What are the main types of autoimmune disorders affecting joints. How do polymyalgia rheumatica, multiple sclerosis, rheumatoid arthritis, and fibromyalgia impact the body. What are the key symptoms and causes of these conditions.

Understanding Autoimmune Disorders of the Joints

Autoimmune disorders occur when the body’s immune system mistakenly attacks healthy tissues. With over 80 different types of autoimmune diseases, symptoms can affect various organs and tissues throughout the body. This article focuses on autoimmune disorders that primarily impact the muscles, joints, and nerves, including polymyalgia rheumatica, rheumatoid arthritis, multiple sclerosis, and fibromyalgia.

These conditions share some common features, such as inflammation and pain, but they also have distinct characteristics that set them apart. By exploring each disorder in detail, we can gain a better understanding of their symptoms, causes, and impact on patients’ lives.

Polymyalgia Rheumatica: A Closer Look

Polymyalgia rheumatica (PMR) is an inflammatory disorder that primarily affects older adults. It causes pain and stiffness in specific areas of the body, particularly the neck, shoulders, arms, and hips. Who is most at risk for developing PMR?

• People over the age of 50
• Women (twice as likely as men to develop PMR)
• Caucasians (with higher rates in Denmark and Sweden)

PMR often coexists with or precedes a condition called temporal arteritis, which involves inflammation of blood vessels. However, in most cases, PMR occurs on its own. What are the key symptoms of polymyalgia rheumatica?

• Muscle pain and stiffness, especially in the morning
• Difficulty raising arms above shoulder level
• Fatigue and general malaise
• Mild fever and loss of appetite

While the exact cause of PMR remains unknown, researchers believe that genetic and environmental factors may play a role in its development. Treatment typically involves corticosteroids to reduce inflammation and manage symptoms.

Multiple Sclerosis: Unraveling the Complexities

Multiple sclerosis (MS) is a chronic autoimmune disorder that affects the central nervous system, specifically targeting the brain and spinal cord. The disease damages the protective covering of nerve cells, called the myelin sheath, leading to a wide range of neurological symptoms. What causes the damage to the myelin sheath in MS?

In MS, the body’s immune system mistakenly attacks the myelin sheath, causing inflammation and damage. This damage disrupts the normal transmission of nerve signals, resulting in various neurological symptoms. The severity and progression of MS can vary significantly from person to person.

Key Facts About Multiple Sclerosis

• Affects approximately 400,000 people in the United States
• More than 2.5 million people affected worldwide
• More common in women than men
• Usually diagnosed between ages 20 and 40
• More prevalent in whites compared to other racial groups

What are the primary symptoms of multiple sclerosis?

• Fatigue
• Vision problems
• Numbness or tingling in limbs
• Muscle weakness or spasms
• Balance and coordination issues
• Cognitive difficulties
• In severe cases, paralysis

While the exact cause of MS remains unknown, researchers believe that a combination of genetic predisposition and environmental factors may contribute to its development. Some studies suggest that viral infections may play a role in triggering the disease in susceptible individuals.

Rheumatoid Arthritis: The Inflammatory Joint Disorder

Rheumatoid arthritis (RA) is a chronic autoimmune disorder that primarily affects the joints, causing inflammation, pain, and potential joint damage. Unlike osteoarthritis, which is caused by wear and tear, RA results from the immune system attacking the body’s own tissues. How does rheumatoid arthritis differ from other forms of arthritis?

RA is characterized by symmetric joint involvement, meaning it typically affects the same joints on both sides of the body. The inflammation in RA can be more severe and widespread compared to other forms of arthritis, potentially affecting organs beyond the joints.

Joints Commonly Affected by Rheumatoid Arthritis

• Wrists
• Fingers
• Knees
• Feet
• Ankles

What are the main symptoms of rheumatoid arthritis?

• Joint pain, swelling, and stiffness
• Fatigue and general weakness
• Flu-like symptoms
• Loss of appetite
• Depression
• Weight loss
• Anemia
• Cold or sweaty hands and feet

RA affects approximately 1.3 million people in the United States, with onset typically occurring between ages 30 and 50. Women are more likely to develop RA, accounting for about 70% of cases. However, men with RA often experience more severe symptoms.

Fibromyalgia: The Controversial Condition

Fibromyalgia is a complex disorder characterized by widespread musculoskeletal pain, fatigue, and other symptoms. While it is not officially classified as an autoimmune disorder, fibromyalgia is often grouped with other autoimmune conditions due to its overlapping symptoms and frequent co-occurrence with disorders like rheumatoid arthritis and lupus.

Why is fibromyalgia considered controversial in the medical community?

The lack of clear diagnostic markers and the absence of visible abnormalities in laboratory tests have made fibromyalgia a challenging condition to diagnose and understand. This has led to ongoing debates about its classification, causes, and optimal treatment approaches.

Key Symptoms of Fibromyalgia

• Chronic, widespread pain in muscles, joints, and soft tissues
• Fatigue
• Sleep disturbances
• Cognitive difficulties (often referred to as “fibro fog”)
• Depression and anxiety
• Headaches
• Digestive problems

What are the current theories about the causes of fibromyalgia?

• Sleep disturbances
• Decreased blood flow
• Viral infections
• Genetic predisposition
• Central nervous system sensitization

Fibromyalgia affects an estimated 3 to 6 million people in the United States, with the majority of patients being women between the ages of 20 and 50. Despite ongoing research, the exact cause of fibromyalgia remains elusive, making it a challenging condition to treat effectively.

Comparing Autoimmune Joint Disorders: Similarities and Differences

While polymyalgia rheumatica, multiple sclerosis, rheumatoid arthritis, and fibromyalgia all involve joint and muscle symptoms, they have distinct characteristics that set them apart. How do these conditions differ in their presentation and impact on patients?

• Polymyalgia rheumatica primarily affects older adults and causes pain in specific body areas.
• Multiple sclerosis targets the central nervous system, leading to a wide range of neurological symptoms.
• Rheumatoid arthritis focuses on joint inflammation and can cause systemic effects throughout the body.
• Fibromyalgia involves widespread pain and fatigue without clear physical abnormalities.

Despite their differences, these conditions share some common features, such as:

• Chronic nature
• Higher prevalence in women
• Potential for significant impact on quality of life
• Need for long-term management and multidisciplinary care

Diagnostic Challenges and Treatment Approaches

Diagnosing autoimmune disorders affecting the joints can be challenging due to overlapping symptoms and the complex nature of these conditions. What are the key diagnostic tools used to identify these disorders?

• Physical examination
• Blood tests for inflammatory markers and autoantibodies
• Imaging studies (X-rays, MRI, ultrasound)
• In some cases, nerve conduction studies or muscle biopsies

Treatment approaches for autoimmune joint disorders often involve a combination of medications and lifestyle modifications. What are the main categories of treatments used for these conditions?

• Anti-inflammatory medications (NSAIDs, corticosteroids)
• Disease-modifying antirheumatic drugs (DMARDs)
• Biologic therapies
• Pain management techniques
• Physical therapy and exercise programs
• Stress reduction and relaxation techniques
• Dietary modifications

The specific treatment plan depends on the individual disorder, its severity, and the patient’s overall health status. Many patients benefit from a multidisciplinary approach that addresses both the physical and emotional aspects of living with a chronic autoimmune condition.

Living with Autoimmune Joint Disorders: Coping Strategies and Support

Autoimmune disorders affecting the joints can have a significant impact on a person’s daily life, relationships, and overall well-being. How can patients effectively manage their condition and maintain a good quality of life?

• Educate yourself about your specific condition
• Adhere to prescribed treatment plans
• Engage in regular, appropriate exercise
• Practice stress management techniques
• Maintain a healthy diet
• Get adequate rest and sleep
• Communicate openly with healthcare providers
• Join support groups or connect with others who have similar conditions

What role does emotional support play in managing autoimmune joint disorders?

Emotional support is crucial for individuals living with chronic autoimmune conditions. It can help reduce stress, improve coping skills, and enhance overall well-being. Support can come from various sources, including:

• Family and friends
• Mental health professionals
• Support groups (in-person or online)
• Patient advocacy organizations

By building a strong support network and adopting effective coping strategies, patients with autoimmune joint disorders can better manage their symptoms and maintain a fulfilling life despite the challenges posed by their condition.

Advances in Research and Future Directions

The field of autoimmune disorders is rapidly evolving, with ongoing research aimed at improving our understanding of these conditions and developing more effective treatments. What are some of the promising areas of research in autoimmune joint disorders?

• Genetic studies to identify risk factors and potential therapeutic targets
• Investigation of environmental triggers and their role in disease onset
• Development of more targeted and personalized therapies
• Exploration of the gut microbiome’s influence on autoimmune processes
• Research into stem cell therapies and regenerative medicine approaches

How might future advancements impact the management of autoimmune joint disorders?

As research progresses, we can expect to see:

• More precise diagnostic tools for earlier detection and intervention
• Improved understanding of disease mechanisms, leading to novel treatment strategies
• Development of biomarkers to predict disease progression and treatment response
• Advancements in personalized medicine, tailoring treatments to individual patients
• Potential breakthroughs in prevention strategies for high-risk individuals

While much remains to be discovered about autoimmune joint disorders, ongoing research offers hope for improved outcomes and quality of life for affected individuals in the future.

The Importance of Raising Awareness and Advocacy

Raising awareness about autoimmune joint disorders is crucial for improving public understanding, promoting early diagnosis, and supporting research efforts. How can individuals and organizations contribute to raising awareness?

• Participate in awareness campaigns and events
• Share personal stories and experiences
• Support patient advocacy organizations
• Engage in community education initiatives
• Advocate for increased research funding

What role do patient advocacy groups play in supporting those with autoimmune joint disorders?

Patient advocacy groups serve several important functions:

• Providing education and resources for patients and families
• Offering support services and connecting individuals with similar experiences
• Advocating for policy changes to improve access to care and research funding
• Collaborating with healthcare professionals and researchers to advance understanding and treatment options
• Raising public awareness about the impact of autoimmune joint disorders

By supporting and engaging with advocacy efforts, individuals can contribute to improving the lives of those affected by autoimmune joint disorders and advancing the field of research and treatment.

Autoimmune Disorders of the Joints – MS, RA & Polymyalgia Rheumatica

Autoimmune disorders occur when the body’s own immune system goes haywire and starts attacking healthy tissue. Because more than 80 different types of diseases exist that are autoimmune in nature, symptoms may affect organs and tissues throughout the body. For that reason, these conditions are often categorized according to the affected areas.

Autoimmune disorders of the muscles, joints, and nerves include polymyalgia rheumatica, rheumatoid arthritis, and multiple sclerosis. Fibromyalgia is also often categorized with these disorders, though it has yet to be officially classified as an autoimmune disorder.

Polymyalgia Rheumatica

Like many autoimmune disorders that affect the muscles, polymyalgia rheumatica causes symptoms of pain and stiffness, typically in the neck, shoulder, arms, or hip areas. Polymyalgia rheumatica usually occurs in people over the age of 50, and women are twice as likely as men to develop the disorder.

Patients with this disorder may also have signs of inflammatory arthritis. Moreover, polymyalgia rheumatica sometimes appears at the same time as, or right before, a condition called temporal arteritis, which inflames blood vessels. More often than not, however, polymyalgia rheumatica occurs alone and predominately in caucasians. Denmark and Sweden are the countries with the highest rates of polymyalgia rheumatica.

Multiple Sclerosis

Commonly referred to as MS, multiple sclerosis is an autoimmune disorder that affects the central nervous system — the brain and spinal cord. MS involves injury to the protective covering that surrounds nerve cells. This protective covering is called the myelin sheath, which when damaged, causes nerve impulses to slow down. This is why MS is considered an autoimmune condition — the body’s immune system is what attacks the myelin sheath, through inflammation.

