pathophys2 final: Rheumatology ppt

What is Rheumatology?

• Study and treatment of systemic autoimmune diseases, also known as collagen vascular diseases or connective tissue diseases
• Autoimmune reaction causes inflammation in various body parts, leading to pain, swelling, and organ damage
• Can affect any part of the body, including eyes, skin, nerves, kidneys, lungs, and heart

Common Systemic Autoimmune Diseases

• Osteoarthritis
• Rheumatoid arthritis
• Gout
• Ankylosing spondylitis
• Systemic Lupus Erythematosus (SLE)
• Sjogren's Disease
• Scleroderma

Systemic Lupus Erythematosus (SLE)

• More common in women (10:1) and 20-40-year-olds
• Disease process develops slowly, with frequent remissions and exacerbations
• A chronic, multisystem, inflammatory disease
• Pathophysiology involves production of autoantibodies against nucleic acids, histones, ribonucleoproteins, and other nuclear materials
• Immune complexes containing antibody against DNA deposit in tissues, causing tissue damage
• Most common clinical manifestations:
  • Arthralgias or arthritis (90%)
  • Vasculitis and rash (70-80%)
  • Renal disease (40-50%)
  • Hematologic abnormalities (50%)
  • Cardiovascular diseases (30-50%)

Clinical Findings of SLE

• Facial rash confined to the cheeks (malar rash)
• Discoid rash (raised patches, scaling)
• Photosensitivity
• Oral or nasopharyngeal ulcers
• Nonerosive arthritis of at least two peripheral joints
• Serositis (pleurisy, pericarditis)
• Renal disorder
• Neurologic disorders (seizures or psychosis)
• Hematologic disorders (hemolytic anemia, leukopenia, lymphopenia, or thrombocytopenia)
• Immunologic disorders (antibodies against double-stranded DNA or Smith antigen)
• Presence of antinuclear antibody (ANA)

Arthropathies

• Joint diseases
• Non-inflammatory arthropathy: Osteoarthritis
• Inflammatory Arthropathies:
  • Rheumatoid Arthritis (autoimmune)
  • Gout (crystals cause inflammation)
  • Ankylosing Spondylitis (immune-mediated)

Osteoarthritis

• Most common joint disease
• Leading cause of disability in middle-aged and older populations in the US
• Prevalence is 20% in the elderly
• Most often affects knees, hip, neck, hands, and lower back
• Characterized by:
  • Local areas of loss and damage of articular cartilage
  • Bone spurs (osteophytes)
  • Subchondral bone changes
  • Variable degrees of mild synovitis
  • Thickening of the joint capsule

Osteoarthritis Pathogenesis

• Primary pathogenesis is degeneration, loss, and disordered repair of articular cartilage
• People with OA have higher levels of pro-inflammatory markers
• Cascade of cytokine, biochemical, and growth factor pathways
• Chondrocytes of articular cartilage become damaged
• Leading to increased remodeling of articular cartilage and loss of smooth, frictionless joint
• Cartilage becomes thin and may be absent over some areas, leaving the underlying subchondral bone unprotected

Osteoarthritis Clinical Manifestations

• Joint pain and stiffness
• Stiffness in the morning and usually brief
• Decreased range of motion
• Crepitus
• Local tenderness

Gout

• Increase in serum urate concentration
• Recurrent attacks of monoarticular arthritis
• Severe pain, swelling, tenderness, and erythema
• 50% of initial attacks are in the great toe metatarsophalangeal joint
• Tophi: Deposits of monosodium urate in and around joints
• Renal disease involving glomerular, tubular, and interstitial tissues and blood vessels
• Formation of renal stones
• 3 clinical stages:
  • Asymptomatic Hyperuricemia
  • Acute Gouty Arthritis
  • Tophaceous Gout

This quiz covers the study and treatment of systemic autoimmune diseases, including collagen vascular diseases and connective tissue diseases, and their effects on various body parts.