rheumaderm

Rheumatoid arthritis (RA) is a disease with  predominant manifestations involving joints. Extraarticular manifestations appear during the later  stages of disease. The onset of manifestations may  be acute/intermediate, chronic (insidious) and rarely  palindromic. The involvement of joint/s may also  vary from single to multiple joints. Monoarticular  or oligoarticular, involving one to three joints for  substantial period, is less common (1 to 15%) in  RA patients. The usual presentation is polyarticular,  symmetrical and often having the initial involvement of small joints of hands/feet. The polyarticular  presentation accounts for more than 80% of the  manifestations. The remaining 10–15% may have  non-classical presentations like oligoarticular,  predominantly having arthritis of large joints,  shoulders and hip. Rarely, the patients may present  with dominant extra-articular features like fever,  scleritis, vasculitis and carpel tunnel syndrome.  Sometimes, the initial presentation may be bursitis  and tendinitis. Subsequently, the disease may  progress to the remaining joints. RA can present  with diverse clinical features but the most common presentation is polyarthritis of small joints.

Spondyloarthropathies or spondyloarthritides are  constellation of inflammatory arthritides including  ankylosing spondylitis (AS), non-radiographic axial  SpA (nr-axSpA), peripheral SpA, reactive arthritis  (Reiter’s syndrome), arthritis/spondylitis associated  with psoriasis, arthritis/spondylitis associated with  inflammatory bowel diseases (IBD) and juvenile onset SpA. There is an overlap of symptoms and  complications within this constellation of disorders.  Inflammatory back pain, peripheral arthritis,  anterior uveitis and enthesitis are the prime clinical  features.Patients with psoriasis or IBD may present  with skin psoriasis or colitis as presenting  symptoms.Manifestations involving other organs  are very rare. Most often, there is a lag in time  between the onset of symptoms and diagnosis of  spondyloarthropathies.

Juvenile idiopathic arthritis (JIA) is the commonest  rheumatologic condition that afflicts children. This  condition has many subcategories of arthritis  included under its umbrella and the presentation  of these patients is thus varied.

Systemic Lupus Erythematosus (SLE) is a multisystem prototype autoimmune heterogenous illness  characterized by myriad of systemic features  primarily due to immune dysregulation at multiple  levels of the immune cascade with hyperactivation  of B cell activity and diminished T cell suppressor  activity leading to increased tissue specific and nontissue specific circulatory antibodies. Having highly  variable features like constitutional symptoms,  glomerulonephritis, neuropsychiatric disease and  cutaneous manifestation SLE is hardly curable, but  most of the patients experience remission and their  survival has improved over the years.

Sjögren’s syndrome (SS) is an autoimmune  epithelitis affecting primarily the exocrine glands  and epithelium, characterized by dry eyes and dry  mouth. SS can be seen alone (primary SS) or in  association with another autoimmune disease like  rheumatoid arthritis (RA) or systemic lupus  erythematosus (SLE) when it is called secondary  SS. Prevalence varies from 0.5 to 5%. This is a  disease predominantly affecting middle-aged  females.

Osteoarthritis (OA) is the commonest joint disease  affecting human beings and an important cause of  disability. It is a disease of the joint as a whole in  which all parts of the joint are involved. There is  focal loss of cartilage with accompanying periarticular bone response in the form of subchondral  bone sclerosis and attempted new bone formation  by way of bony over-growths called osteophytes.  This may be preceded by bone marrow oedema and  meniscal damage, and may be associated with  inflammation of the synovium. OA usually presents,  clinically, as joint pain and crepitus in the elderly.  Radiologically it is characterised by decreased joint  space (cartilage space), osteophytes, eburnation and  a variety of deformities that develop as the disease  progresses. On MRI it is characterized by presence  of bone marrow lesions, meniscal damage, focal  cartilage damage, and osteophytes. Its progress is  variable and in some patients it is relentless, leading  to joint failure (end stage joint disease) necessitating  joint replacement.

Osteoporosis is a metabolic bone disease characterized  by reduced bone mass and micro-architectural  deterioration in bone tissue resulting in an increased  susceptibility to fragility fractures. Common sites  for fragility fractures are the spine, hip and the wrist.  Osteoporosis is a significant public health problem  in many parts of the world including India. The  importance of osteoporosis can be gauged by the  fact that a woman’s lifetime risk of hip fracture  equals the combined risk of breast, uterine and  ovarian cancers, and the risk of dying from hip  fracture equals mortality from breast cancer. Men  account for nearly 20–30% of all hip fractures that  occur, and one-third of these men do not survive  more than a year. The economic consequences of  osteoporosis continue to mount as the lifespan of  populations around the world increases. The  disease, unfortunately, has attracted a little attention  and even less action in our country. The effectiveness of treatment strategies currently available  mandates that osteoporosis be diagnosed and treated  much before the occurrence of complications like  fracture.

Gout is characterized by deposition of monosodium  urate monohydrate (MSU) in synovial fluid and  other tissues. It is the most common form of  inflammatory arthritis, with a prevalence of 3.9%  in the US,1 0.9% in France,2,3 1.4–2.5% in the  UK,4,6 1.4% in Germany,5 and 3.2% (European  ancestry)—6.1% (Maori ancestry) in New Zealand.7  The development of gout requires three distinct  steps:  1. Long-standing hyperuricaemia,  2. Formation of monosodium urate monohydrate (MSU) crystals and  3. Interaction between MSU crystals and the  inflammatory system.