MS symptoms vary in severity from person to person, ranging from limb numbness to paralysis. The disease is considered progressive, meaning it gets worse over time, but the rate of progression also is widely variable. The cause of MS remains unknown, but most research points to a virus or a genetic defect.

More women than men, and more whites than blacks, have MS, and it is most commonly diagnosed between the ages of 20 and 40. According to the National Multiple Sclerosis Society, about 400,000 people have MS in the United States, and more than 2.5 million people are affected worldwide.

Rheumatoid Arthritis (RA)

This form of arthritis, unlike osteoarthritis, is autoimmune in nature. When the body’s immune system attacks itself, inflammation results, which causes joint linings to thicken, leading to pain and swelling. If RA goes untreated, the inflammation can become so severe that it causes bone damage or deformities. The joints most commonly affected are those of the:

• Wrists
• Fingers
• Knees
• Feet
• Ankles

Joint pain and swelling are the signature symptoms of RA, but it can also affect other organs throughout the body. RA patients may also experience fatigue, general weakness, flu-like symptoms, loss of appetite, depression, weight loss, anemia, and cold or sweaty hands and feet. Advanced RA can make those with the disorder more susceptible to infections.

In the United States, an estimated 1.3 million people have RA. Onset typically occurs between ages 30 and 50, but even children can get the disease — a version known as juvenile rheumatoid arthritis, or JRA. Seventy percent of RA cases are in women, but men who have RA tend to be more severely affected.

Fibromyalgia

To much of the medical community, fibromyalgia remains a mystery. It has not been officially categorized as an autoimmune condition, but it is sometimes put in that category because it frequently occurs in patients with other diseases that cause musculoskeletal symptoms, including rheumatoid arthritis and lupus, which are both autoimmune disorders.

The main symptom of fibromyalgia is chronic, widespread pain in the muscles, joints, and other soft tissues. Fibromyalgia patients also have:

• Fatigue
• Trouble sleeping
• Depression
• Anxiety

Although the pain experienced by fibromyalgia patients can be excruciating, lab tests typically come back with no clear abnormalities. This has left doctors and researchers puzzled, leading to theories that fibromyalgia might be caused by sleep disturbances, or that it may be a result of decreased blood flow. Others have hypothesized that fibromyalgia is a viral condition, while some preliminary research hints at a genetic cause.

An estimated three to six million people in the United States have fibromyalgia symptoms, with the majority of patients being female, between the ages of 20 and 50.

Susan A. Baker, MD: Rheumatology

An autoimmune disease is the result of a malfunction in the immune system where healthy cells are mistaken for foreign bodies, causing the immune system to attack healthy cells in the body. It is estimated that as many as 50 million Americans suffer from some form of autoimmune disease. There are many different forms, and the symptoms and effects will vary from case to case. Treatment for autoimmune diseases typically focuses and managing pain and symptoms of the condition.

Signs and Symptoms of Autoimmune Disease

Autoimmune diseases can develop from a variety of factors with no known definitive causes for the onset of the disease. Some suspected sources are:

• Bacterial or viral infection
• Effects from certain drugs
• Chemical toxins
• Environmental pollutants

When the immune system determines that healthy cells are foreign, it begins to produce antibodies to fight off the healthy cells it believes to be the source of an illness or infection. When an autoimmune disease is suspected, a rheumatologist will administer tests to determine what antibodies are being produced. There are more than 80 potential autoimmune diseases and some of the most common areas affect can be:

• Joints and muscles
• Red blood cells
• Blood vessels
• Connective tissue

When faced with symptoms or an autoimmune disease diagnosis, it is very important to seek treatment from an experienced rheumatologist to find the best plan to manage symptoms. Dr. Susan Baker, MD specializes in Rheumatology and Internal Medicine in Beverly Hills, and offers patients everything from arthritis treatment to Lupus.

Most Common Autoimmune Diseases

1. Rheumatoid Arthritis – Rheumatoid arthritis is a chronic inflammation of the lining of the joints, leading to pain and swelling typically in the hands and feet. It can affect anyone, but is most prevalent in women over 40. Rheumatoid arthritis can sometimes affect other organs as well, such as skin, eyes, lungs and blood vessels. As with all autoimmune disorders, treatment focuses on managing pain and minimizing bone erosion and joint damage.

We have more in-depth information on Rheumatoid Arthritis here.

2. Juvenile Rheumatoid Arthritis – Juvenile rheumatoid arthritis is the most common form of arthritis in children under 16. Symptoms usually include pain and swelling in the joints, and can vary from moderate to severe. In some cases, symptoms will subside over time while others can persist well into adulthood.

We have more in-depth information on juvenile rheumatoid arthritis here.

3. Systemic Lupus Erythematosus (Lupus) – Lupus can be difficult to diagnose because it shares symptoms with many other disorders. The inflammation resulting from lupus can affect many different areas of the body, from the lungs, heart, joints, skin, kidneys, and brain. Like rheumatoid arthritis, lupus is more prevalent in women and can sometimes be identified by a butterfly-shaped rash on the face, along with photosensitivity, fatigue and fever, joint pain, and other skin lesions that worsen under sun exposure.

We have more in-depth information on lupus here.

4. Psoriatic Arthritis – People with the skin condition psoriasis sometimes develop arthritis as well, but in certain cases the joint inflammation can occur before the skin rash. The main symptoms of psoriasis are joint pain, swelling, and stiffness. The condition can affect any part of the body, such as the fingertips and spine, and range from mild to severe.

We have more in-depth information on psoriatic arthritis here.

5. Inflammatory Bowel Arthritis (Crohn’s Disease and Ulcerative Colitis) – With inflammatory bowel arthritis (or IBA), inflammation affects the intestines. With ulcerative colitis, the colon or large intestine are affected. Crohn’s Disease can affect any part of the gastrointestinal tract, but usually occurs in either the small intestine or colon or both.

We have more in-depth information on inflammatory bowel arthritis here.

Arthritis Treatment in Beverly Hills

Are you experiencing symptoms or have already been diagnosed with an autoimmune disease? If so, contact Dr. Susan Baker MD in Beverly Hills today at (310) 448-2693 or online for an appointment or consultation.

Next, read more about 6 Common Symptoms of Rheumatoid Arthritis.

Autoimmune Arthritis: Types, Symptoms, and Diagnosis

When your body’s natural defense system cannot tell the difference between the cells that belong in your body and foreign cells, your body attacks your own cells by mistake. This is what happens with an autoimmune disease. There are also autoimmune forms of arthritis, where the immune system attacks joints and causes inflammation. The most common types of autoimmune arthritis are rheumatoid arthritis (RA) and psoriatic arthritis.

The cause of autoimmune diseases, including autoimmune arthritis, are not known, which can make diagnosis of these conditions difficult. Several different types of autoimmune arthritis and other autoimmune diseases also affect the joints, all of which can lead to confusion.

manusapon kasosod / Getty Images

Osteoarthritis vs. Rheumatoid Arthritis

Although the symptoms of osteoarthritis and rheumatoid arthritis are very similar (for example, joint pain and swelling are associated with both conditions), there are some key differences between the two, not only in symptoms but also in the cause.

Cause

Osteoarthritis (OA), also known as degenerative joint disease, happens when the smooth cartilage on the joint surface wears out over time. It is generally considered a result of the aging process or overuse of a particular joint. RA, on the other hand, is an autoimmune disease that occurs when the body’s immune system attacks the synovial membrane that lines the joints.

Given how these two diseases develop, the damage from osteoarthritis can take years to develop, but the onset of RA can cause symptoms that worsen over several weeks or months.

Symptoms

Osteoarthritis generally starts in one isolated joint, while rheumatoid arthritis tends to affect several joints at once. The first symptoms of rheumatoid arthritis are usually accompanied by systemic symptoms like fatigue, fever, and weakness. That’s because RA can affect other body systems besides joints. However, osteoarthritis damages the cartilage between joints only, so the symptoms are usually felt around the joints and not the whole body.

People with osteoarthritis and rheumatoid arthritis can both experience joint stiffness in the morning, but it goes away with just a few minutes of activity in the former while it lingers for an hour or longer in the latter. Prolonged joint stiffness in the morning is usually the first symptom and a defining characteristic of rheumatoid arthritis.

Types of Autoimmune Arthritis

RA is the most common type of autoimmune arthritis, but it certainly isn’t the only one. A large number of conditions fall under this umbrella.

Rheumatoid Arthritis

RA affects about 1.28 to 1.36 million adults in the United States, and is three times more prevalent in women than in men. It commonly affects the joints in the hands, wrists, and knees. The tissue damage caused by RA can lead to chronic pain, lack of balance, and joint deformity. RA can also affect other organs, including the lungs, heart, and eyes.

There are two types of RA: seropositive and seronegative RA. People with seropositive RA test positive for the rheumatoid factor (an antibody) and/or anti-cyclic citrullinated peptide (anti-CCP), while those with seronegative RA have neither.

Symptoms of rheumatoid arthritis are:

• Pain or aching in more than one joint
• Stiffness in more than one joint
• Tenderness and swelling in more than one joint
• The same symptoms on both sides of the body (such as in both hands or both knees)
• Weight loss
• Fever
• Fatigue or tiredness
• Weakness

Psoriatic Arthritis

Psoriatic arthritis affects about 30% of people who have psoriasis, an autoimmune condition that affects the skin. Psoriatic arthritis affects the joints and where the ligaments and tendons connect to bone. This disease can start at any age, but commonly affects those between 30 and 50 years old. For many people, psoriatic arthritis starts about 10 years after psoriasis develops.

In psoriasis, an overactive immune system can cause a rapid increase in skin cell production that leads to raised, scaly patches on the skin. For people with both psoriatic arthritis and psoriasis, joint problems can begin before skin patches appear.

Some people may develop psoriatic arthritis after an injury. Genetics may also play a role.

Psoriatic arthritis can develop slowly or rapidly. Symptoms include:

• Fatigue
• Tenderness, pain, and swelling over tendons
• Swollen fingers and toes that sometimes resemble sausages
• Stiffness, pain, throbbing, swelling, and tenderness in one or more joints
• Reduced range of motion
• Morning stiffness and tiredness
• Nail changes, such as pitting or separation from the nail bed
• Redness and pain of the eye (uveitis)

There is little connection between psoriasis and psoriatic arthritis severity. A person could have few skin lesions but many joints affected by arthritis.

Reactive Arthritis

Reactive arthritis, also known as Reiter’s syndrome, occurs in reaction to an infection by specific bacteria found either in the gastrointestinal or genitourinary tract. It commonly affects men between 20 and 50 years old. The incidence of this disease is 0.6 to 27 per 100,000 people.

Bacteria involved in reactive arthritis include:

• Chlamydia trachomatis
• Campylobacter
• Salmonella
• Shigella
• Yersinia

These bacteria are really common, but not everyone who becomes infected with them will develop reactive arthritis. Researchers have found that people who have a weakened immune system and those with the HLA-B27 gene are more prone to getting the disease, and may have a more sudden and severe onset as well as chronic and long-lasting symptoms.

Reactive arthritis can cause the following symptoms:

• Pain and swelling of certain joints, often the knees and ankles
• Swelling and pain at the heels
• Extensive swelling of the toes or fingers
• Persistent low back pain, which tends to be worse at night or in the morning

Ankylosing Spondylitis

Ankylosing spondylitis causes inflammation between vertebrae, the bones that make up the spine, and in the joints between the spine and pelvis. In some people, it can affect other joints. Ankylosing spondylitis is the most common type of spondyloarthritis, a family of arthritis-associated diseases.

