What are the common inflammatory eye conditions associated with rheumatic diseases. How do ocular symptoms relate to systemic rheumatic disorders. What are the diagnostic and treatment approaches for rheumatic eye inflammation.

Understanding the Link Between Rheumatic Diseases and Ocular Inflammation

Rheumatic diseases are a group of disorders that affect the joints, muscles, and connective tissues. Many of these conditions can also impact various organs, including the eyes. Ocular inflammation is a common manifestation of several rheumatic diseases, often presenting as uveitis, scleritis, or keratoconjunctivitis sicca.

The relationship between rheumatic diseases and eye inflammation is complex and bidirectional. In some cases, ocular symptoms may precede the onset of systemic symptoms, serving as an early warning sign of an underlying rheumatic condition. Conversely, eye inflammation can also develop as a complication of an established rheumatic disease, reflecting the severity of the systemic disorder.

Key Rheumatic Diseases Associated with Ocular Inflammation

• Rheumatoid Arthritis (RA)
• Juvenile Rheumatoid Arthritis (JRA)
• Systemic Lupus Erythematosus (SLE)
• Temporal Arteritis
• Wegener’s Granulomatosis
• Polyarteritis Nodosa
• Relapsing Polychondritis
• Adamantiades-Behçet’s Disease

Understanding the connection between these rheumatic diseases and ocular inflammation is crucial for both rheumatologists and ophthalmologists. Early recognition and proper management of eye involvement can significantly impact patient outcomes, potentially preventing vision loss and improving quality of life.

Rheumatoid Arthritis and Its Ocular Manifestations

Rheumatoid arthritis (RA) is a chronic inflammatory disorder that primarily affects the joints but can also involve various organs, including the eyes. Ocular manifestations are relatively common in RA patients and can range from mild discomfort to sight-threatening conditions.

Common Eye Conditions in Rheumatoid Arthritis

1. Keratoconjunctivitis Sicca (Dry Eye Syndrome)
2. Scleritis
3. Episcleritis
4. Peripheral Ulcerative Keratitis (PUK)
5. Anterior Uveitis

Keratoconjunctivitis sicca, also known as dry eye syndrome, is the most frequent ocular manifestation in RA patients. It occurs due to decreased tear production or increased tear evaporation, leading to eye discomfort, irritation, and potential corneal damage. Scleritis, characterized by inflammation of the sclera (the white part of the eye), is another serious complication that can cause severe pain and vision loss if left untreated.

Peripheral ulcerative keratitis (PUK) is a rare but potentially sight-threatening condition associated with RA. It involves inflammation and ulceration of the peripheral cornea, which can lead to corneal thinning and perforation if not promptly addressed.

Juvenile Rheumatoid Arthritis and Ocular Complications

Juvenile rheumatoid arthritis (JRA), also known as juvenile idiopathic arthritis (JIA), is the most common rheumatic disease in children. Ocular involvement is a significant concern in JRA, with uveitis being the primary manifestation.

Uveitis in Juvenile Rheumatoid Arthritis

Uveitis, inflammation of the uveal tract (iris, ciliary body, and choroid), occurs in approximately 10-20% of children with JRA. Unlike adult-onset uveitis, JRA-associated uveitis is often asymptomatic in its early stages, making regular ophthalmologic screening crucial for early detection and management.

The risk of developing uveitis varies depending on the JRA subtype:

• Oligoarticular JRA: Highest risk (20-30%)
• Polyarticular JRA: Moderate risk (5-10%)
• Systemic-onset JRA: Lowest risk (<5%)

Early detection and treatment of uveitis in JRA patients are essential to prevent complications such as cataracts, glaucoma, and vision loss. Regular eye examinations, typically every 3-4 months, are recommended for children with JRA, especially those with high-risk factors such as ANA positivity and early disease onset.

