Synopsis of a few disorders/phenomenon.
Felty’s syndrome: A seropositive RA which is common in aged females and is associated with anaemia, neutropenia, thrombocytopenia and splenomegaly.
Caplan’s syndrome: It is seen in coal miners who is having RA with pneumoconiosis of the lung.
Systemic lupus erythematosus (SLE): It is an inflammatory, autoimmune, multisystem disorder
with arthralgia and skin rash as the most common clinical presentation.
It virtually affects most of the systems in the body while renal and cerebral involvement pose serious
problems. SLE is common in women of 20–40 years age group. Malar rash , discoid rash, photosensitivity, oral ulcers (commonly painless palatal ulcer), arthritis/arthralgia, serositis (e.g., pleurisy or pericarditis),
neurological (e.g., psychosis), renal (e.g., proteinuria), and haematological (e.g., leucopenia or thrombocytopenia) manifestations are common. The patient may present with ‘pyrexia of unknown origin (PUO)’. The morbidity (refers to the distressed and unhealthy state of the individual) and mortality (the state of being subject to death) is high in SLE.
Gout : It is a crystal-induced arthritis where monosodium urate (MSU) crystals are deposited in joints, tendons, bursa, etc. Gout is always associated with hyperuricaemia but all hyperuricamic patients do not suffer from gout. Acute gout usually affects the 1st MTP joint of the foot, especially after an alcoholic debauch (any joint may be affected) which is tremendously painful; if acute gout is not treated properly, the patient develops into chronic gout which may give rise to tophi formation (MSU crystal deposition in tendon, ligament or soft tissues) or renal involvement.
Sjögren’s syndrome: It is another autoimmune disease which affects the entire body. The patient presents with dry eyes (xerophthalmia), dry mouth (xerostomia), myalgia, arthralgia and fatigue. Older women are commonly affected. Bilateral parotid swelling may be a presenting feature. There is an increased chance of
development of lymphoma.
Osteoarthritis: It is the commonest form of arthritis in clinical practice and is usually regarded as a degenerative process due to ageing. Now it is thought that some amount of inflammation is also present in its pathology which affects the cartilage, subchondral bone, meniscus, ligaments, synovium and capsule of
the joint. It may affect any weightbearing joint but in India, knee joint is commonly affected while hip joint
involvement is seen in western world. DIP joints of hands are commonly involved. As there is no definite treatment of this disease, it is the commonest cause of disability in the older population.
Osteoporosis: It is defined as low bone density, which results in a micro-architectural deterioration of bone tissue and leads to increased bone fragility with enhanced risk of fracture. Common risk factors are
female sex, post-menopausal women, prolonged immobilisation, CRF, diabetes, drugs (e.g., heparin), increasing age and smoking. Osteoporosis is being treated by calcium, vitamin D, bisphosphonates and recombinant human parathyroid hormone.
Osteomalacia: It is the defective mineralization of newly formed bone matrix due to vitamin D deficiency in an adult; the patients may have bone pain (bone tenderness too) and muscle weakness. When this defective mineralization (as a result of vitamin D deficiency) occurs in epiphyseal growth plate in children before puberty, it is known as rickets.
Fibromyalgia: It is one of the common soft tissue rheumatism. The disease is common in females who complain of widespread body pain, ongoing tiredness and tender points detectable on application of pressure on their muscles. The disease is often associated with irritable bowel syndrome (IBS), migraine, dysmenorrhoea, tension headache, etc. The diagnosis is clinical and is commonly due to disturbed or unrefreshing sleep. The disease is due to ‘abnormal pain perception’ by the patient. The response to treatment is unsatisfactory.
Raynaud’s phenomenon: It is a vasospastic disorder, manifested clinically by ‘triphasic colour response’ i.e., sequential development of pallor, cyanosis and rubor (i.e., redness), commonly seen in fingers and toes. Exposure to cold precipitates Raynaud’s phenomenon in a susceptible individual. The common causes are scleroderma, SLE, thoracic inlet syndrome, hyperviscosity syndrome (e.g., multiple myeloma), and ergot or -blocker-induced. It is being treated by different vasodilators.