Severe cases of ankylosing spondylitis can lead to ankylosis, where sections of the spine fuse in a fixed, immobile position. Up to 30 genes associated with this condition have been identified. The major gene associated with this disease is HLA-B27.

This type of arthritis occurs more often in men than women. About 80% of people with this disease experience some symptoms before 30 years old, and 5% will start having symptoms at over 45 years old.

Symptoms of ankylosing spondylitis include:

• Inflammation
• Pain
• Stiffness in the shoulders, hips, ribs, heels, and small joints of the hands and feet
• Iritis or uveitis
• Problems with the lungs and heart

A rare complication is cauda equina syndrome, which results from scarring on the nerves at the base of the spine. It can cause urinary retention or incontinence, loss of bowel control, sexual dysfunction, and pain and weakness of the legs.

Axial Spondyloarthritis

Axial spondyloarthritis is another type of spondyloarthritis. It typically affects the sacroiliac joints and spine. The joints in the arms and legs are also affected in some cases. People with this condition most often have low back pain. Men in their teens and 20s, and people with a family history of this disease, are most commonly affected.

People with damage of the sacroiliac joints that is visible on X-rays have a subtype of the disease called radiographic axial spondyloarthritis, while those who don’t, have non-radiographic axial spondyloarthritis. Some with non-radiographic axial spondyloarthritis will progress to have structural damage that is visible on X-rays, but some will not. Ankylosing spondylitis is actually a form of radiographic spondyloarthritis.

This condition can progress over the years to cause spinal fusion as well, and can result in a stooped posture if the spine fuses in a forward position.

Symptoms of axial spondyloarthritis include:

• Slow or gradual onset of back pain and stiffness over weeks or months
• Early-morning stiffness and pain, wearing off or reducing during the day with exercise
• Persistence for more than three months (rather than coming on in short attacks)
• Feeling better after exercise and worse after rest
• Weight loss, especially in the early stages
• Fatigue or tiredness
• Feeling feverish and experiencing night sweats

Juvenile Arthritis

Children can have arthritis too. Juvenile arthritis, also known as pediatric rheumatic disease or childhood arthritis, is an umbrella term for inflammatory and rheumatic diseases that affect children under the age of 16. The most common type of juvenile arthritis is juvenile idiopathic arthritis. Most kinds of juvenile arthritis are autoimmune diseases.

There are three main types of juvenile arthritis, differentiated by the number of joints involved and the presence of certain antibodies in the blood:

• Oligoarticular (just a few joints are affected)
• Polyarticular (more than five joints are affected)
• Systemic (causes swelling, pain, and limited motion in at least one joint and includes systemic symptoms)

Juvenile arthritis affects each child differently and can last for indefinite periods of time. There may be times when symptoms improve or disappear, but sometimes symptoms can worsen. A child with juvenile arthritis may also have one or two flare-ups and never have symptoms again. 

Symptoms of this type of arthritis are:

• Painful joints in the morning that improve by afternoon
• Joint swelling and pain
• Joints may become inflamed and warm to the touch
• Muscles and other soft tissues around the joint may weaken
• High fever and light pink rash, which may disappear very quickly
• Growth problems—for example, joints may grow too fast or too slowly, unevenly, or to one side
• Eye problems, such as iridocyclitis

Palindromic Rheumatism

Palindromic rheumatism is a rare type of recurrent arthritis characterized by episodes, or attacks, of joint inflammation, sequentially affecting one to several joint areas for hours to days. An attack can occur without any obvious triggers or warning signs. Finger joints, the wrists, and the knees are most commonly affected. This usually occurs in people between 20 and 50 years old.

Some people with PR eventually develop chronic rheumatic disease, the most common being RA. Others may develop lupus or other systemic disorders. People with anti-CCP antibodies detected in a blood test appear more likely to develop RA. There has been some evidence to support that PR can be a presenting feature of RA (or part of the spectrum of RA), rather than a distinct condition.

Symptoms during episodes include:

• Pain
• Swelling
• Stiffness
• Redness
• Fever
• Other systemic symptoms

The time between episodes may last from days to months.

Other Autoimmune Diseases Causing Joint Pain

Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE, often just called lupus) can cause inflammation and pain in any part of the body, with the most commonly affected areas being the skin, joints, and internal organs like the heart and kidneys. People with lupus experience joint pain and swelling at some point, and some may develop arthritis. SLE often affects the joints of the fingers, hands, wrists, and knees.

SLE appears most often in women between the ages of 15 and 44. In the United States, the disease is more common in African Americans, Asian Americans, African Caribbeans, and Hispanic Americans, compared with white Americans.

Besides joint pain and swelling, people with SLE can also have the following symptoms:

• Chest pain when taking a deep breath
• Fatigue
• Fever with no other cause
• General discomfort, uneasiness, or ill feeling (malaise)
• Hair loss
• Weight loss
• Mouth sores
• Sensitivity to sunlight
• A butterfly-shaped rash across the face, which develops in about half the people with SLE
• Swollen lymph nodes

Systemic Sclerosis

Also called systemic scleroderma, this autoimmune disease occurs when scar tissue (fibrosis) builds up in the skin and other internal organs, including muscles and joints. The skin thickening that accompanies systemic scleroderma can cause tightening, resulting in a loss of flexibility and ease of movement, especially in the fingers. The word “scleroderma” means hard skin in Greek. Fibrosis is due to the excess production of collagen, which normally strengthens and supports connective tissues throughout the body.

The three types of systemic scleroderma, defined by the type of tissues affected, are:

• Limited cutaneous systemic scleroderma also includes the CREST syndrome and affects the hands, arms, and face.
• Diffuse cutaneous systemic scleroderma affects large areas of the skin, including the torso and the upper arms and legs. It also often involves internal organs.
• Systemic sclerosis sine scleroderma affects one or more internal organs but not the skin.

Symptoms of systemic sclerosis include:

• Joint pain and swelling
• Raynaud’s phenomenon, where the body’s normal response to cold or emotional stress is exaggerated, resulting in painful color changes in the fingers and toes due to abnormal spasms (vasospasms) in small blood vessels called arterioles
• Skin sores or ulcers
• Reduced facial movements
• Internal organ fibrosis and/or vascular damage (involving the lungs, heart, gastrointestinal tract, or kidneys)

Polymyalgia Rheumatica

Polymyalgia rheumatica (PMR) causes widespread aching and stiffness. This condition usually affects the shoulders, upper back, and hips. It can start at 50 years old, although the average age for symptoms to start is 70. Approximately 15% of people with PMR develop a potentially dangerous condition called giant cell arteritis (GCA), which is inflammation of the lining of the arteries.

Symptoms of PMR are a result of inflammation of the joints and surrounding tissues, and they include:

• Aching
• Stiffness
• Fatigue
• Fever
• Poor appetite
• Weight loss
• Persistent headaches
• Scalp tenderness (GCA)
• Vision changes (GCA)
• Jaw pain (GCA)

Diagnosis Challenges

Since many of the symptoms of all of these autoimmune arthritis conditions can be very similar and nonspecific, it is important to consult with a rheumatologist to get a proper diagnosis.

Here are some things the doctor will do to help determine your diagnosis:

• Gather your medical history, including asking about a family history of autoimmune diseases
• Perform a physical exam to check your symptoms
• Order laboratory tests to check for inflammatory markers
• Order X-rays, CTs, and MRIs to look for signs of joint damage

Treatment

There is currently no real cure for autoimmune arthritis, but some medications can help control disease progression and alleviate symptoms. They can slow or stop the joint damage caused by these diseases. Some lifestyle changes can also help people manage their autoimmune arthritis. Treatment is most effective when started early.

Medications

Medical treatment varies by the type of autoimmune arthritis a person has. Medications for autoimmune arthritis include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) control pain and inflammation.
• Corticosteroids reduce inflammation and the functions of an overactive immune system. Side effects can be serious, relating to bone strength, diabetes, hypertension, and how prone you are to infection, so doctors usually only prescribe these for the shortest duration possible.
• Disease-modifying anti-rheumatic drugs (DMARDs) have been shown to slow, or modify, the progress of joint damage for people who have rheumatoid arthritis, psoriatic arthritis, and juvenile arthritis. These medications can take weeks or months to take effect, however. One of the most commonly used drugs in this class is methotrexate.

Lifestyle Changes

Besides medications, lifestyle changes can help with the pain and movement issues associated with autoimmune arthritis. Consider the following:

• Regular physical activity as your condition allows and with the approval of your doctor. Choose activities that put less stress on your joints, such as walking, bicycling, and swimming.
• When you exercise, wear protective equipment to reduce the chance of injury.
• Manage your weight to reduce the stress you place on your joints.
• Maintain a healthy diet including fruits, vegetables, fish, nuts, beans, low processed foods, and low saturated fats.
• Stop smoking. Research has linked smoking to some autoimmune diseases such as rheumatoid arthritis.

A Word From Verywell

With so many different types of autoimmune arthritis and other autoimmune diseases that can cause joint pain and swelling, it is important to give your doctor all the information needed to correctly identify and target the one causing your symptoms. While much of why autoimmune arthritis occurs is still a mystery, research is ongoing to learn more about these conditions, which can potentially lead to better treatments and quality of life for those affected.

Stay positive even if you are diagnosed with one of these conditions. There are many ways to manage your disease and relieve painful and annoying symptoms through medications and lifestyle changes.

Autoimmune Diseases | Boston Children’s Hospital

What are autoimmune diseases?

If it weren’t for the immune system — the human body’s natural defense against outside invaders — we would be sick all the time. This complex network of cells, organs and molecules fights off things like bacteria and viruses 24 hours a day, from our head to our toes. It’s a powerful protection when it’s working for us, but can also be a powerful threat when it turns against us, in what’s called an autoimmune disease (“auto” meaning self).

Autoimmune diseases in children are rare. When they occur they can be challenging to diagnose and difficult to treat. Doctors are still learning about this large group of mostly chronic illnesses — more than 80 in all — most of which have no cure yet. If your child has an autoimmune problem, much depends on figuring out what it is and then treating the condition aggressively.  

How the immune system works

Autoimmune diseases affect an estimated 23 million Americans, yet the study of the immune system (immunology) is still an evolving field. Doctors and researchers are still learning about the body’s natural defense system and what happens when it malfunctions.

To better understand your child’s autoimmune disease, it helps to know some basic facts about how the immune system works:

• When a foreign invader (antigen) like bacteria, a virus or pollen, enters the body, it encounters the innate immune system.
• The innate system is our inborn, nonspecific response to antigens. It’s a general set of defenses that includes barriers like skin and mucous membranes, and reactions like coughing and sneezing reflexes.
• The innate system also includes white blood cells called phagocytes (literally, eating cells), designed to devour any antigen that gets through the outer defenses.
• The innate system will either destroy the invader or buy time for the more complex adaptive immune system to work.
• The adaptive system is the continually evolving, specific response to antigens. It’s a targeted defense that identifies an invader and makes unique proteins (antibodies) to mark it for attack.
• Among the key players in the adaptive system are special white blood cells called B cells, which produce antibodies, and T cells which coordinate and carry out the attack — and, importantly, also signal when the attack should stop.

What happens when a child has autoimmune disease?

In autoimmune disease, the immune system mistakenly begins attacking healthy cells and tissues — and fails to shut off the attack. This is different from other immune system malfunctions, such as acquired immunodeficiency disorders, like AIDS, in which the immune system is weakened or ineffective, and allergic disorders, in which the immune system overreacts to things like pollen or nuts.

