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DISEASES TREATED
RHEUMATOID ARTHRITIS
Rheumatoid Arthritis (RA) is the most common form of autoimmune arthritis. It affects more than 1.3 million Americans. About 75% of RA patients are women. In fact, 1 – 3% of women may get rheumatoid arthritis in their lifetime. The disease most often begins between the ages of 30 and 50. However, RA can start at any age.
RA is a chronic disease that causes joint pain, stiffness, swelling and decreased movement of the joints. Small joints in the hands and feet are most commonly affected. Sometimes RA can affect your organs, such as eyes, skin or lungs.
The joint stiffness in active RA is often the worst in the morning. It may last one to two hours (or even the whole day). It generally improves with movement of the joints. Stiffness for a long time in the morning is a clue that you may have RA, as this is not common in other conditions. For instance, osteoarthritis most often does not cause prolonged morning stiffness.
Other signs and symptoms that can occur in RA include:
Loss of energy
Low fevers
Loss of appetite
Dry eyes and mouth from a related health problem, Sjogren's syndrome
Firm lumps, called rheumatoid nodules, which grow beneath the skin in places such as the elbow and hands
PSORIATIC ARTHRITIS
Psoriasis is a disease in which scaly red and white patches develop on the skin. Psoriasis is caused by the body's immune system going into overdrive to attack the skin. Some people with psoriasis can also develop psoriatic arthritis, manifested by painful, stiff and swollen joints. Like psoriasis, psoriatic arthritis symptoms flare and subside, vary from person to person, and even change locations in the same person over time.
Psoriatic arthritis can affect any joint in the body, and it may affect just one joint, several joints or multiple joints. For example, it may affect one or both knees. Affected fingers and toes can resemble swollen sausages, a condition often referred to as dactylitis. Finger and toe nails also may be affected.
Psoriatic arthritis in the spine, called spondylitis, causes stiffness in the back or neck, and difficulty bending. Psoriatic arthritis also can cause tender spots where tendons and ligaments join onto bones. This condition, called enthesitis, can result in pain at the back of the heel, the sole of the foot, around the elbows or in other areas. Enthesitis is one of the characteristic features of psoriatic arthritis.
Recent research suggests that persistent inflammation from psoriatic arthritis causes joint damage later, so early accurate diagnosis is essential. Fortunately, treatments are available and effective for most people.
SPONDYLOARTHRITIS (ANKYLOSING SPONDYLITIS)
Spondyloarthritis is a type of arthritis that attacks the spine and, in some people, the joints of the arms and legs. It can also involve the skin, intestines and eyes. The main symptom (what you feel) in most patients is low back pain. This occurs most often in axial spondyloarthritis.
In a minority of patients, the major symptom is pain and swelling in the arms and legs. This type is known as peripheral spondyloarthritis.
People in their teens and 20s, particularly males, are affected most often. Family members of those with spondyloarthritis are at higher risk.
Many people with axial spondyloarthritis progress to having some degree of spinal fusion, known as ankylosing spondylitis. This more often strikes young males.
Non-steroidal anti-inflammatory drugs (commonly called NSAIDs) offer symptom relief for most patients by reducing pain and swelling. Other medicines called biologics, including anti-TNF drugs (TNF blockers) and anti-IL-17 drugs (IL-17 blockers) are effective in patients who do not respond well enough to NSAIDs.
Newer treatments have helped a great deal in controlling symptoms. Frequent fitness activities and back exercises are important in managing the symptons of spondyloarthritis.
The most common is ankylosing spondylitis, which affects mainly the spine. Others include:
axial spondyloarthritis, which affects mainly the spine and pelvic joints
peripheral spondyloarthritis, affecting mostly the arms and legs
reactive arthritis (formerly known as Reiter's syndrome)
enteropathic arthritis/spondylitis associated with inflammatory bowel diseases (ulcerative colitis and Crohn's disease).
GOUT
Gout is a painful and potentially disabling form of arthritis that has been around since ancient times. It is sometimes referred to as the “disease of kings,” because people long have incorrectly linked it to the kind of overindulgence in food and wine only the rich and powerful could afford. In fact, gout can affect anyone, and its risk factors vary.
The first symptoms usually are intense episodes of painful swelling in single joints, most often in the feet, especially the big toe. The swollen site may be red and warm. Fifty percent of first episodes occur in the big toe, but any joint can be involved. Fortunately, it is possible to treat gout and reduce its very painful attacks by avoiding food and medication triggers and by taking medicines that can help. However, diagnosing gout can be hard, and treatment plans often must be tailored for each person.
