About Rheumatic Diseases

What is an autoimmune disease?

Our immune system protects us from diseases. Sometimes, in response to an unknown trigger, the “specific” response system develops a problem and the body starts making “antibodies” that attack its own tissues; this is called autoimmunity. These self-attacks can affect joints, skin, muscles, blood vessels, skin and several other body parts. The diseases resulting from this process are called autoimmune diseases.

Advanced Skin Vasculitis

Advanced Rheumatoid Arthritis

Arthritis in Children

What are the different forms of arthritis?

There are several different forms of arthritis. In addition, arthritis can occur in various autoimmune rheumatic conditions (where in response to an unknown trigger, the body makes antibodies that attack its own tissues). The different forms of arthritis may co-exist.

What are the common autoimmune rheumatic diseases?

Several inflammatory arthritis (the joints become painful, stiff, swollen and often hot to touch) and certain rare but serious diseases are examples of autoimmune rheumatic diseases.

Rheumatoid arthritis: Rheumatoid arthritis is a chronic, progressive inflammatory arthritis. The condition usually starts between the ages of 30 to 55 but can also be found in even younger or older people. Pains in hands, wrists, toes along with stiffness and swelling are common. Inflammation can also affect other body parts such as heart, lungs and kidneys. Disease attacks, called flare-ups, occur periodically, or can be continuous in some people leading to the damage of the affected joints.

Ankylosing spondylitis: In this condition inflammation affects the spine and often other joints such as hips, knees and wrists. Males of younger age group are commonly affected. The spine becomes painful and stiff. Inflammation of eyes (red eyes) and heels can also occur. If left untreated progressive fusion of the spine makes spine rigid, leading to loss of spinal movements.

Psoriatic arthritis: Psoriasis is an inflammatory condition of skin causing red rash on scalp, back of neck and back, elbows and knees etc. About 10% of patients with skin psoriasis can also have inflammatory arthritis affecting several joints such as fingers, wrists, toes, knees and spine.

Systemic Lupus Erythemtosus (SLE): In this autoimmune condition patient might experience joint pains, red rash on the face, skin irritation and red rash on exposure to sun, mouth ulcers occurs. Leakage of protein through kidneys and involvement of brain and nerves may occur. This condition may also cause collection f fluid around heart and lungs. Lupus can also affect blood system causing low haemoglobin and platelets (cells which help in clotting of blood).

Scleroderma (Systemic sclerosis): In this condition the skin becomes thick; there might be difficulty in swallowing of food. Patients may have Raynaud’s phenomenon with fingers becoming blue and painful in the cold environment. Painful ulcers can develop at fingertips. Other organs such as lungs, heart & kidneys may be affected.

Polymyositis/Dermatomyositis: In this condition inflammation of the muscles causes weakness in the muscles. This might present as difficulty in getting up from chair or climbing stairs. It can also involve muscles of swallowing (causing difficulty in swallowing food) and of breathings (causing breathing difficulty). Red spots in the skin may be present.

Antiphospholipid antibody syndrome (APS): In this condition the blood becomes” sticky”. It can cause recurrent abortions, very high blood pressure during pregnancy, clot in the veins and arteries, heart valve diseases, stroke can occur.

Sjogren’s syndrome: Patients experience dryness of the eyes and the mouth as the glands of saliva and tear are affected. Joint pains, tiredness and muscle pain may also occur.

Behcet’s syndrome: Causing ulcers in mouth and genitalia, red eyes and inflammatory arthritis.

Vasculitis: In this wall of the blood vessels become inflamed and the vessel may become blocked. The vasculitis are grouped together according to the size of the damaged vessel.

Takayasu’s arteritis or aortoarteritis attacks the large blood vessels leaving the heart – the aorta and the vessels coming off the aorta. This causes pain in the legs; the pulses in the arm may become weak.
Polyarteritis nodosa (PAN) causes weight loss, muscle pain, nerve problems and high blood pressure.
Kawasaki disease is seen in children more than adults. Patients will get a fever lasting a long time, eye problems, a skin rash and swollen lymph nodes. Some will get chest pain from the heart.
Wegener’s granulomatosis can attack the lungs causing breathing problems, ulcers in the nose or mouth, bleeding from the nose, blood in the urine and kidney problems.
Churg Strauss syndrome causes “granulomatosis” and gives asthma, nerve damage causing weakness. Kidneys and lungs could also become severely affected.
Microscopic polyangiitis – skin rash, kidney damage and nerve damage may occur.

Crystal deposition in Gout

Knee swelling in Ankylosing Spondylitis

Psoriatic Arthritis

Other conditions

Gout: Crystals of uric acid cause inflammation of joints called gouty arthritis. Toes, ankles, knees and wrists are commonly affected. Attacks of inflammation happen rapidly and affected joint becomes swollen and very painful. A similar arthritis is called “psuedogout” where crystals of a different type are responsible for the joint inflammation.

Osteoarthritis: Wear and tear of the cartilage of the joints is normally an age related process occurring in persons of above 55 years in age. Any joint can be affected but knees and hips are most commonly affected.

Osteoporosis: Osteoporosis is a silent disease where bones gradually become thinner. This makes them susceptible of fractures. The causes can be varied from advancing age to autoimmune rheumatic diseases. Treating osteoporosis reduces the risk of fractures.

What are the symptoms of arthritis and autoimmune rheumatic diseases?

Joint pains
Back pain
Joint swelling and redness
Joint stiffness
Tiredness
Skin rash
Recurrent mouth ulcers
Red rash on face when exposed to sunlight
Dry eyes and mouth
Recurrent abortions
Heel pain
Red eyes
Ulcers in the legs
Unexplained clot in the leg veins
Other members affected in the family

Red eye

Rheumatoid Arthritis

Skin vasculitis

How are arthritis and autoimmune rheumatic conditions diagnosed?

Assessment and treatment of autoimmune rheumatic diseases, including arthritis comes under Rheumatology. Various factors, including symptoms and findings on examination are considered. Specific blood tests may be required for confirming the inflammation and in identifying the underlying autoimmune process. Specific other tests are also done to assess the involvement of other body parts. As the symptoms of autoimmune disease can be non-specific in the beginning, awareness can help in the early diagnosis of these conditions.

How are arthritis and autoimmune rheumatic diseases treated?

Autoimmune rheumatic conditions require specific medicines, which control the autoimmune process. Early treatment with “disease modifying agents” often can bring the disease under control. When the disease is serious or does not respond to other medicines, rheumatologists use a special class of medicines called “biological agents”. These medicines bring about dramatic improvement and help patients maintain their economic productivity and quality of life.

Supervised treatment and regular follow-ups are important

Like the treatment of high blood pressure and diabetes, the treatment of autoimmune rheumatic diseases is also long term. The rheumatologist closely supervises the therapy and carries out periodic systematic assessments of the disease process. Stopping the treatment against the advice of rheumatologist may lead to severe recurrence of disease. It is important, therefore, that the patients comply with the required duration of treatment and have periodic assessments by the rheumatologist.