Autoimmune diseases can affect almost any part of the body, though they often target connective tissues (skin, muscle and joints). Symptoms can range from fatigue and mild rashes to rare, serious side effects, like seizures. Diagnosis can be difficult, because many symptoms tend to come and go and are frequently nonspecific. They occur in different kinds of autoimmune diseases as well as other types of illnesses, like infection and cancer.

Autoimmune diseases occur most often in females by a 3-to-1 margin over males.

Doctors don’t know why some children’s immune systems begin attacking their own bodies. We do know it’s related to something in their genes and likely a number of other, unknown factors. It’s important for parents to know that their child’s disease wasn’t caused by anything they did, and there’s nothing they could have done to prevent it.

What types of autoimmune disease affect children?

The immune system is designed to protect the entire body. When it malfunctions, it can attack virtually any part of the body, from the skin to the joints to the blood vessels—which all respond in different ways and often require different treatment strategies.

In general, autoimmune diseases often fall into one of two basic groups:

Organ-specific disorders (also called localized) focus on one organ or a specific type of tissue:

Non-organ-specific disorders (also called systemic) cause problems throughout the body:

Who is at risk for autoimmune disease?

Because there are several dozen kinds of autoimmune diseases, risk factors can vary by illness. In general, though, researchers have found strong links to the following factors:

• Gender: Girls are almost three times as likely as boys to have an autoimmune disease, with adolescent girls and young women being at greatest risk. For some diseases, such as scleroderma and lupus (SLE), more than 85 percent of patients are female. However, one of the more common autoimmune diseases in children, type 1 diabetes, affects boys and girls almost equally.
• Age: Most autoimmune diseases affect younger and middle-aged people. Some illnesses begin specifically in childhood, as their name suggests—juvenile idiopathic arthritis and juvenile dermatomyositis, for example.
• Genetics: A family history of autoimmune disease puts a child at higher risk. In fact, it’s estimated that about one-third of the risk of developing an autoimmune disease is tied to something in a child’s genes.
• Race: Some reports suggest that children of different races may be more prone to certain autoimmune diseases. African-American children, for instance, seem to be more likely than Caucasians to develop lupus (SLE) and scleroderma, but the opposite is true of multiple sclerosis (MS), which more often affects Caucasian children.
• Other illnesses: Children with one autoimmune disease tend to be at higher risk of developing another. For example, kids with type 1 diabetes appear to be more susceptible to developing celiac disease or Addison’s disease.

Can autoimmune disease be prevented?

So far, there’s no way to prevent a person from developing an autoimmune disease, although researchers are working toward that long-term goal. The National Institutes of Health outlined three challenges that researchers face:

• recognizing the specific genetic patterns of people susceptible to autoimmune disease
• zeroing in on environmental factors (viruses, toxins, etc.) that may trigger disease
• coming up with ways to intervene before the disease begins, along with creating public screening programs

How we care for autoimmune diseases

While the health care team for children with autoimmune disease may include many kinds of specialists, the doctors with the greatest expertise in these illnesses are called pediatric rheumatologists. Of the roughly 200 pediatric rheumatologists in the country, more than half a dozen work at Boston Children’s Hospital. This, and the many other resources we offer, makes Boston Children’s a unique and powerful force in fighting autoimmune disease:

• Our Rheumatology program is one of the biggest in the U. S., treating more than 4,000 outpatients and almost 1,000 inpatients every year.
• Our Samara Jan Turkel Clinical Center brings together pediatric rheumatologists and consulting specialists from across the hospital to offer comprehensive, coordinated care, from providing outpatient and inpatient treatment to helping children and families connect to a wide range of support services.
• The Division of Immunology and Rheumatology Departments collaborate to help children with multiple autoimmune symptoms that don’t fit a single diagnosis through the hospital’s Multiple Manifestations of Autoimmune Disease Clinic
• The Dermatology-Rheumatology Center unites rheumatologists and dermatologists in caring for children with autoimmune diseases that involve the skin, such as psoriatic arthritis, scleroderma and juvenile dermatomyositis.

Our areas of innovation for autoimmune diseases

Home to the world’s largest pediatric research enterprise, Boston Children’s is also looking toward the future. Through initiatives like the Manton Center for Orphan Disease Research and the Program in Cellular and Molecular Medicine, our clinicians and scientists are working together on new ways to identify, treat and potentially cure autoimmune diseases.

Myositis | ColumbiaDoctors – New York

What is myositis?

Myositis (my-o-SY-tis) is a rare type of autoimmune disease that inflames and weakens muscle fibers. Autoimmune diseases occur when the body’s own immune system attacks itself. In the case of myositis, the immune system attacks healthy muscle tissue, which results in inflammation, swelling, pain, and eventual weakness. When there is no skin involvement, it is called polymyositis. When there is skin involvement, it is called dermatomyositis.

The areas of the body affected by myositis may differ from patient to patient. Most often, myositis involves the muscles in the upper arms and thighs, which can cause difficulty raising arms above the head and rising from a chair. Some people may also experience symptoms in their lungs, such as difficulty breathing, while others may have difficulty swallowing. Women are more than twice as likely to be diagnosed as men, with most patients between ages of 30 and 60 when first diagnosed. In patients younger than 20 years old, the disease is referred to as juvenile myositis and may be treated differently.

Over time, myositis symptoms may continue to worsen until everyday tasks, like climbing stairs or carrying groceries, become difficult. These symptoms develop gradually and though there is no cure, treatments are available to retain muscle strength and function. It is important to work with your rheumatologist to delay myositis complications as long as possible. Depending on whether your lungs or esophagus are affected, you may experience some of the following symptoms or physical findings:

• Breathing difficulty ranges from shortness of breath to respiratory failure.
• Rashes may develop over the knuckles, around the fingernails, around the nose and cheeks, and on the chest, in addition to other areas. In the presence of a typical myositis related rash, the diagnosis is referred to as dermatomyositis. Skin involvement can sometimes be quite severe.
• Calcinosis means that over time, calcium deposits form in your muscles, skin, and connective tissues which can be painful and lead to infections.
• Swallowing difficulty including weight loss and malnutrition or aspirating food or liquids into your lungs can lead to pneumonia.

Myositis frequently occurs with other conditions, which share similar symptoms or affected organs. For example, people with myositis may have other autoimmune conditions like lupus or rheumatoid arthritis. They can also experience Raynaud’s disease (this is a blanching of the fingers when exposed to the cold). Depending on how long the myositis symptoms have occurred and which muscles are affected, heart muscle or lung tissue can also become inflamed, leading to poor health consequences like heart arrhythmias and interstitial lung disease.

What causes myositis?

The specific causes of myositis are unknown. There are characteristics in common with other autoimmune disorders that may help researchers determine specific causes. Research has identified some causal pathways, including:

Virus Trigger: Some patients have been exposed to a virus like HTLV-1 or the Coxsackie B virus prior to developing myositis symptoms. This does not mean that either virus causes the disease; the patient was likely to develop an autoimmune disorder anyway, but and the virus may have been the trigger that initiated the symptoms.

Drug Trigger: Some patients with myositis were exposed to drugs such as penicillamine, interferon-alpha, cimetidine, carbimazole, phenytoin, growth hormone, and hepatitis B vaccine. These drugs treat a range of conditions from ulcers to cancer and do not otherwise have anything in common. Whether they truly cause myositis remains unclear.

Genetic Trigger: The specific genes that put a person at risk for myositis have not been identified, but there may be genetic factors that increase the likelihood in some patients for myositis to occur. There is also on-going research into the blood mixing between mother and fetus that could possibly create risk for myositis in either the mother or child later in life.

What are the symptoms of myositis?

You should contact your physician if you experience unexplainable weakness in the muscles closest to the middle of your body (such as your thighs, hips, shoulders, neck, back, or forearms). Specific symptoms include:

• Gradual, worsening weakness that develops over a period of weeks or months
• Difficulty rising from a seated position or reaching above your head
• Difficulty swallowing
• Joint pain
• General, unexplained fatigue

How is myositis diagnosed?

A myositis diagnosis involves multiple tests. Your physician will ask you questions about your muscle weakness symptoms. It is worthwhile to take a moment before your appointment and write down when you first noticed your symptoms. Do you notice anything that makes it worse (or better)? Do any of your immediate family members have an autoimmune disease? Your doctor will also ask you for a detailed description of your past medical history and any conditions you currently have or treatments that are in process.

If your physician suspects that your muscle weakness may be myositis, he or she may order tests that could include:

• Blood test: to determine whether you have elevated muscle enzymes such as creatine kinase (CK) and aldolase, which can indicate muscle damage. Blood tests also indicate specific autoantibodies which are associated with polymyositis. If these autoantibodies are found in your blood, they will help determine which subtype of myositis you have.
• Electromyography: a test to measure electrical activity in muscles
• Muscle biopsy: used to look for damage, infection, inflammation, or abnormal changes

How is myositis treated?

There is no cure for myositis, but there are a number of different treatments that improve your muscle strength and function. Starting treatment as soon as you first discover symptoms can minimize the complications you experience and slow or stop the course of the disease. Your rheumatologist will help determine the best treatment or treatment strategy:

Therapy

Depending on the type and severity of your symptoms, your doctor may prescribe the following therapies:

• Physical therapy: Strength training exercises help maintain strength and improve flexibility.
• Speech therapy: Myositis can weaken muscles around your vocal chords and impact speech; a speech therapist can help.
• Diet changes: Myositis can affect the esophagus as well as jaw muscles. Registered dieticians can advise you on which foods provide the most nutrition with the least difficulty chewing and swallowing.
• Emotional support: An autoimmune disease support group or counseling can support you and your emotional needs as you manage your health.

Medications

Myositis treatments include prescription and over-the-counter medications, such as anti-inflammatories, steroids, and other immunosuppressants.

Other Treatments

After trying other therapies, your rheumatologist may recommend intravenous immunoglobulin (IVIg), an IV treatment that contains healthy antibodies collected from thousands of blood donors. It is an expensive treatment that needs to be repeated regularly to maintain its effects and block the myositis muscle damage from occurring. Another potential treatment is rituximab, an antibody that depletes B cells, which make the antibodies that damage muscles. Clinical trials of other agents are currently in progress.

Understanding Autoimmune Diseases

The prevalence of autoimmunity is on the rise in the United States. Researchers have found a 44% increase in ANA, the autoantibody (antibodies that target self) in lupus, in the last 25 years, with 41 million people affected. These autoantibodies presage autoimmune diseases such as rheumatoid arthritis, which is the most common type of autoimmune arthritis, and systemic lupus erythematosus (SLE) in about 30% of individuals over a 5-10 year period, said Richard Bucala, MD, PhD, Waldemar Von Zedtwitz Professor of Medicine (Rheumatology) and Professor of Pathology and of Epidemiology (Microbial Diseases) and the chief of the Section of Rheumatology, Allergy & Immunology at Yale School of Medicine (YSM).

“The good news is that high-risk individuals can be identified, and treatment may prevent disease progression,” Bucala said.

Degenerative joint disease, known as osteoarthritis, is the most common joint disorder, affecting 20-44% of adults over age 70. It is the single greatest cause of disability globally, with a more than 1% GDP cost to the U.S, Bucala said.

The other common autoimmune diseases are rheumatoid arthritis and lupus. Rheumatoid arthritis occurs when the body’s immune system attacks the lining of its joints, causing pain, inflammation, and eventually, cartilage and bone damage. Rheumatoid arthritis can also harm the body’s internal organs such as the heart, lungs, and nervous system.

Lupus is an autoimmune disorder that causes inflammation in the skin, joints, and kidneys. Symptoms include fatigue, joint pain, skin rashes, leg swelling, and chest discomfort.

A less frequent autoimmune disease, scleroderma, has the highest case-fatality rate for any rheumatic disease.

