eroding away may be affected. photosensitivity, cartilage and bone. Raynaud's Primary osteoarthritis, White blood cells, the agents of osteoarthritis not phenomenon, the immune system, travel to resulting from injury pleuritis, and the synovium and cause or disease, is partly a pericarditis. inflammation (synovitis), result of natural aging characterized by warmth, of the joint. With redness, swelling, and pain -- aging, the water typical symptoms of rheumatoid content of the arthritis. cartilage increases, and the protein As rheumatoid arthritis makeup of cartilage progresses, the inflamed degenerates as a synovium invades and destroys function of biologic the cartilage and bone within processes. Eventually, the joint. The surrounding cartilage begins to muscles, ligaments, and tendons degenerate by flaking that support and stabilize the or forming tiny joint become weak and unable crevasses. In advanced to work normally. These effects osteoarthritis, there is lead to the pain and joint a total loss of the damage often seen in cartilage cushion rheumatoid arthritis. between the bones of the joints. Repetitive Regardless of the exact trigger, use of the worn joints the result is an immune system over the years can that is geared up to promote mechanically irritate inflammation in the joints and and inflame the occasionally other tissues of the cartilage, causing joint body. Immune cells, called pain and swelling. Loss lymphocytes, are activated and of the cartilage chemical messengers (cytokines, cushion causes friction such as tumor necrosis between the bones, factor/TNF, interleukin-1/IL-1, leading to pain and and interleukin-6/IL-6) are limitation of joint expressed in the inflamed areas. mobility. Inflammation of the cartilage can also stimulate new bone outgrowths (spurs, also referred to as osteophytes) to form around the joints. Osteoarthritis occasionally can develop in multiple members of the same family, implying a hereditary (genetic) basis for this condition. Osteoarthritis is therefore felt to be a result of a combination of each of the above factors that ultimately lead to a narrowing of the cartilage in the affected joint. Diagnosis & 11 lupus symptoms and 7 RA symptoms and signs Manifestation signs (1987) Common lupus complaints 1. Joint Stiffness >1hour, and symptoms and signs before improvement include 2. Artritis in 3 or more joints simultaneously 1. fatigue or feeling 3. 1 artritis at hand joint tired, 4. Simetric artritis 2. low-grade fever, 5. Nodul rheumatoid 3. loss of appetite, 4. muscle aches, subcutan at a bone 5. hair loss (alopecia), spike 6. arthritis, 6. Serum rheumatoid (+) 7. ulcers of the mouth 7. X-ray: and nose, erosion/decalcification 8. facial rash at joint or its area ("butterfly rash"), 9. unusual sensitivity to sunlight (photosensitivity), 10. chest pain caused by inflammation of Four areas are covered in the the lining that diagnosis:[54] surrounds the lungs (pleuritis) and the joint involvement, heart (pericarditis), designating the and metacarpophalangeal joints, 11. poor circulation to proximal interphalangeal the fingers and toes joints, the interphalangeal with cold exposure joint of the thumb, second (Raynaud's through fifth phenomenon). metatarsophalangeal joint and wrist as small joints, and Skin manifestations are shoulders, elbows, hip joints, frequent in lupus and can knees, and ankles as large sometimes lead to joints: scarring. In discoid lupus, o Involvement of only the skin is typically 1 large joint gives 0 points involved. The skin rash in o Involvement of discoid lupus often is found 210 large joints gives 1 point o Involvement of on the face and scalp. It 13 small joints (with or usually is red and may have without involvement of large raised borders. Discoid joints) gives 2 points lupus rashes are usually o Involvement of painless and do not itch, 410 small joints (with or but scarring can cause without involvement of large permanent hair loss joints) gives 3 points (alopecia). Over time, 5%- o Involvement of 10% of those with discoid more than 10 joints (with lupus may develop SLE. involvement of at least 1 small joint) gives 5 points serological parameters including the rheumatoid factor as well as ACPA "ACPA" stands for "anti- citrullinated protein antibody": o Negative RF and negative ACPA gives 0 points o Low-positive RF or low-positive ACPA gives 2 points o High-positive RF or high-positive ACPA gives 3 points acute phase reactants: 1 point for elevated erythrocyte sedimentation rate, ESR, or elevated CRP value (c-reactive protein) duration of arthritis: 1 point for symptoms lasting six weeks or longer
Rheumatoid factor (RF):
Rheumatoid factor is an antibody that is present eventually in the blood of most people with rheumatoid arthritis. (An antibody is a special protein made by the immune system that normally helps fight foreign substances in the body.) Not all people with rheumatoid arthritis test positive for rheumatoid factor, and some people test positive for rheumatoid factor, yet never develop the disease.
