Rheumatic Diseases

About Arthritis

Today, millions of Americans are affected by some form of arthritis. Arthritis is the leading cause of pain and disability in the United States. There are more than 100 types of arthritis, but it has three tell-tale signs: pain, stiffness, and swollen joints. Fatigue is also common.

While some types of arthritis can be mildly nagging, other forms of arthritis can be serious and debilitating. Accurate and early diagnosis is important to minimizing joint damage and disability while maximizing and preserving mobility and function.

The most common types of arthritis in adults include rheumatoid arthritis (RA), osteoarthritis (OA), ankylosing spondylitis (AS), psoriatic arthritis (PA), lupus, Sjögren's syndrome,scleroderma, gout, and osteoporosis.

Common Diseases and Conditions Treated:

1. Ankylosing spondylitis — Ankylosing spondylitis, like psoriatic arthritis, is a part of a group of diseases known as seronegative spondyloarthropathies. It is a chronic inflammatory condition that not only affects joints in the spine, sacrum, and lower extremities, but also the eye, heart, kidneys, and lungs. The first symptoms typically occur before age 40. Early diagnosis is important to avoid joint damage, deformity and disability. But diagnosis is often delayed because the symptoms often mimic common back problems. Laboratory tests, X-rays and bone scans can aid an accurate diagnosis. Treatment is most effective if started before any irreversible damage has been done.

2. Back pain — Back pain is a very common condition and is high on the list of reasons for missed work. There are many causes for back pain; the more common causes including degenerative disc disease, strains of muscles and ligaments, sciatica or pinched nerve, osteoporotic fracture, herniated disc, and skeletal abnormalities. Treatment is highly individualized depending on the condition, degree of severity, patient's needs and comfort level.

3. Bursitis — Bursitis is inflammation or irritation of a bursa which is the soft-tissue padding amongst bones, tendons, and muscles around your joints. Bursitis is often due to repetitive motion and overuse of the associated joint. Common areas affected are bursae around the shoulders, elbows, hips, and knees. Although the pain can be quite severe, this condition is treatable. Treatment often includes rest, pain management, physical therapy and in severe or recurrent cases, corticosteroid injections.

4. Fibromyalgia — Fibromyalgia is a condition that is widely misunderstood both by the general population and even health care providers. It causes generalized pain, fatigue, and nonrestorative sleep. Patients with this condition are much more sensitive to pain and light touch. Contrary to the myth that this disease is "all in one's head" and that "it is not a real disease," there is research showing that there is a real physiologic and neurochemical basis for these symptoms. People with fibromyalgia complain of fatigue and hurting all over. While fibromyalgia can affect men and women at any age, it more commonly affects women. Even with adequate amounts of sleep, people with FM still may wake up unrefreshed, resulting in a vicious cycle of increasing fatigue and pain. There is no laboratory test to diagnose fibromyalgia. Other conditions, including lupus, rheumatoid arthritis, thyroid disease, and sleep apnea must first be ruled out. A diagnosis of FM may be confirmed by identifying a number of "tender points," which are certain areas of the body that are painful to the touch. The approach to treatment is multifactorial and aimed at understanding the disease and taking control of one's symptoms rather than letting the symptoms take control of the patient.

5. Frozen shoulder — Frozen shoulder, also known as adhesive capsulitis, is quite common, especially amongst diabetics. It causes pain and stiffness of the shoulder with decreased active and passive range of motion. Whenever there is decreased activity of the shoulder joint as in a stroke patient or one who has his arm in a sling due to injury, the risk of frozen shoulder is increased. Medical intervention coupled with physical therapy can be effective; however, in some cases, surgery to loosen up the fibrosis of the joint capsule, may be required so the shoulder joint can move more freely.

6. Gout — Gout is a common form of arthritis due to the formation of uric acid crystals within a joint. It is marked by acute attacks of severe pain, tenderness, redness, and swelling of a joint. The joint at the base of the big toe is most often affected. Gout is more common in men than women; although, women are at an increased risk after menopause. It is quite common in Filipinos and Pacific Islanders. Certain foods may trigger an attack. It may be a challenging disorder to treat, but with the right treatment, the frequency of attacks can be significantly decreased.

7. Lupus — Lupus is a chronic inflammatory disease in which your immune system abnormally attacks your own tissues and organs. This disease most commonly affects young females. There are different forms of lupus and the most common and most serious is systemic lupus erythematosus. It is a multi-system disease which can often affect the skin, joints, kidneys, brain, heart, lungs, and blood cells. The presentation of lupus is quite variable; fortunately, there are multiple medications that can effectively treat this condition.