Scleroderma is a rare autoimmune disease in which normal tissue is replaced with scar tissue with extra collagen. Although it most often affects the skin, scleroderma also can affect many other parts of the body. It is four times more common in women than in men. Scleroderma usually develops between the ages of 25 and 55, although it can occur in adults at any age.

The Yale Medicine Scleroderma Program has been designated as a Scleroderma Center of Excellence by the Scleroderma Foundation. “This means that we have successfully developed a program that is specifically geared to the special needs of scleroderma patients,” says Monique Hinchcliff, MD, MS, associate professor in the Section of Rheumatology, Allergy & Immunology at YSM and the director of the Yale Scleroderma Program. “We have specialists not only from rheumatology, but also from allergy & immunology, cardiology, dermatology, gastroenterology, nephrology, and pulmonary critical care that are experienced and dedicated to providing top-notch care to scleroderma patients.”

The Section of Rheumatology, Allergy & Immunology is one of the eleven academic sections within YSM’s Department of Internal Medicine. To learn more about its work, visit Rheumatology, Allergy & Immunology.

Juvenile Idiopathic Arthritis (for Parents)

It may begin with a swollen knuckle, a spiking fever, or an unexplained rash. But no matter what symptoms appear, hearing the word “arthritis” in a diagnosis for your child can be unexpected and confusing.

Arthritis is an inflammation of the joints, meaning that the joints get swollen, warm, and painful. Nearly 300,000 children in the United States have some sort of arthritis. Arthritis can be short-term — lasting for just a few weeks or months, then going away forever — or it can be chronic and last for months or years. In about half of cases, it can last a lifetime.

The most prevalent form of juvenile arthritis is juvenile idiopathic arthritis (JIA) (also known as juvenile rheumatoid arthritis, or JRA). It is very different from adult rheumatoid arthritis.

What Causes JIA?

It’s not known exactly what causes JIA in kids. Research indicates that it is an autoimmune disease. In autoimmune diseases, white blood cells can’t tell the difference between the body’s own healthy cells and germs like bacteria and viruses. The immune system, which is supposed to protect the body from these harmful invaders, instead releases chemicals that can damage healthy tissues and cause inflammation and pain.

To effectively manage and minimize the effects of arthritis, an early and accurate diagnosis is essential. By understanding the symptoms and characteristics of each type of JIA, you can help your child maintain an active, productive lifestyle.

Types of JIA

JIA usually appears in kids between 6 months and 16 years old. The first signs often are joint pain or swelling or warm joints. Many rheumatologists (doctors specializing in joint disorders) find that the greater the number of joints affected, the more severe the disease and the less likely that the symptoms will eventually go into total remission. Remission is a medical term for temporary or permanent recovery.

There are seven types of JIA:

1. Systemic JIA. Affects the whole body. Symptoms include high fevers that often increase in the evenings and then may suddenly drop to normal. During the onset of fever, the child may feel very ill, appear pale, or develop a rash. The rash may suddenly disappear and then quickly appear again. The spleen and lymph nodes might become enlarged. Eventually many of the body’s joints are affected by swelling, pain, and stiffness. Rashes may suddenly appear and disappear, developing in one area and then another. High fevers that tend to increase in the evenings and disappear are characteristic of systemic JIA
2. Oligoarthritis. Affects four or fewer joints, often the knee or ankle. Symptoms include pain, stiffness, or swelling in the joints. The two types of oligoarthritis, persistent and extended, are determined by how many joints are ultimately involved. 
3. Polyarticular arthritis, rheumatoid factor negative. About 1 in 4 kids and teens with JIA have polyarthritis, which affects more girls than boys. Symptoms include swelling or pain in five or more joints. The small joints of the hands are affected as well as the weight-bearing joints like the knees, hips, ankles, feet, and neck. A low-grade fever also might develop, as well as bumps or nodules in areas of the body subjected to pressure from sitting or leaning.
4. Polyarticular arthritis, rheumatoid factor positive. This type of JIA behaves the most like adult rheumatoid arthritis, and kids who have it have a protein called rheumatoid factor (RF) or anti-cyclic citrullinated peptide (CCP antibody) in their blood.  Kids with polarticular JIA are at a higher risk of joint damage with erosions than in the other forms of JIA.
5. Psoriatic arthritis. Kids with this also have the psoriasis rash (a scaly red rash that can start behind the ears, on the eyelids, elbows, knees, or scalp) themselves or a close relative with psoriasis. Their fingernails and toenails might be affected by the condition.
6. Enthesitis-related arthritis. This type of arthritis often affects the legs and spine. Kids also might have inflammation at the entheses – areas where tendons join bones (where the Achilles tendon attaches to the back of the heel). Enthesitis-related arthritis includes a special group call juvenile ankylosing spondylitis (where joints of the low back are inflamed) and arthritis associated with inflammatory bowel disease (Crohn’s disease and ulcerative colitis).
7. Undifferentiated arthritis. Arthritis that doesn’t fit into any of the above categories or fits into more than one of the categories.

The first signs of arthritis, which can be subtle or obvious, include limping or a sore wrist, finger, or knee. Joints may suddenly swell and remain enlarged. Stiffness in the neck, hips, or other joints also can occur.

Inflammation of the iris (the colored area of the eye) may happen with or without active joint symptoms in any type of JIA. This inflammation, more likely to happen in girls than boys, is called iridocyclitis, iritis, or uveitis. Kids and teens with JIA should see an ophthalmologist (an eye doctor) regularly to check for this.

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Diagnosis

To diagnose JIA, the doctor will take ask you questions about your child’s symptoms, find out whether other family members have had similar problems, and do a thorough physical examination. The doctor may order X-rays or blood tests to rule out other conditions or infections, such as Lyme disease, that may cause similar symptoms or occur along with the arthritis.

Other tests may include:

• CBC (complete blood count), a common blood test that checks all the basic cell types in blood, including red blood cells, white blood cells, and platelets. Knowing the amount and appearance of each cell type in a person’s blood can help doctors identify many medical conditions.
• Blood culture, a test to detect bacteria that cause infections in the bloodstream.
• Bone marrow biopsy, a test that allows doctors to look at blood where it’s formed (in the bone marrow) to look for conditions such as leukemia.
• Erythrocyte sedimentation rate, which checks how rapidly red blood cells settle to the bottom of a test tube. This rate often increases in people when inflammation is occurring in the body.
• C-reactive protein (CRP) is a protein that the liver releases into the blood at the start of infection or inflammation; this level can rise if a person is having an arthritis flare-up.
• A test for rheumatoid factor (RF) and cyclic citrullinated peptide antibody (CCP), substances made in the blood of children with some forms of JIA. But it’s found more often in adults with rheumatoid arthritis.
• ANA (antinuclear antibody), a blood test to detect autoimmune diseases. It’s also useful in predicting which kids are likely to have eye disease with JIA.
• X-rays of the affected joints, and sometimes an MRI, to detect changes in bone and joints to evaluate the causes of unexplained bone and joint pain. In some cases, doctors may do a test called a bone scan. 

In some cases, the doctor may want an orthopedic surgeon to examine your child’s joints and take samples of joint fluid or synovium (the lining of the joints) for examination and testing.

Treatments

In many cases, JIA is treated with a combination of medication, physical therapy, and exercise. In some cases, a child may require corticosteroid injections into the joint. In very rare cases, kids and teens may need surgery. The health care providers, including the primary care physician, rheumatologist, and physical therapist, will work together to develop the best method of treatment.

The goals of treatment are to relieve pain and inflammation, slow down or prevent the destruction of joints, and restore use and function of the joints to promote optimal growth, physical activity, and social and emotional development.

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Medications

For inflammation and pain, the doctor or pediatric rheumatologist may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, such as Advil, Motrin, or naproxen (Naprosyn or Aleve). These can help reduce inflammation and pain by limiting the release of harmful chemicals from white blood cells.

Higher or lower dosages might be needed, depending upon your child’s response to the medication. The doctor or rheumatologist should explain what the medication is meant to do and what side effects, if any, it could cause. It’s important for your child to continue taking the medication until the doctor says to stop.

Doctors sometimes prescribe corticosteroids (like prednisone) for arthritis flares, but they try to keep these to a minimum to reduce problems that can come with prolonged steroid use, such as skin changes, weight gain, abnormal blood pressure, diabetes, and bone mass changes.

If NSAIDs don’t control joint inflammation, your doctor may prescribe other medications such as methotrexate. In addition, treatment options now include a newer class of medications called biologics. The U.S. Food and Drug Administration (FDA) has approved many of these medicines for kids and teens with JIA. Some are subcutaneous injections (injections given just under the skin) that can be done at home. Others are intravenous (IV) infusions through a vein that are done regularly at the hospital.

Physical Therapy

An appropriate physical therapy program is essential to the management of any type of arthritis. A physical therapist will explain the importance of certain activities and recommend exercises suited to your child’s specific condition. The therapist may recommend range-of-motion exercises to restore flexibility in stiff, sore joints and other exercises to help build strength and endurance.

Regular Exercise

When pain strikes, it’s natural for your child to want to sit still. But it’s important to maintain a regular exercise program. Muscles must be kept strong and healthy so they can help support and protect joints. Regular exercise also helps to maintain range of motion.

At home and at school, your child should have regular exercise and physical fitness programs. Safe activities include walking, swimming, and bicycling (especially on indoor stationary bikes). Be sure that your child warms up the muscles through stretching before exercising. Make exercise a family activity to build fun and enthusiasm.

Ask the doctor and physical therapist about sports restrictions. Some, especially impact sports, can be hazardous to weakened joints and bones. And make sure your child eats a balanced diet that includes plenty of calcium to promote bone health.

Med Travel – Autoimmune joint disease

Humanity is “aging”. The active lifestyle of some, sports and related injuries, and vice versa, the sedentary lifestyle of others, and the associated excess weight, lead to the fact that among people over 40, doctors are faced with a real epidemic of the 21st century associated with pain in joints. Arthritis is a collective term used to describe more than one hundred different diseases caused by dysfunction of muscles, ligaments and the joints themselves.

Over the past 20 years, the number of people who have consulted doctors for joint pain has doubled. Today, every second elderly person is more or less concerned about pain and deformity of the joints, which significantly worsen the quality of life.

What is the reason for such a frequent illness? And what can be done to prevent the irreparable consequences of arthritis in time, leading to immobility and ultimately to disability.

Not so long ago, arthritis was mistakenly thought to be a natural aging process.And if earlier people with sore joints were associated with a portrait of a grandfather with a cane or a grandmother with knitting needles in hands crumpled with a disease, now arthritis is getting younger and younger.

And, indeed, the reasons for the development of arthritis in younger and older people are different.

So, the predisposing factors for the development of osteoarthritis after the age of 40 are metabolic disorders, and excess weight, and a sedentary lifestyle on the one hand, and on the other hand, frequent joint microtrauma during physical exertion.

In the case when certain problems with joints are observed at an early or adolescent age, then autoimmune diseases can be the culprit.

What is autoimmune joint damage?

Autoimmune diseases are characterized by impaired performance of the immune system, which at a certain stage of the disease is able to begin the process of rejection of its own tissues, thereby affecting the entire body.

Rheumatoid arthritis is one of the most pronounced side effects of autoimmune disease, despite the fact that it is a symptom of diseases such as lupus erythematosus and scleroderma.

The second place is occupied by psoriatic arthritis, which often occurs in patients with psoriasis. Psoriasis refers to autoimmune diseases of the skin, however, it is more correct to consider skin manifestations and pain in the joints as different symptoms in patients with the same autoimmune pathology, which simply manifests itself differently depending on the characteristics of the development of autoimmune inflammation

Another severe autoimmune joint disease is spondyloarthritis or ankylosing spondylitis. And, if in the case of the disease with the above diseases, the disease often affects the wrist and knee joints, then in the case of ankylosing spondylitis, the spinal column and the joints of the intervertebral joints suffer.