Systemic Lupus Erythematosus and Its Impact on the Eyes

Systemic lupus erythematosus (SLE) is a complex autoimmune disorder that can affect multiple organ systems, including the eyes. Ocular involvement in SLE can manifest in various forms, ranging from mild to severe.

Ocular Manifestations of SLE

• Keratoconjunctivitis Sicca
• Retinal Vasculitis
• Optic Neuritis
• Choroidopathy
• Scleritis
• Episcleritis

Keratoconjunctivitis sicca is the most common ocular manifestation in SLE, often associated with secondary Sjögren’s syndrome. Retinal vasculitis, characterized by inflammation of the retinal blood vessels, can lead to vision loss if not promptly treated. Optic neuritis, inflammation of the optic nerve, may cause sudden vision loss and requires immediate medical attention.

SLE-associated choroidopathy, although rare, can cause serious visual impairment. It typically presents as multiple areas of serous retinal detachment and is often associated with active systemic disease. Early recognition and aggressive treatment of ocular manifestations in SLE patients are crucial for preserving vision and improving overall prognosis.

Temporal Arteritis and Ocular Emergencies

Temporal arteritis, also known as giant cell arteritis (GCA), is a systemic vasculitis primarily affecting large and medium-sized arteries. It most commonly occurs in individuals over 50 years of age and can lead to severe ocular complications if left untreated.

Ocular Manifestations of Temporal Arteritis

1. Anterior Ischemic Optic Neuropathy (AION)
2. Central Retinal Artery Occlusion (CRAO)
3. Ocular Ischemic Syndrome
4. Diplopia

Anterior ischemic optic neuropathy (AION) is the most feared ocular complication of temporal arteritis, causing sudden, painless vision loss. It results from inflammation-induced occlusion of the short posterior ciliary arteries that supply the optic nerve head. AION can lead to permanent blindness if not promptly diagnosed and treated.

Central retinal artery occlusion (CRAO) is another severe complication that can cause sudden, profound vision loss. Ocular ischemic syndrome may develop due to chronic hypoperfusion of ocular tissues, leading to various symptoms such as pain, decreased vision, and rubeosis iridis.

Prompt recognition of temporal arteritis and its ocular manifestations is crucial. High-dose systemic corticosteroids should be initiated immediately upon suspicion of the disease to prevent vision loss and other systemic complications.

Wegener’s Granulomatosis and Ocular Involvement

Wegener’s granulomatosis, now known as granulomatosis with polyangiitis (GPA), is a rare systemic vasculitis that primarily affects small to medium-sized blood vessels. Ocular involvement is common in GPA, occurring in up to 50-60% of patients throughout the course of their disease.

Spectrum of Ocular Manifestations in GPA

• Orbital Inflammation
• Scleritis and Episcleritis
• Peripheral Ulcerative Keratitis
• Uveitis
• Retinal Vasculitis
• Optic Neuropathy

Orbital inflammation is one of the most common ocular manifestations of GPA, presenting as proptosis, diplopia, and orbital pain. It can lead to compressive optic neuropathy if left untreated. Scleritis and episcleritis are also frequent, with necrotizing scleritis being a particularly severe form that can result in scleral thinning and perforation.

Peripheral ulcerative keratitis (PUK) is a sight-threatening condition that can occur in GPA patients. It is characterized by peripheral corneal thinning and ulceration, which may progress to corneal perforation if not managed promptly.

Early recognition and aggressive treatment of ocular manifestations in GPA are essential to prevent vision loss and other complications. Management typically involves systemic immunosuppression, often combining corticosteroids with other immunomodulatory agents such as cyclophosphamide or rituximab.

Polyarteritis Nodosa and Its Ocular Manifestations

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that primarily affects medium-sized arteries. While less common than in some other rheumatic diseases, ocular involvement can occur in PAN and may present with various manifestations.

