Rheumatoid Arthritis and Cancer Quiz

Lecture 7: Metabolic & Rheumatic Disorders of Skeletal System, Neoplasia and Diabetes Mellitus

• Objectives:
  • Study different disorders affecting musculoskeletal function.
  • Define, examine the pathogenesis, and categorize neoplasia.
  • Study diabetes and its complications.

1- Metabolic & Rheumatic Disorders of Skeletal System

• During childhood, skeletal structures grow in length and diameter, increasing bone mass.
• Skeletal disorders can arise from abnormal growth and developmental processes, potentially due to hereditary or congenital factors.
• Other contributing factors include metabolic disorders, hormonal influences, aging, and nutritional deficiencies.

Osteoporosis and Osteomalacia

• Osteoporosis: Characterized by the loss of mineralized bone mass, increasing porosity, and causing fragile bones prone to fractures.
• Osteomalacia: Results from inadequate bone mineralization (lack of vitamin D), leading to soft bones prone to fractures.
• Symptoms of osteomalacia include muscle pain and weakness, difficulty walking, muscle cramps, painful bones and joints.
• Symptoms of osteoporosis include painful bones & joints
• Diagnosis of both relies on X-ray studies, laboratory testing, bone scans, and bone biopsies.

Etiology of Osteoporosis

• Hormonal imbalance: Postmenopausal osteoporosis is a result of estrogen deficiency.
• Age: Risk increases with age.
• Gender: Women are more susceptible.
• Genetic predisposition:
• Activity level: Sedentary lifestyles are a contributing factor.
• Nutritional status: Nutritional deficiencies negatively affect bone health.

Etiology of Osteomalacia

• Vitamin D deficiency: Common causes include reduced Vitamin D absorption (due to biliary or intestinal diseases) and kidney failure.
• Calcium deficiency.
• Phosphate deficiency.

Rickets

• Rickets is the softening and weakening of bones in children.
• Rickets is caused by vitamin D deficiency.
• It is linked to kidney failures and malabsorptive syndromes, as in osteomalacia.

Rheumatoid Arthritis

• Rheumatoid arthritis (RA) is an autoimmune, inflammatory disease, primarily targeting joints.
• Women are affected more frequently than men (approximately three times).
• The etiology and pathogenesis are speculated to involve genetic predisposition combined with a cell-mediated response to a microbial agent.
• The disease process involves synovial cell proliferation, plasma cell production, mast cell interaction, neovascularization, and edema, eventually leading to synovial hyperplasia and lymphoid nodules.
• The synovium spreads, resorbs cartilage, and spreads to the joint space, causing further damage.

Diagnosis and Treatment of RA

• Diagnosis involves history, physical examinations, and laboratory tests.
• Treatment aims at preventing and reducing pain, minimizing stiffness and swelling, maximizing mobility, and potentially halting the pathological process.
• Treatment involves drugs such as Methotrexate, Steroids, and NSAIDs.

Osteoarthritis (OA)

• Osteoarthritis (OA) is a slowly progressive destruction of cartilage in weight-bearing joints (including fingers) in older adults and those who have suffered trauma earlier in life.
• OA's prevalence increases with age.
• OA is sometimes called degenerative joint disease.
• It's a leading cause of disability and pain in older adults
• Diagnosis involves detailed history, physical examinations, X-ray studies, and lab tests to rule out other diseases.
• Treatment involves medications (NSAIDs), intermittent hot and cold packs, physical/exercise therapy, and weight loss

Gout

• Gout is a group of disorders characterized by increased serum uric acid and urate crystal deposits in kidneys and joints.
• Uric acid is the end product of purine metabolism (from adenine and guanine).
• Primarily affects older men.
• Gout is diagnosed by the presence of a high uric acid level (>6.8 mg/dL) and the presence of uric acid crystals in affected joints.
• Gout has four phases: Asymptomatic hyperuricemia, Acute gout arthritis, Intercritical gout, and Chronic tophaceous gout.