What is the cause of the flaw in the immune system that leads to joint damage?

The most modern and generally accepted concept today speaks of a combination of genetic factors (in everyday life it is called hereditary predisposition) and provoking environmental factors, which give rise to a malfunction of the immune system, as a super system for recognizing “friend or foe”.Infections (streptococcus, staphylococcus, viruses, fungi), psychoemotional stress, metabolic disorders that lead to endocrine shifts in the body, which negatively affect the immune system, are considered such a push.

With one and the same harmful actions, some people get sick, and others do not. Therefore, the mechanism of the onset of the disease is more complex, and includes a combination of genetic factors, stressful external influences, which, with a certain probability, cause an error in the immune balance.

Why are autoimmune disorders of the joints so dangerous?

The main danger for a person with rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis is that these diseases progress, that is, over time, all new and new joints are involved, and periods of aggravation of the inflammatory process in the already affected joints functions until the development of immobilization. A sharp restriction of mobility in the joints leads to a decrease in the possibility of self-care (it is difficult to dress, wash, comb, shave, etc.)and disability. Unfortunately, already 3 years after the onset of autoimmune joint lesions, signs of bone destruction appear on the X-ray. And after 10 years, 4 out of 5 patients have pronounced deformities of the joints, which leads to disability.

Ultimately, the joints are so destroyed that a person is not able to perform normal movements without assistance, and a wheelchair may be needed.

For large joints, surgical joint replacement is a solution, albeit a temporary one, since the service life of the most modern prostheses is still limited to 5-10 years

Therefore, the sooner a patient turns to a specialist for joint pain, the sooner the cause of joint lesions is identified, the sooner he begins to engage in prevention and proper treatment, the more likely he is to maintain an active lifestyle.

What is the correct treatment for rheumatoid arthritis, psoriatic arthritis and spondyloarthritis?

The purpose of the treatment of these diseases is clinical and laboratory remission, as well as the maximum prevention of changes in the shape of joints and disability. For this, a number of comprehensive measures are being taken that solve the problem from several sides at once: pharmacology and rehabilitation. Therefore, patients receive treatment almost continuously. But, unfortunately, the ideal treatment has not yet been invented.

Are there new, more effective treatment regimens?

Over the past decade, active research has been carried out to find the ideal treatment. However, treatment approaches have leaped forward significantly.

This is associated with the active development of innovative biotechnologies in medicine, significant advances in genetic engineering and the introduction of biological products into medical practice. This group of drugs is a monoclonal antibodies against proinflammatory agents produced in autoimmune diseases and which have a damaging effect on joints.

Infliximab is the first most studied and widely used in modern immunotherapy worldwide. In Belarus, it is registered under the name FLAMMEGIS. After a single intravenous injection of infliximab, the patient feels a significant reduction in joint pain and the ability to move. The infusion is repeated after 2 weeks, then after 6 weeks, then once every 2 months. In addition to the rapidly advancing clinical effect, Inflikmimab (Flammegis) also inhibits the X-ray progression of joint lesions up to a stable remission.Well, the quality of life of patients with musculoskeletal disorders during treatment is described by the patients themselves with the words: “I felt as if I was born again.” Flammegis is an infliximab co-produced by Celltrion (South Korea) and Egis (Hungary).

Today it is the most affordable biological product on the Belarusian pharmaceutical market for the treatment of autoimmune diseases such as rheumatoid arthritis, psoriatic arthritis and spondyloarthritis (ankylosing spondylitis), as well as for the treatment of severe intestinal pathology – ulcerative colitis and Crohn’s disease.

Development and implementation into practice of fundamentally new biotechnological drugs, such as FLAMMEGIS, for the treatment of such serious ailments gives patients a new chance to live without pain and new prospects for an active future.

90,000 Autoimmune diseases in neurology | Clinic Rassvet

A heterogeneous group of diseases, which are based on the autoaggression of the body’s immune system and the production of active cells – antibodies that destroy their own healthy cells and tissues.

Autoimmune diseases can affect any system and organ, including the nervous system.

The symptoms of autoimmune diseases of the nervous system are varied, since each of them is characterized by the production of specific antibodies that affect only certain cell structures.

Classification of autoimmune diseases in neurology

Major autoimmune diseases affecting the central nervous system : :

• Multiple sclerosis and some more rare demyelinating diseases . Antibodies are produced against the sheath of nerve processes – myelin. The result is a violation of the signal conduction along the nerve fibers. The main symptoms: various visual impairments, weakness and numbness of the arms and / or legs, unsteadiness, urination disorders.
• Autoimmune encephalitis. An extensive group of diseases, the common feature of which is damage to the brain exclusively. Each encephalitis is characterized by a specific type of antibodies and, therefore, some features of the clinical picture.However, there are a number of common symptoms for all autoimmune encephalitis: mental disorders, memory impairment, seizures.

Autoimmune diseases affecting the peripheral nervous system (nerve roots and nerves):

• Guillain-Barré Syndrome. Acutely developing autoimmune disease. Antibodies are produced against the myelin of the peripheral nerves. It manifests itself as ascending muscle weakness up to the weakness of the respiratory muscles, less often numbness.
• Chronic autoimmune polyneuropathies. A group of diseases that are manifested by various combinations of weakness and numbness of the limbs and have a slowly progressive course.

Autoimmune diseases affecting muscles and neuromuscular system :

• Myasthenia gravis. Antibodies in myasthenia gravis affect the area where nerves and muscles join – synapses. As a result of exposure to antibodies, the sensitivity of the muscles to the signal coming from the nerves is reduced.Clinically, the condition is manifested by muscle fatigue – muscle weakness is not felt constantly, but increases gradually in the process of movement.
• Myopathies. Muscle damage can also be autoimmune. These diseases are united by a common symptom – muscle weakness, the severity and localization of which, however, differs depending on the disease and the type of antibodies.

Treatment of autoimmune diseases of the nervous system

The approach to treatment is common to all autoimmune diseases. Therapy is aimed not so much at correcting the symptoms of damage to the nervous system, but at modulating the functioning of the immune system: corticosteroids, immunoglobulins and monoclonal antibodies, cytostatics, plasmapheresis are used.

Benefits of treating autoimmune diseases of the nervous system in the Rassvet Clinic

Neurologists of the Rassvet clinic do not prescribe symptomatic drugs with unproven efficacy. Long-term treatment and prevention of autoimmune diseases are developed in the framework of outpatient consultations.Day hospital therapy is aimed at combating exacerbations.

TYPES OF DISEASES | orto.lv

All arthritis or rheumatic diseases are divided into four large groups:

Degenerative arthritis

The natural aging process of a person can affect joints and their health, causing wear, pain and inflammation at the ends of the bones. At risk are people with overweight, joint injuries, heredity and age.

Osteoarthritis is the most common form of degenerative arthritis.

Inflammatory arthritis

The role of the human immune system is to provide protection to all systems of the body, for example, to destroy the infectious agent. In the case of an autoimmune disease, the body loses tolerance to its tissues. The body perceives its tissues as foreign and tries to fight them by producing antibodies. Rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis are the most common causes of inflammatory arthritis.

Infectious arthritis

There are two types of infectious arthritis:

• the infection affects the joint itself;
• Reactive arthritis, when an infection affects other systems in the body, but in response to it, one or more joints become inflamed. Reactive arthritis is caused by microorganisms, bacteria and fungi, such as those caused by tuberculosis, salmonellosis, Lyme disease, dysentery, sexually transmitted diseases, hepatitis C.

Crystalline arthropathy (arthritis resulting from metabolic disorders)

Gout is one of the most common diseases of this group of arthritis. Gout differs from other forms of arthritis – it occurs as a result of improper metabolic processes when uric acid accumulates in the blood, which, in the form of needle-shaped crystals, settles in tissues and joints. The presence of salt crystals irritates tissues, causing severe, sudden pain and swelling.The disease most commonly affects the big toes, base of the fingers, and knee joints.

Often people can have several diseases of arthritis at the same time, so treatment should be comprehensive, consistent and reasonable .

The most common types of arthritis or rheumatic diseases

Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disease whose causes are not fully understood.In the case of rheumatoid arthritis in the body, antibodies are produced against the synovial membrane of the joints, destroying the structure of the joints, causing irreversible damage to the cartilage and joint, as well as bone erosion.

In addition to joint damage, patients with rheumatoid arthritis may develop subcutaneous nodules, enlargement of lymph nodes, and damage to the heart (myocarditis, endocarditis). Inflammation of the blood vessels (vasculitis), endocrine system abnormalities, eye damage (iritis or iridocyclitis), and damage to other organs may also occur.

Reactive arthritis

Reactive arthritis is a consequence of another disease. Reactive arthritis is caused by microorganisms, bacteria and fungi, for example, pathogens of tuberculosis, salmonellosis, Lyme disease, dysentery, sexually transmitted diseases, hepatitis C, as well as inflammatory processes in the body – in the urinary tract or intestines. The disease usually affects the knee joints, ankles, and feet. The inflammation can also affect the eyes and mouth and cause skin rashes.By timely starting treatment of the underlying disease, joints can be protected from the development of chronic arthritis.

Psoriatic Arthritis

Approximately 10-30% of people with psoriasis develop psoriatic arthritis, which causes joint inflammation. In some cases, psoriatic arthritis develops first, and only later does psoriasis appear. Psoriatic arthritis can affect any joints in the body, including the finger and spine.

Ankylosing spondylitis

A chronic autoimmune joint disease that causes inflammation in the spine.Inflammation and degenerative changes in the spine are common, causing stiffness. Inflammation is characterized by a progressive course with periods of remission (rest) and exacerbation, which ultimately can cause the formation of severe ankylosis or adhesions. The causes of the disease are still not exactly clear, but heredity is of great importance.

Fibromyalgia

A common condition with chronic pain. Fibromyalgia is musculoskeletal aching pain with nearly 20 distinct points of pain. The causes of pain are not fully understood. Fibromyalgia is 9 times more common in women than in men.

Juvenile idiopathic arthritis

Juvenile idiopathic arthritis is a chronic disease characterized by persistent joint inflammation. Typical signs of joint inflammation are pain, swelling, and limitation of movement. “Idiopathic” means that the cause of the disease is not clear, and “juvenile” in this case means that symptoms appear before the age of 16.

As a result of the disease, the synovial membrane, which covers the joint and is usually very thin, becomes much thicker and inflammation cells enter it, and the amount of joint fluid increases.This causes swelling, pain, and limitation of movement. A characteristic sign of joint inflammation is its stiffness after a long rest, so it is especially pronounced in the morning (morning stiffness). Juvenile idiopathic arthritis has several forms, depending on the symptoms.

Osteoarthritis

In the case of osteoarthritis, the inflammation involves the joint capsule, the surfaces of the joint bones and the articular ligaments. As a result of the inflammatory process, the cartilage layer of the joint is worn out.It is the most common chronic joint disease in the world, affecting about 150 million people. All types of arthritis cause joint inflammation. Osteoarthritis affects many people as they age, but young people are also at risk of the disease.

Gouty arthritis

Gout is a metabolic disease associated with the accumulation of uric acid salts in the body in the form of small crystals. They are deposited mainly in joints, cartilage, kidney tissue, in the subcutaneous layer and other places.This process can proceed without any noticeable external signs. Symptoms of joint pain, tenderness, redness, and swelling may appear suddenly. They can be caused by infection, joint injury, surgery, excessive alcohol consumption, or eating foods rich in purines (a chemical) (brain, liver, sardines, anchovies, beans, etc.). Gout most commonly affects the big toe joint, less commonly the heel, foot, hand, or elbow joint.