8. Osteoarthritis — Osteoarthritis, characterized by the gradual wear and tear of the cartilage in joints over time, is the most common form of arthritis. Joints that are most commonly affected include hand joints, knees, hips, neck and low back. Unfortunately, there is no cure but oral, topical, and intraarticular injectable medications are available to help you function and live an active lifestyle. Treatment focuses on relieving pain, reducing inflammation and improving joint motion though exercise to increase flexibility and build strength. Despite these measures, surgery is sometimes needed.

9. Osteoporosis — Osteoporosis is a common condition in this country and is a major cause of spine and hip fractures. It is marked by weak, thin, and brittle bones and is common in postmenopausal women. If osteoporosis goes untreated, simple falls and other nontraumatic activities such as bending or pulling can lead to fractures. Because hip fractures have a significant increase in mortality, the diagnosis and prevention/treatment of osteoporosis is a major issue. Risk factors for developing this silent and often, preventable disease include advancing age, female sex, low weight, previous spontaneous or low trauma fracture( an injury that would not be expected to cause a fracture), hip fracture in a mother or father, smoking, corticosteroid use, Rheumatoid arthritis, diabetes, 3 or more alcoholic drinks per day and a low bone density.

10. Psoriatic arthritis — Psoriatic arthritis is marked by psoriasis and joint inflammation. Most patients typically develop psoriasis before developing the arthritis, although the reverse can also occur. Just about any joint can be affected, including the spine and sacroiliac joints. Inflammation of the eye, known as iritis or anterior uveitis, can be associated with psoriatic arthritis. Highly specialized medications are available to treat the skin and musculoskeletal manifestations.

11. Rheumatoid arthritis — Rheumatoid arthritis is an autoimmune disorder in which your own immune system attacks the affected joint (s). This condition is marked by chronic inflammation primarily of the small joints of your hands and feet. Ultimately, if left untreated, it can cause joint erosion and deformities. Unlike osteoarthritis, rheumatoid arthritis affects the synovium, or the lining of the joint. Patient history, physical examination of the affected joints, X-rays and blood tests are used to diagnose RA. Early, aggressive treatment is essential to preserving function and preventing deformity. There are multiple medications available to treat this condition.

12. Scleroderma — The term "scleroderma" means, literally, "hard skin," which refers to the smooth, tightened or thickened areas of skin that are a common sign of the disorder. Scleroderma is not well understood, but is believed to be a relatively rare, autoimmune condition. The disease affects all age groups. Its onset is most commonly seen in women between the ages of 25 and 55. A definitive diagnosis of scleroderma can be difficult because the symptoms mimic many other diseases. A definite diagnosis is based on a medical history, physical examination, and blood tests. Treatment is based on relieving symptoms, particularly those of dry skin and joint inflammation and pain.

13. Sjögren's Syndrome — Sjögren's syndrome is an autoimmune condition, in which the body's immune system destroys the exocrine glands that produce tears, saliva and mucus. The cause of Sjögren's syndrome is unknown, although scientists believe that patients who are genetically predisposed to Sjögren's syndrome may come in contact with a virus or certain bacteria that triggers the immune response. This response inactivates tear and saliva glands. The result is uncomfortably dry eyes and dry mouth. A burning sensation in the mouth or throat is also common, as is a hoarse voice or difficulty swallowing because food sticks to the dry tissue. Enlarged or infected glands that cause pain are also common, as is vaginal dryness among women. Many patients also complain of aching and fatigue. Definitive diagnosis is based on a thorough history, physical examination and results of blood tests. Treatment focuses on treating symptoms of dry eyes and mouth to increase moisture and decrease inflammation.

14. Soft tissue Rheumatic syndromes — Tendonitis—Tendonitis is inflammation or irritation of a tendon which is the thick fibrous tissue that connect muscles to bones. This condition may be associated with inflammatory conditions, sports-related injuries, or overuse. Common tendons involved include those around the elbow, wrist, shoulder, and heel. Treatment may include rest, pain management, physical therapy, corticosteroid injection, and massage. a. Trigger finger—Trigger finger is a condition that causes any one of your fingers or thumbs to catch and become flexed when you bend them. In severe cases, the digit involved may not straighten and may become locked. Individuals with diabetes or those whose work or hobbies require a lot of gripping are at increased risk. Medical treatment can be effective although in severe cases with recurrence, surgery may be required.



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