Systemic Lupus Erythematosus (SLE)

• SLE is a chronic inflammatory disease impacting many organ systems, including the musculoskeletal system.
• The etiology is unknown, but is thought to be linked to autoantibodies and immune complexes.
• Treatment involves nonsteroidal anti-inflammatory drugs (NSAIDs), antimalarial drugs, corticosteroids, and immunosuppressants.

2- Neoplasia

• Neoplasia involves uncontrolled cell growth.
• Tumors can be benign or malignant.
• Benign tumors remain localized, lacking invasive capacity and with slow growth
• Malignant tumors are invasive, potentially fatal, and grow rapidly.
• Benign and malignant tumors each have surrounding rims of connective tissue capsules.
• Benign tumor capsules often facilitate surgery, assisting containment and separation.
• Neoplasms have different types from malignant solid tumors to hematologic cancers.

Cell Proliferation

• Cell proliferation is the process of increasing cell numbers through mitotic cell division.
• Normal tissue regulation involves maintaining a balance between dividing cells and cells undergoing apoptosis.

Physiology of Cell Proliferation

• There are three main groupings of cells in terms of their proliferation capabilities.
• Well-differentiated cells like neurons and cardiac muscle cells divide rarely.
• Progenitor cells repeatedly divide and reproduce, including blood, skin, and liver cells.
• Undifferentiated stem cells can rapidly divide and produce progenitor cells when needed.

3- Diabetes Mellitus and the Metabolic Syndrome

• Insulin's Role: Insulin is the primary hormone regulating blood glucose:

  • Promotes glucose uptake by cells and storage as glycogen
  • Prevents glycogen and fat breakdown
  • Inhibits gluconeogenesis and promotes protein synthesis

• Diabetes Diagnosis:

  • Fasting Plasma Glucose (FPG): Glucose level after 8 hours of fasting. Normal <100 mg/dL, Impaired Fasting Glucose 100-125 mg/dL, Diabetes ≥126 mg/dL
  • Casual Blood Glucose Test: Glucose level at any time. ≥200 mg/dL is suggestive of diabetes, particularly when combined with symptoms like polyuria, polydipsia, polyphagia, and blurred vision.
  • Oral Glucose Tolerance Test (OGTT): Glucose level after drinking a glucose solution.
  • Glycosylated hemoglobin (A1C): Reflects average blood glucose levels over the past 2-3 months.
  • Urine test: No longer a routine method for diabetes diagnosis due to the limitations of the test.

• Classification of Diabetes:

  • Type 1: Autoimmune destruction of beta cells in the pancreas, requiring insulin therapy.
  • Type 1A: Immune-mediated type 1 diabetes.
  • Type 1B: Idiopathic type 1 diabetes.
  • Type 2: Insulin resistance and relative deficiency in pancreatic insulin secretion; often associated with obesity.
  • Gestational diabetes: Diabetes diagnosed during pregnancy.

• Stages of Diabetes: The stages of diabetes are based on different blood testing levels.

• Acute Complications of Diabetes:

  • Diabetic ketoacidosis (DKA): Caused by extremely high blood glucose levels and a lack of insulin. Characterized by high glucose, abnormal ketone production, and metabolic acidosis.
  • Hyperosmolar hyperglycemic state (HHS): High blood glucose without significant ketone production, frequently seen in type 2 diabetes and is more life-threatening than DKA.
  • Hypoglycemia: Extremely low blood sugar.

• Dyslipidemia: Serum total cholesterol (TC) has a composite of LDL cholesterol.HDL cholesterol and VLDL cholesterol levels. TC/HDL ratio serves as a predictor for CVD risk.

Test your knowledge on rheumatoid arthritis, osteoarthritis, and various cancers. This quiz covers causes, symptoms, and treatment goals related to these conditions, providing a comprehensive overview of important medical concepts. Ideal for students and professionals in the health sciences.