Polymyalgia rheumatica

Polymyalgia rheumatica is a chronic, episodic inflammatory disease of large arteries – one of the most common forms of arthritis in people over 70 years of age.Manifested by pain in the hip and shoulder joints, morning stiffness. Patients may have nonspecific complaints of fever, weight loss, and weakness. There is usually muscle pain in both the shoulder and hip joints. Sleep is disturbed due to pain.

Systemic lupus erythematosus

Systemic lupus erythematosus is a chronic disease of the immune system, when the body’s defenses mistakenly begin to attack the cells and tissues of its own body due to too many antibodies in the blood (an autoimmune disease), which causes inflammation and damage to joints, muscles, kidneys and other organs.Patients are characterized by a red butterfly-shaped rash on the face.

Scleroderma

Scleroderma or systemic sclerosis is a general disease of the connective tissue, which is characterized by thickening of the skin and fibrosis (fibrosis), as well as specific damage to internal organs, mainly the heart, lungs, kidneys and digestive tract.

90,000 Autoimmune diseases

Immune system disorders are a serious threat to your dog’s health

What is the immune system

The term “Autoimmune Disease” remains in use among breeders, show dog owners, and the veterinary community.In particular, diseases caused by disorders of the immune system are a problem for many purebred animal lovers. Sometimes the abbreviation AIZ is used to denote (A) uto (I) mmunny (Z) diseases.

The immune system is an amazing defense network of leukocytes, antibodies and other components involved in the fight against infection and in the rejection of foreign proteins. Like a police squad patrolling an organism, this system distinguishes “own” cells from “foreign” ones by markers located on the surface of each cell.That is why the body rejects the transplanted skin grafts, organs and transfused blood. The immune system, like any other, can malfunction due to either the inability to do its job, or its overly active performance.

Sometimes babies (as well as Arabian foals) are born with severe combined immunodeficiency (SCID). In addition, certain viruses, such as feline and monkey immunodeficiency virus and human immunodeficiency virus (HIV), cause species-specific acquired immunodeficiency syndrome (AIDS).With all these diseases, a defective immune system cannot protect the body, leaving it vulnerable and open to attack by opportunistic pathogens.

Autoimmune diseases are the opposite type of immune system disorder. In this case, the immune system loses its ability to recognize “its” markers, therefore it begins to attack and reject the tissues of its own body as foreign. In this case, both damage to a specific type of tissue, such as red blood cells, and a generalized disease, such as systemic lupus, are possible.

What causes a “short circuit” in the immune system, causing it to reject normal tissue? There are many theories, but the final answer is “It is unknown.” Jean Dodds, a veterinarian who studies immunology, believes that polyvalent modified live vaccines overstimulate the immune system. Others blame environmental pollution or food preservatives such as ethoxyquin, an antioxidant found in most dog foods.There is strong evidence for the role of a genetic factor in the development of autoimmune diseases in many animal species. Some cases develop spontaneously and involve kidney, lung, or thyroid damage.

Firstly, there is the risk of serious illness or even death of the affected dogs, which can lead to a very large loss, if we are talking about your winning bitch or a high-quality stud dog. Second, most autoimmune diseases are treated with very high doses of corticosteroids or other immunosuppressive drugs that suppress the immune response and are similar to drugs that kidney recipients take to suppress rejection.Steroids suppress the bitch’s reproductive cycle, sometimes rendering her unable to reproduce. If pregnancy occurs, daily medication can cause birth defects in puppies, including cleft palate and malformations of the limbs, as well as premature birth or spontaneous abortion. Since there are good reasons to believe that such diseases are hereditary and pose a risk to the bitch and her litter, such dogs should not be allowed to breed. And what about the breeding of close relatives – littermates, mother, father, half-siblings – sick dogs? Should mating be repeated that has produced one or more sick puppies? To confirm or reject the hereditary nature of any disease with a suspected genetic component, it is necessary to carry out a series of test crosses.As far as is known, there are no official recommendations on which one could rely when making such a decision, but one can adhere to a completely obvious algorithm:

1. Breeding of any male or female dog with a diagnosed autoimmune disease should not be recommended.
2. In the event that two or more puppies from the same litter are diagnosed with any autoimmune disease, do not breed those two specific dogs or dogs from the same line.
3. Finally, you should refrain from mating two dogs if each of them has close relatives with an autoimmune disease.

Unfortunately, due to the implicit nature of autoimmune diseases, offspring may show symptoms after the breeding career of your suspect dogs has ended. Until more concrete evidence is obtained, veterinarians will have to rely on the breeders’ conscientiousness in researching pedigrees and allowing only the best of the breed to breed.

Autoimmune hemolytic anemia

Anemia is not a disease, but a clinical sign, which is a decrease in the number of red blood cells or hemoglobin content, which reduces the ability of the blood to carry oxygen.Anemia can be caused by blood loss, decreased production of new red blood cells, or increased destruction of red blood cells known as hemolytic anemia.

In hemolytic anemia, erythrocytes are perceived by the immune system as “defective”, since they carry markers on their surface that are recognized as “foreign”. These markers can be true autoantetyls, both in primary AIHA, and produced as a result of the use of drugs, due to infectious diseases, cancer, infection with blood parasites or heavy metal poisoning.Substances such as levamisol, certain antibiotics, dilantin (phenytoin), lead and zinc can cause hemolytic anemia.

The spleen and the rest of the immune system seek to rid the body of old, diseased or damaged red blood cells, which is their normal function. If a large percentage of cells are affected and they are destroyed faster than they are replenished, AIHA develops and the animal develops external signs of the disease.

The clinical signs of AIHA usually develop gradually and progress, but sometimes an apparently healthy animal suddenly collapses and has an acute hemolytic crisis.Symptoms are usually associated with a lack of oxygen: weakness, severe lethargy, lack of appetite, increased heart rate and increased breathing. Heart murmurs and pallor of the mucous membranes (gums, eyelids, etc.) are possible. In more severe cases, fever and jaundice (icterus) develop, that is, yellow discoloration of the gums, whites of the eyes, and skin. This is due to the accumulation of bilirubin, one of the breakdown products of hemoglobin.

Diagnosis is usually based on these clinical signs and on a CBC indicating anemia; at the same time, erythrocytes of irregular shape or stuck together are often found.To confirm the diagnosis, you can perform the Coombs reaction. The main treatment for any autoimmune disease is corticosteroids. At the beginning of treatment, very high immunosuppressive doses are used to induce remission, and then the dose is slowly reduced over many weeks or months to a low maintenance dose. Most sick animals require lifelong steroid therapy, while still at risk of relapse.

If steroids alone are not enough, more powerful immunosuppressive drugs can be added: cytoxan (cyclophosphamide) or imuran (azathioprine).These are very effective chemotherapy drugs, so the dog should remain closely monitored for possible side effects, including the possibility of a decrease in the white blood cell count.

In cases that do not respond to treatment, splenectomy – the surgical removal of the spleen – can be recommended. The positive effect of this intervention is due to two mechanisms: the dog produces fewer antibodies against red blood cells and the main organ responsible for their destruction is removed.An animal without a spleen can live a completely normal life.

Blood transfusion is rarely used. The addition of foreign protein can actually exacerbate the crisis by increasing the production of bilirubin and other waste products that the liver must process and suppressing the bone marrow’s normal response to anemia. For life-threatening anemia, blood transfusion (after a cross-test for compatibility) is possible in combination with immunosuppressive therapy.

Immune-mediated thrombocytopenia

IOT is the destruction of platelets (cells involved in blood coagulation) by the immune system by approximately the same mechanism by which the destruction of red blood cells occurs in AIHA.The clinical signs of this disease include bruising; excessive bleeding after injury, during surgery, or during estrus; as well as an admixture of blood in the urine or feces. Typically, these animals do not come to the clinic in a crisis state, unlike animals with AIHA, and they have fewer relapses. Many more common diseases must be ruled out before IOT is diagnosed, including but not limited to warfarin poisoning, various clotting disorders (hemophilia, von Willebrand disease), bladder or prostate infection or cancer, and intestinal parasites.It is necessary to do a complete clinical blood test with platelet count, as well as a coagulogram. In addition, a bone marrow biopsy can provide useful information, and if an autoimmune disease is suspected, a Coombs test can be performed.

Treatment is the same as for AIHA — high doses of corticosteroids and the addition of cyclophosphamide or vincristine if corticosteroids are ineffective. Removal of the spleen is possible; however, the surgical risk is higher because of the poorer blood clotting with IOT.In some cases, transfusion of fresh whole blood or platelet-rich plasma is effective.

The prognosis for AIHA is cautious. With the lightning-fast development of a crisis state, animals often die before the start of active therapy, while in other cases it is not always possible to achieve remission or maintain it. With IOT, the prognosis is usually good, although ovariohysterectomy is recommended after platelet count has returned to normal. This reduces the risk of uterine bleeding in the event of a relapse.Affected males and females should not be used for breeding due to the effects of steroids on the offspring and the risk of inherited susceptibility.

Autoimmune skin diseases

Autoimmune skin diseases belong to the group of infrequent or rare diseases. Diagnosis can be difficult, especially for a general practitioner who has seen no more than 1 or 2 cases in his entire career. Usually, skin biopsy and immunofluorescence staining are needed to diagnose these conditions, and the prognosis of recovery varies.Corticosteroids are considered the main treatment.

“Pemphigus complex” – a group of four autoimmune skin diseases characterized by the appearance of “vesicles” or “vesicles” (blisters), erosions and ulcers. With pemphigus (“pemphigus vulgaris”), lesions are usually located in the oral cavity and at the border of the skin and mucous membranes, that is, between the hairy skin and mucous membranes. These areas include the eyelids, lips, nostrils, anus, prepuce, and vulva.Skin lesions in the groin or armpits are also found. The bubbles are thin, fragile and break easily. Skin lesions are described as red, weeping, ulcerated plaques.

And with “vegetative pemphigus” the affected areas are thick, have an irregular shape and proliferate with the formation of vegetative foci with exudation and pustules. It is believed to be a benign form of pemphigus vulgaris.

Pemphigus foliaceous (“Pemphigus foliaceous”) – a rare disease affecting the oral cavity or areas on the border of the skin and mucous membranes.Bubbles are short-term; The most common symptoms are redness, crusting, flaking and hair loss. Pemphigus foliaceus usually begins on the face and ears and often spreads to the limbs, paw pads, and groin. Secondary skin infections often develop, and in severe cases, fever, depression and refusal to feed are possible.

Pemphigus erythematosis clinically leaf-like and often develops on the nose.Ultraviolet radiation aggravates this form of pemphigus and can lead to a misdiagnosis of solar nasal dermatitis (collie nose). This form is considered a benign form of pemphigus leaf. The term “bullous pemphingoid” is similar to the term “pemphigus” (pemphigus), the clinical course of these diseases is also similar. At the same time, bubbles and ulcers of the same type can be found in the oral cavity, at the border of the skin and mucous membranes, in the armpits and in the groin. Differentiation is only possible with a biopsy.Assessment of the blisters is critical to the diagnosis and because they rupture shortly after formation, it is often necessary to admit the dog to the hospital and check it every 2 hours until a biopsy can be obtained.

Left – Pemphigus in a dog.
Right – Pemphigus in a cat.

Discoid lupus erythematosis is believed to be a benign form of systemic lupus and is an autoimmune dermatitis on the face.Most often found in collies and shelties; more than 60% of sick dogs are bitches. The lesion is often described as a “butterfly silhouette” on the nasal dorsum; it should be differentiated from nasal solar dermatitis and erythematous pemphigus.