LUPUS (SYSTEMIC LUPUS ERYTHEMATOSUS, SLE)
Systemic lupus erythematosus, referred to as SLE or lupus, is a chronic (long-term) disease that causes systemic inflammation which affects multiple organs.
In addition to affecting the skin and joints, it can affect other organs in the body such as the kidneys, the tissue lining the lungs (pleura), heart (pericardium), and brain. Many patients experience fatigue, weight loss, and fever.
Lupus flares vary from mild to serious. Most patients have times when the disease is active, followed by times when the disease is mostly quiet - referred to as a remission. Yet, there is much reason for hope. Improvements in treatment have greatly improved these patients’ quality of life and increased their lifespan.
VASCULITIS
Vasculitis is a term for a group of rare diseases that have in common inflammation of blood vessels. These vessels include arteries and veins. There are many types of vasculitis, and they may vary greatly in symptoms, severity and duration. Most types of vasculitis are rare, and the causes are generally not known. Vasculitis affects persons of both sexes and all ages. A few forms of vasculitis affect certain groups of people. For instance, Kawasaki disease occurs only in children. IgA Vasculitis (Henoch-Schönlein) is much more common in children than adults. On the other hand, giant cell arteritis occurs only in adults over 50 years old.
Vasculitis can result in poor blood flow to tissues throughout the body, such as the lungs, nerves and skin. Thus, vasculitis has a wide range of signs and symptoms (what you see and feel), such as:
Shortness of breath and cough
Numbness or weakness in a hand or foot
Red spots on the skin (“purpura”), lumps (“nodules”) or sores (“ulcers”)
On the other hand, vasculitis of the kidneys may produce no symptoms at first but is still a serious problem. Vasculitis can be mild or disabling, or even lead to death. Patients can have one episode of vasculitis or have repeated episodes over several years.
GIANT CELL ARTERITIS (GCA)
GCA is a type of vasculitis or arteritis, a group of diseases whose main feature is inflammation of blood vessels. In GCA, the vessels most often involved are the arteries of the scalp and head, especially the arteries over the temples, which is why another term for GCA is “temporal arteritis.”
GCA can overlap with polymyalgia rheumatica (PMR). At some point, 5 – 15% of patients with PMR will have a diagnosis of GCA. About 50 percent of patients with GCA have symptoms of PMR. The two conditions may occur at the same time or on their own. It also affects the same types of patients as does PMR. It occurs only in adults, usually over age 50, in women more than men, and in whites more than non-whites.
POLYMYALGIA RHEUMATICA (PMR)
Polymyalgia rheumatica is widespread aching and stiffness. Symptoms tend to come on quickly, over a few days or weeks, and sometimes even overnight. Both sides of the body are equally affected. Involvement of the upper arms, with trouble raising them above the shoulders, is common. Sometimes, aching occurs at joints such as the hands and wrists.
Achiness is always worse in the morning and improves as the day goes by. Yet inactivity, such as a long car ride or sitting too long in one position, may cause stiffness to return. Stiffness may be so severe that it causes any of these problems:
Disturbed sleep
Trouble getting dressed in the morning (for instance, putting on a jacket or bending over to pull on socks and shoes)
Problems getting up from a sofa or in and out of a car
INFLAMMATORY MYOPATHIES (POLYMYOSITIS, DERMATOMYOSITIS)
Myopathy is the medical term for muscle disease. Some muscle diseases occur when the body's immune system attacks muscles. The result is misdirected inflammation, hence the name inflammatory myopathies. This damages muscle tissue and makes muscles weak.
People with inflammatory myopathies may have these features:
Weakness in the large muscles around the neck, shoulders and hips
Trouble climbing stairs, getting up from a seat, or reaching for objects overhead
Little, if any, pain in the muscles
Choking while eating or aspiration (intake) of food into the lungs
Shortness of breath and cough
The inflammatory myopathies include polymyositis and dermatomyositis. Muscle inflammation and weakness occur in both conditions while patients with dermatomyositis also have a rash. This rash of dermatomyositis most often appears as purple or red spots on the upper eyelids or as scaly, red bumps over the knuckles, elbows or knees. Children with the disease also may have white calcium deposits in the skin called calcinosis.
Sometimes patients can have the rash with no sign of muscle disease. Doctors call this form of the disease amyopathic dermatomyositis. People with dermatomyositis may also have lung inflammation that causes cough and shortness of breath.