Felty’s syndrome: A seropositive RA which is common in aged females and is associated with anaemia, neutropenia, thrombocytopenia and splenomegaly.
Caplan’s syndrome: It is seen in coal miners who is having RA with pneumoconiosis of the lung.
Systemic lupus erythematosus (SLE): It is an inflammatory, autoimmune, multisystem disorder
with arthralgia and skin rash as the most common clinical presentation.
It virtually affects most of the systems in the body while renal and cerebral involvement pose serious
problems. SLE is common in women of 20–40 years age group. Malar rash , discoid rash, photosensitivity, oral ulcers (commonly painless palatal ulcer), arthritis/arthralgia, serositis (e.g., pleurisy or pericarditis),
neurological (e.g., psychosis), renal (e.g., proteinuria), and haematological (e.g., leucopenia or thrombocytopenia) manifestations are common. The patient may present with ‘pyrexia of unknown origin (PUO)’. The morbidity (refers to the distressed and unhealthy state of the individual) and mortality (the state of being subject to death) is high in SLE.
Gout : It is a crystal-induced arthritis where monosodium urate (MSU) crystals are deposited in joints, tendons, bursa, etc. Gout is always associated with hyperuricaemia but all hyperuricamic patients do not suffer from gout. Acute gout usually affects the 1st MTP joint of the foot, especially after an alcoholic debauch (any joint may be affected) which is tremendously painful; if acute gout is not treated properly, the patient develops into chronic gout which may give rise to tophi formation (MSU crystal deposition in tendon, ligament or soft tissues) or renal involvement.
Sjögren’s syndrome: It is another autoimmune disease which affects the entire body. The patient presents with dry eyes (xerophthalmia), dry mouth (xerostomia), myalgia, arthralgia and fatigue. Older women are commonly affected. Bilateral parotid swelling may be a presenting feature. There is an increased chance of
development of lymphoma.
Osteoarthritis: It is the commonest form of arthritis in clinical practice and is usually regarded as a degenerative process due to ageing. Now it is thought that some amount of inflammation is also present in its pathology which affects the cartilage, subchondral bone, meniscus, ligaments, synovium and capsule of
the joint. It may affect any weightbearing joint but in India, knee joint is commonly affected while hip joint
involvement is seen in western world. DIP joints of hands are commonly involved. As there is no definite treatment of this disease, it is the commonest cause of disability in the older population.
Osteoporosis: It is defined as low bone density, which results in a micro-architectural deterioration of bone tissue and leads to increased bone fragility with enhanced risk of fracture. Common risk factors are
female sex, post-menopausal women, prolonged immobilisation, CRF, diabetes, drugs (e.g., heparin), increasing age and smoking. Osteoporosis is being treated by calcium, vitamin D, bisphosphonates and recombinant human parathyroid hormone.
Osteomalacia: It is the defective mineralization of newly formed bone matrix due to vitamin D deficiency in an adult; the patients may have bone pain (bone tenderness too) and muscle weakness. When this defective mineralization (as a result of vitamin D deficiency) occurs in epiphyseal growth plate in children before puberty, it is known as rickets.
Fibromyalgia: It is one of the common soft tissue rheumatism. The disease is common in females who complain of widespread body pain, ongoing tiredness and tender points detectable on application of pressure on their muscles. The disease is often associated with irritable bowel syndrome (IBS), migraine, dysmenorrhoea, tension headache, etc. The diagnosis is clinical and is commonly due to disturbed or unrefreshing sleep. The disease is due to ‘abnormal pain perception’ by the patient. The response to treatment is unsatisfactory.
Raynaud’s phenomenon: It is a vasospastic disorder, manifested clinically by ‘triphasic colour response’ i.e., sequential development of pallor, cyanosis and rubor (i.e., redness), commonly seen in fingers and toes. Exposure to cold precipitates Raynaud’s phenomenon in a susceptible individual. The common causes are scleroderma, SLE, thoracic inlet syndrome, hyperviscosity syndrome (e.g., multiple myeloma), and ergot or -blocker-induced. It is being treated by different vasodilators.