Ulcerative colitis See inflammatory bowel disease undifferentiated connective tissue disease

Cure Arthritis Naturally

Cure Arthritis Naturally

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OVERLAP SYNDROME.

uveitis See eye problems.

vaccination When a virus or bacteria invades the body, the immune system recognizes small areas on the microbe as foreign. These are called antigenic determinants. As a result of this recognition the immune system is able to mount a response against the invading microbe and, hopefully, destroy it. once the immune system has responded successfully to an infection, it retains a memory of the important antigenic determinants. This enables the immune system to mount another attack much more quickly and effectively should it come into contact with the same microbe again.

This natural ability is utilized in vaccination. By showing a person's immune system the important antigenic determinants of important disease-causing viruses and bacteria, it is possible to pre-arm the immune system and fully or at least partially protect the individual from that disease. This is usually done by killing the microbe and extracting parts that contain the important antigens. It can also be done by giving people an infection with a closely related but much less dangerous microbe than the one that is being protected against. In this way, vaccination has practically eradicated polio and diphtheria from the developed world. Tetanus and hepatitis B are much less common, and the fetal abnormalities caused by rubella (German measles) are theoretically completely preventable. Measles epidemics now occur every seven years rather than every second year as they did before vaccination. Several issues are relevant to the rheumatic diseases.

Immunosuppressed patients People on immuno-suppressive treatment, especially potent drugs such as CYCLOPHOSPHAMIDE, AZATHIOPRINE, or high-dose corticosteroids, should not be given live vaccines. Although harmless to most people, these can cause serious illness in those without a competent immune system. Live vaccines include those against polio, measles, mumps, rubella, chicken pox, tuberculosis (BCG), typhoid, yellow fever, and the vaccinia vaccine against smallpox. These are not absolute contraindications. The use of live vaccines depends on the degree of immunosuppression and the importance of having the vaccine. Immunosup-pressed patients may not respond very well to killed vaccines, but they will be safe.

Asplenia Patients who have no spleen are highly susceptible to infections with certain bacteria. In rheumatic disease patients the likely reason for not having a spleen is having it removed to treat resistant autoimmune thrombocytopenia. Patients with sickle-cell disease are often effectively without a spleen because it has shrunken up due to loss of blood supply. Protecting against some of the infections these patients are at risk from is possible. Therefore, patients with sickle-cell disease and those about to have their spleen removed should be vaccinated against Pneumococcus, Haemophilus influenza type b, and Meningococcus before, not after, surgery.

Protection of immunosuppressed children It is important to vaccinate the relatives and close friends of children who are heavily immunosup-pressed to lessen the risk of those children getting the common infectious diseases that could be devastating for them.

Musculoskeletal adverse reactions Local reactions to vaccination are common, and there are other less common adverse effects. only muscu-loskeletal reactions will be discussed here. oral polio vaccine quite commonly causes muscle aching. Rubella vaccine (usually given as part of the measles, mumps, rubella (MMR) vaccine) is well known to cause a short-lived arthritis (see rubella). Up to 15 percent of adult women get this arthritis after rubella vaccination but much fewer men or children. A few patients appear to have developed a longer lasting arthritis, but it is not yet clear whether this is related to the vaccine. Thrombocytopenia occurs in one in every 30,000 people vaccinated for rubella. Very rarely, osteomyelitis may follow BCG vaccination for tuberculosis and musculoskeletal symptoms following hepatitis b vaccination.

vasculitis Inflammation of blood vessels that damages arteries, veins, and the fine network of capillaries that joins them. The definition of vasculi-tis is deceptively simple but describes a vast range of diseases and symptoms. Vasculitis can mimic virtually any illness, and therefore, making the correct diagnosis can be difficult. Several illnesses can mimic vasculitis, for example cancer, infections,

INFECTIVE ENDOCARDITIS, and CHOLESTEROL EMBOLI.

Cause

There are many different types and causes of vas-culitis, and they are described in detail under their individual headings. The cause of most types of vasculitis is not known. Vasculitis typically affects several organs simultaneously. A rare type of vasculitis, central nervous system vasculitis, affects only the central nervous system, most often the brain.

Kussmaul and Maier were probably the first to describe vasculitis in 1866. Then over decades physicians described different types of vasculitis. in

1952, Zeek classified vasculitis into different subtypes, based mainly on the size of the blood vessels affected. Unfortunately, there is a lot of overlap, and a particular type of vasculitis can affect different-sized vessels. Consequently, many other classifications evolved, but most rheumatologists still classify vasculitis into three groups based on the size of the vessels most often affected (see the table below).

Vasculitis affecting predominantly the small vessels of the skin is often called leukocytoclastic vas-culitis, a name that describes its appearance under a microscope. The polymorphonuclear white blood cells that invade the blood vessel wall are often partially degenerated, and there is cellular debris present. The most prominent clinical feature is palpable purpura, a rash consisting of small, raised, purple spots. Leukocytoclastic vasculitis can occur with other rheumatic diseases, for example rheumatoid ARTHRITIS and SYSTEMIC LUPUS ERYTHEMATOSUS (see RHEUMATOID VASCULITIS).

Leukocytoclastic vasculitis is sometimes also called hypersensitivity vasculitis. More correctly this refers to vasculitis that is caused by a specific antigen, for example a viral infection or drug. Many drugs such as penicillins, sulfonamides, cephalospo-rins, thiazides, phenytoin, and captopril can cause vasculitis (see drug-induced rheumatic disease). Similarly many infections have been associated with vasculitis, including hepatitis b, hepatitis c, hiv, Epstein-Barr virus, parvovirus, rubella, herpes virus, and many others.