Discoid lupus erythematosus.

Finally, a syndrome similar to Vogt-Koyanagi-Garada syndrome (VCG) is an extremely rare disease, possibly of an autoimmune nature, leading to depigmentation and concomitant eye damage. The black pigments in the nose, lips, eyelids, paw pads, and anus fade to pink or white, and acute uveitis (inflammation of the eyes) develops.With early treatment, blindness can be prevented, but lost pigment is usually not restored. As you can see from the above descriptions, many autoimmune diseases have similar manifestations, except for discoid lupus, they do not have a breed, sex or age predisposition.

As with other autoimmune diseases discussed previously, the primary goal of treatment is to suppress the body’s immune response with high doses of systemic glucocorticoids.If steroids are ineffective, more powerful drugs such as cytoxin or imuran are prescribed.

For the treatment of diseases from the pemphigus or pemphingoid group, gold preparations were proposed. In the case of nose depigmentation, tattooing the affected areas helps prevent sunburn and the possible development of squamous cell carcinoma.

Prognosis for discoid lupus is usually good, but may vary for other conditions. Many dogs with VCG are euthanized due to blindness.Breeding sick dogs is not recommended. Currently, there is insufficient information on the heritability of autoimmune skin diseases.

Systemic lupus erythematosus

Systemic lupus erythematosus (SLE) (or simply lupus) is a classic example of a multisystem autoimmune disease. Lupus is often referred to as the “great mimic” because it can manifest itself just like any other disease. SLE symptoms can be acute (abrupt onset) or chronic and are usually cyclical.Non-persistent fever that does not respond to antibiotics is one of the distinguishing clinical signs; another sign is a stiff gait or lameness passing from one limb to another (polyarthritis, see below). Other possible signs include hemolytic anemia or thrombocytopenia, leukopenia (low white blood cell count), or symmetrical dermatitis, especially on the nasal dorsum (butterfly-shaped).

SLE may affect two other organ systems.Polymyositis (inflammation of many muscle groups) causes gait changes, muscle wasting, fever and pain, and behavioral changes that are common in dogs in pain. Inflammation of the glomeruli, the functional units of the kidneys, causes a condition called glomerulonephritis. It leads to the loss of protein in the urine and ultimately to kidney failure.

As with the diagnosis of other similar diseases, first of all, it is necessary to do a complete CBC, serum biochemical analysis and urinalysis.The definitive diagnostic method for SLE is the determination of antinuclear antibodies (ANA). This method detects positive cases with greater consistency than older methods, and its results are less influenced by time and steroid therapy. Only a few ml is required for the analysis. serum, which must be sent to a veterinary laboratory specializing in the analysis of samples from animals.

Therapy is based on the anti-inflammatory and immunosuppressive action of corticosteroids or more powerful drugs – cytoxan and imuran.However, due to the wide variety of manifestations of lupus, individual therapy may be required on a case-by-case basis. If an infection develops due to a decrease in white blood cells and immunosuppressive therapy, antibiotics should be prescribed. Infusion therapy and a low protein diet can be used as maintenance treatment for a dog with kidney dysfunction.

The prognosis for SLE is cautious, especially with complications from renal impairment. Severe generalized infections of the kidneys (pyelonephritis), joints (septic arthritis), or blood (septicemia) are usually incurable and develop late in the disease.

Polyarthritis

Immune-mediated polyarthritis occurs both in SLE described above and independently. This classification includes several different specific diseases, but all the main symptoms are similar. Typical signs include severe fever, tenderness and swelling of the joints, and lameness that goes from one limb to another. In some cases, enlarged lymph nodes are found. In deforming (erosive) arthritis, for example, rheumatoid arthritis (RA), X-ray of the joints is informative, but in non-deforming (non-erosive) types, it does not show changes.Blood counts can be normal, high, or low.

In uncomplicated immune-mediated polyarthropathies, remission with corticosteroids is achieved in about half of the cases. In the remaining cases, cytoxin or imuran is prescribed to induce remission, and then steroids are used to maintain it. The prognosis for these diseases, with the exception of rheumatoid arthritis, is usually good. RA is more common in small breeds.

Researchers have recently begun to study the possible role of the immune component in many well-known diseases.Endocrine disorders (such as hypothyroidism or diabetes mellitus) can be caused by the rejection of hormone-forming cells by the immune system. Keratoconjunctivitis keratoconjunctivitis dry (SCC or dry eye syndrome), which develops when tear production stops, can be treated with cyclosporine, which is used to suppress rejection. Chronic active hepatitis (liver disease) can also be immune-based. In these and many other areas of medicine, research is currently underway to find possible links to the complex world of autoimmune diseases.

St Petersburg State University told how autoimmune diseases are associated with silicone, smoking and flying

On the eve of the opening of the congress, a traditional science lunch was held at St. Deputy Head of the Laboratory “Mosaic of Autoimmunity” Leonid Churilov.

Experts told St. Petersburg journalists that, oddly enough, people suffering from autoimmune diseases often have strong immune systems. In addition, the risks of getting sick are more especially among the fair sex, because a woman’s body is usually much better than a man’s in resisting infections.

We can compare two cars: a racing car and a low-speed car. If a fast car gets hit for some reason, the consequences will be serious, and nothing special will happen to a slow car from a collision.So it is with the body’s defenses: people who have evolved genetically to have a stronger immune system are more likely to suffer from autoimmune diseases.

Head of the laboratory of St. Petersburg State University “Mosaic of Autoimmunity” Yehuda Schoenfeld

The expert noted that today every fifth inhabitant of the planet has a similar ailment, and also that the spread of such diseases is closely related to a number of external factors, including the use of aluminum and other substances that enhance the immune response, silicone implants, hormonal contraceptives, night flights and many others.One of the most dangerous is smoking.

When a person smokes, special enzymes are activated in his body that trigger the formation of citrullinated proteins, and these proteins are strong autoantigens. They can lead to rheumatoid arthritis, one of the most common diseases affecting joints and the entire body. For example, in Europe, when tobacco was not yet brought there from America, such a disease did not exist in principle. This is confirmed by the finds of skeletons of a thousand years ago.In short, today it is firmly established that smoking is harmful not only because of lung cancer, but also because of rheumatoid arthritis.

Deputy Head of the Laboratory “Mosaic of Autoimmunity” Leonid Churilov

As noted by Professor Schoenfeld, the immune system also suffers during long flights, when a person experiences the so-called “jetlag” – time zone change syndrome. At this time, the body disrupts the rhythmic production of certain hormones that affect the immune system.Another dangerous factor is silicone implants, from which silicone gets into organs and tissues, chronically stimulating the immune system. This fact, notes Yehuda Schoenfeld, is associated not only with the development of autoimmune diseases, but also with breast lymphoma.

Today, biomedicine and human health are among the priority areas of the St. Petersburg State University development program, which is why the University is actively developing research centers headed by leading foreign and Russian scientists.Among them are the Institute of Translational Biomedicine, the Center for Genomic Bioinformatics, the Center for Algorithmic Biotechnology, the Biobank Center and many others.

After the end of the science lunch, the opening ceremony of the 1st St. Petersburg International Congress on Autoimmunity was held in the Assembly Hall of St. Petersburg State University, where Sergei Aplonov, Vice-Rector for Scientific Work of St. Petersburg State University, made a welcoming speech. He noted that the congress promotes the integration of Russian scientists into the vanguard of autoimmunologists around the world, and also represents a unique platform for the exchange of ideas, knowledge and research results.In addition, professor at Tel Aviv University, researcher of psychology and music Dorit Tanay and rheumatologist at the Center for Autoimmune Diseases. Zabludovich Amir Tanay gave a lecture “Music and Pain”, after which a virtuoso pianist Amir Shenfeld played for the guests. The evening ended with a lecture by Yehuda Schoenfeld on the main causes and mechanisms of autoimmune diseases. All congress participants received the “Guide to Autoimmune Diseases for General Practitioners” created by authors from 15 countries with the participation of SPbU scientists.

The site of the first autoimmune congress of this scale in Russia was St. Petersburg State University, the largest scientific and educational institution in the city, where more than 100 research laboratories are operating. It was here that in December 2016, at the expense of the only mega-grant of the Russian Government in clinical medicine in the fifth competition, an autoimmunity mosaic laboratory was opened, headed by the world-renowned specialist in the study, treatment and prevention of autoimmune diseases Yehuda Schönfeld.

90,000 Treatment of rheumatoid arthritis in clinics MEDSI

Due to the absence of obvious symptoms of rheumatoid arthritis at its early stage, the diagnosis is made by the presence of pronounced symptoms – joint stiffness, pain, swelling, and the presence of rheumatoid nodules. The doctor-rheumatologist determines them in the process of examining the patient.

Detailed diagnostics of rheumatoid arthritis includes:

• Consultation of a rheumatologist
• General blood test with leukoformula
• Biochemical blood test (including for the detection of rheumatoid factor in blood serum)
• X-ray of inflamed joints
• Magnetic resonance imaging
• Consultations of an orthopedist for lesions of the leg joints

To check the degree of involvement of internal organs in the development of rheumatoid arthritis, MEDSI rheumatologists prescribe additional examinations.

Drug and injection therapy is aimed at relieving pain and inflammation. Massage, acupuncture, physical therapy, physiotherapy exercises help restore joint mobility. The diet will help prevent osteoporosis and its complications. The diet should include vegetables, fruits, foods high in calcium. It is necessary to limit the use of table salt, fatty, spicy, fried, smoked foods.

Spa treatment is recommended and will be quite effective in the initial, mild stage of rheumatoid arthritis.

Treatment should be started earlier than severe pathologies appear. It should be aimed at eliminating the key factors of its development. This will help avoid the development of complications of rheumatoid arthritis and disability.

Experienced doctors of MEDSI apply an integrated approach to the treatment of rheumatoid arthritis, in which its effectiveness can reach 75 percent or more. As a result of therapy, the patient’s general condition is normalized and the normal quality of life returns.

Arthritis

Arthritis is the generalized name for related inflammatory joint diseases caused by various disorders, infectious or bacterial diseases.

Arthritis. Types of the disease and its treatment
The main symptoms of arthritis are painful sensations of “aching” joints, difficulty in movement, and swelling. This is due to the destruction of the cartilage that protects the joint, allowing it to move smoothly, relieve pressure on the joint when walking, etc.e. Since cartilage is the connecting part of two bones, when it is damaged or destroyed, the bones begin to press against each other, and due to constant friction, damage to the bones occurs. All this is accompanied by severe pain and discomfort.

If you do not take action, then over time, arthritis can develop into a more complex and serious disease, turning into a chronic condition and threatening serious damage to the joints.
Types of arthritis
Arthritis includes types of diseases such as:

Osteoarthritis is the most common joint disease, manifested mainly in elderly people or as a consequence of trauma.

Rheumatoid arthritis is an autoimmune disease of connective tissue and most often affects small joints.

Infectious arthritis is a disease caused by damage to the joints after an infectious disease.

Juvenile arthritis – children are most often affected by this disease.

Psoriatic arthritis is a chronic, rapidly progressive joint disease caused by psoriasis.

Gout is a disease caused by a large accumulation of uric acid in the body.

In general, there are more than 100 different types of arthritis in medicine.
Arthritis treatment
Before starting treatment, a specialist makes a diagnosis and establishes an accurate diagnosis. Depending on the type of disease, physiotherapy exercises can be prescribed, which helps to strengthen the musculo-ligamentous apparatus. In this case, the loads during exercise therapy are set individually so as to minimize pain as much as possible. Over time, the load can be increased.

In addition, general anti-inflammatory drugs are prescribed, for example, Diclofenac.