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Disease SLE RA OA

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.