Symptoms

Vasculitis damages blood vessels and can impair the blood supply to organs and cause them to malfunc

THE PROPENSITY OF DIFFERENT TYPES OF VASCULITIS TO AFFECT BLOOD VESSELS OF PARTICULAR SIZE

Type of Vasculitis

Size of Vessel

Large

Medium

Small

Temporal arteritis

Often

Sometimes

Seldom

Takayasu's arteritis

Often

Sometimes

Seldom

Polyarteritis nodosa

Seldom

Often

Sometimes

Wegener's granulomatosis

Rare

Sometimes

Often

Churg-Strauss syndrome

Rare

Sometimes

Often

Leukocytoclastic vasculitis

No

Rare

Often

tion. Severe vaculitis can cause irreversible damage to tissues. At the site of damage in the vessel wall there is often overgrowth of endothelial cells and fibrous tissue, presumably a response to repair the damage. This can block the artery, particularly if the blood flowing through the narrow channel clots. The symptoms of vasculitis depend on the organs involved. Nonspecific complaints such as fever, loss of weight, arthralgia, and myalgia are common. Small-vessel vasculitis most often causes a rash consisting of small, raised, purple spots that can be felt as well as seen (palpable purpura). Other types of vasculitis cause symptoms that affect a range of organs. Temporal arteritis often causes headaches and may cause blindness. Wegener's granulomatosis often affects the upper respiratory tract, sinuses, lungs, and kidneys. Polyarteritis nodosa is more likely to affect nerves and kidneys. However, there is overlap of symptoms between different types of vasculitis. (See the table below.)

Diagnosis

Diagnosing vasculitis can be difficult. The initial symptoms often suggest infection or cancer as possible diagnoses, but the constellation of symptoms and results of tests such as the antineutrophil cytoplasmic antibody or anca (see Appendix II) lead to the correct diagnosis. For many types of vasculitis a biopsy of affected tissue is the most accurate way to make an unequivocal diagnosis. Because the treatment of vasculitis requires medications with potentially serious side effects, a correct diagnosis is important.

Treatment

The treatment of different types of vasculitis varies and is described in detail under their individual entries. As a general principle, though, more severe vasculitis requires more aggressive treatment. If a drug or infection causes vasculitis that affects only the skin, specific treatment, other than stopping the offending drug, is seldom needed. Treatment of more severe vasculitis almost always involves immunosup-pression with corticosteroids, often combined with cyclophosphamide or another immunosuppressant. The outcome of vasculitis varies and depends on how severe it is, how much organ damage has occurred before treatment, the response to treatment, and the severity of the side effects of treatment. Patients with kidney involvement leading to renal failure and vas-culitis of the bowel leading to bleeding and gangrene have a worse prognosis.

viral arthritis The most important viruses causing rheumatic disease have been discussed in separate sections in this book. These include hepatitis b, hepatitis c, parvovirus, rubella, and hiv. Other viruses that may cause rheumatic symptoms will be briefly listed here. Note that merely finding a virus in an inflamed joint does not prove that it has caused the arthritis. viral infections are common. With the increased blood flow to an inflamed joint, it is relatively easy for them to lodge there.

Also known as arboviruses, alphaviruses are mosquito-borne viruses that have been known for many years to cause arthritis. Alphaviruses belong to the same family as rubella, the Togaviridae. O'nyong-nyong has recently become a problem in Uganda after disappearing for over 30 years. It causes a rash, fever, and arthritis.

Ross river virus in Australia and other South Pacific islands is probably the best known of the alphaviruses. There is fever and rash, and the

APPROXIMATE FREQUENCY OF SYMPTOMS AND LABORATORY TESTS IN DIFFERENT TYPES OF VASCULITIS

Symptom

Wegener's

Churg-Strauss

Polyarteritis

Temporal Arteritis

Granulomatosis

Syndrome

Nodosa

Upper airway disease

95%

60%

No

No

Gastrointestinal vasculitis

5%

60%

70%

Rare

Nervous system affected

30%

15%

70%

Rare

Eosinophilia

Uncommon

Common

Uncommon

No

Elevated ESR

Common

Common

Common

Common

Positive ANCA

85% C-ANCA

70% P-ANCA

15% P-ANCA

No

arthritis affects mainly the hands, knees, and feet. Symptoms start about a week after being bitten by an infected mosquito. About 15 percent of infected people will get arthritis. Adults are more severely affected than children. In Australia, 5,000 cases a year occur, mostly during the summer months. Some people just get joint pain, but swelling of joints and tendons does occur and the arthritis may last up to six years. Barmah virus can cause a very similar disease and is found only in Australia. At least seven other mosquito-borne viruses in Australia are known to cause arthritis.

Pogosta disease, ockelbo disease, and Karelin fever are all caused by related alphaviruses in northern Europe. Pogosta disease tends to cause epidemics every seven years and causes arthritis in over 90 percent of infected people.

Mumps is a rare cause of arthritis. Most patients are young men. The arthritis may flit around or just affect one joint. There is often associated fever. The arthritis may last up to six months but does not cause lasting joint damage.

Adenovirus, a common cause of upper respiratory tract infections, has rarely caused an acute but short-lived arthritis.

Varicella-zoster, Epstein-Barr, herpes simplex, and cytomegalovirus have all been associated with rare reports of arthritis.

Given the rarity with which the last six of these viruses cause arthritis, the occurrence of arthritis at the same time as or shortly after infection with one of them should always give rise to a careful consideration of another separate cause of the arthritis.

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Arthritis Joint Pain

Arthritis Joint Pain

Arthritis is a general term which is commonly associated with a number of painful conditions affecting the joints and bones. The term arthritis literally translates to joint inflammation.

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  • elaine driver
    Can ulcerative colitis cause arthritis?
    2 years ago

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