Anti-CCP antibodies: This
blood test detects antibodies to cyclic citrullinated peptide (anti-CCP). This test is positive in most people with rheumatoid arthritis and can even be positive years before rheumatoid arthritis symptoms develop Treatment & Steroids. Steroid creams can Four of these drugs, Medication be applied directly to rashes. etanercept (Enbrel2), The use of creams is usually golimumab (Simponi), safe and effective, especially infliximab for mild rashes. (Remicade), and adalimumab (Humira), Plaquenil reduce inflammation (hydroxychloroquine). by blocking tumor Commonly used to help keep necrosis factor (TNF), mild lupus-related problems, a cytokine or immune such as skin and joint disease, system protein that under control. This drug is triggers inflammation also effective at preventing lupus flares. during normal immune Cytoxan (cyclophosphamide). responses. A chemotherapy drug that Anakinra (Kineret), has very powerful effects on works by blocking a reducing the activity of the cytokine called immune system. interleukin-1 (IL-1) that is seen in excess Imuran (azathioprine). A in patients with medication originally used to rheumatoid arthritis. prevent rejection of Rituximab (Rituxan) transplanted organs. stops the activation of a type of white blood Rheumatrex (methotrexate). cell called B cells. Another chemotherapy drug This reduces the used to suppress the immune overall activity of the system, for disease that have immune system, which not responded to is overactive in people quinone/prednison with rheumatoid arthritis. Benlysta (belimumab). This Abatacept (Orencia) drug weakens the immune system by targeting a protein blocks a particular that may reduce the chemical that triggers abnormal B cells thought to the overproduction of contribute to lupus. white blood cells called T cells that play CellCept (mycophenolate a role in rheumatoid mofetil). A drug that arthritis inflammation. suppresses the immune system and is also used to Most people who have prevent rejection of rheumatoid arthritis take transplanted organs. medications. Some medications (analgesics) are used only for pain relief; others Rituxan (rituximab). A [corticosteroids and biologic agent used to treat nonsteroidal anti-inflammatory lymphoma and rheumatoid drugs (NSAIDs)] are used to arthritis. It is used to treat the reduce inflammation. Still most serious features of others, often called disease- lupus when other therapies modifying antirheumatic drugs are not effective. (DMARDs), are used to try to slow the course of the disease. People with SLE need more The newest and perhaps most rest during periods of active promising class of arthritis disease. Researchers have medications are the biologic reported that poor sleep response modifiers. These are quality was a significant genetically engineered factor in developing fatigue in medications that help reduce people with SLE. inflammation and structural damage to the joints by Nonsteroidal anti- interrupting the cascade of inflammatory drugs (NSAIDs) events that drive inflammation. are helpful in reducing Joint replacement: Joint inflammation and pain in replacement involves removing muscles, joints, and other all or part of a damaged joint tissues. Examples of NSAIDs and replacing it with synthetic include aspirin, ibuprofen components. (Motrin), naproxen (Naprosyn), and sulindac Arthrodesis (fusion): (Clinoril). Arthrodesis is a surgical procedure that involves Sometimes, medications that removing the joint and fusing prevent ulcers while taking the bones into one immobile NSAIDs, such as misoprostol unit, often using bone grafts (Cytotec), are given from the person's own pelvis. simultaneously. Tendon reconstruction: Rheumatoid arthritis can Corticosteroids are more damage and even rupture potent than NSAIDs in tendons, the tissues that attach reducing inflammation and muscle to bone. This surgery, restoring function when the which is used most frequently disease is active. on the hands, reconstructs the Corticosteroids are damaged tendon by attaching an particularly helpful when intact tendon to it. This internal organs are affected. procedure can help to restore hand function, especially if the Hydroxychloroquine tendon is completely ruptured. (Plaquenil) is an antimalarial medication found to be Synovectomy: In this surgery, particularly effective for SLE the doctor actually removes the people with fatigue, skin inflamed synovial tissue. involvement, and joint Synovectomy by itself is seldom disease. performed now because not all of the tissue can be removed, Get enough rest. and it eventually grows back. Eat well. Calcium and vitamin D Avoid alcohol. supplements or other Don't smoke. treatments to prevent potential Play it safe in the sun. osteoporosis. Treat fevers.