Ocular Features of Polyarteritis Nodosa

1. Retinal Vasculitis
2. Choroidal Infarction
3. Optic Neuropathy
4. Scleritis
5. Peripheral Ulcerative Keratitis

Retinal vasculitis is one of the most significant ocular manifestations of PAN. It can lead to retinal ischemia, hemorrhages, and neovascularization. In severe cases, central retinal artery or vein occlusion may occur, resulting in sudden vision loss.

Choroidal infarction can also occur in PAN due to occlusion of the choroidal vasculature. This can lead to focal areas of retinal pigment epithelium atrophy and visual field defects. Optic neuropathy in PAN may result from vasculitic involvement of the optic nerve blood supply or from direct granulomatous infiltration of the nerve.

Scleritis and peripheral ulcerative keratitis, although less common in PAN compared to other vasculitides, can occur and may require aggressive systemic treatment to prevent vision-threatening complications.

Management of ocular manifestations in PAN typically involves systemic immunosuppression, often combining corticosteroids with cyclophosphamide or other immunomodulatory agents. Close collaboration between rheumatologists and ophthalmologists is crucial for optimal patient care.

Diagnostic Approaches for Rheumatic Eye Inflammation

Diagnosing ocular inflammation associated with rheumatic diseases requires a comprehensive approach involving both clinical examination and laboratory investigations. Early and accurate diagnosis is crucial for initiating appropriate treatment and preventing vision-threatening complications.

Key Diagnostic Tools and Techniques

• Slit-lamp Examination
• Fundoscopy
• Optical Coherence Tomography (OCT)
• Fluorescein Angiography
• Ultrasound Biomicroscopy
• Serological Tests
• Imaging Studies (MRI, CT)

Slit-lamp examination is essential for evaluating anterior segment structures and detecting signs of inflammation such as cell and flare in the anterior chamber. Fundoscopy allows visualization of the retina and optic nerve, crucial for identifying retinal vasculitis or optic neuropathy.

Optical Coherence Tomography (OCT) provides high-resolution cross-sectional images of the retina and choroid, helping to detect macular edema, choroidal inflammation, and other subtle retinal changes. Fluorescein angiography is valuable for assessing retinal and choroidal circulation, particularly in cases of retinal vasculitis or choroidal inflammation.

Serological tests play a vital role in diagnosing underlying rheumatic diseases. These may include antinuclear antibody (ANA), rheumatoid factor (RF), anti-neutrophil cytoplasmic antibodies (ANCA), and other specific autoantibodies depending on the suspected condition.

In some cases, imaging studies such as MRI or CT scans may be necessary, particularly when orbital inflammation or central nervous system involvement is suspected.

Importance of Interdisciplinary Collaboration

Diagnosing and managing rheumatic eye inflammation often requires close collaboration between ophthalmologists and rheumatologists. This interdisciplinary approach ensures a comprehensive evaluation of both ocular and systemic manifestations, leading to more accurate diagnosis and tailored treatment strategies.

Treatment Strategies for Rheumatic Eye Inflammation

Managing ocular inflammation associated with rheumatic diseases requires a multifaceted approach, often combining local and systemic treatments. The goal is to control inflammation, prevent vision loss, and manage the underlying rheumatic condition.

Topical and Local Treatments

• Corticosteroid Eye Drops
• Cycloplegic Agents
• Periocular or Intraocular Steroid Injections
• Artificial Tears (for dry eye)

Topical corticosteroids are the mainstay of treatment for anterior segment inflammation. They are effective in controlling inflammation but require careful monitoring due to potential side effects such as increased intraocular pressure and cataract formation. Cycloplegic agents help reduce pain and prevent synechiae formation in cases of anterior uveitis.

Systemic Treatments

1. Oral Corticosteroids
2. Disease-Modifying Antirheumatic Drugs (DMARDs)
3. Biologic Agents
4. Immunosuppressive Drugs

Systemic corticosteroids are often necessary for managing severe ocular inflammation or when topical treatments are insufficient. They provide rapid control of inflammation but are associated with significant side effects when used long-term.

DMARDs such as methotrexate, azathioprine, and mycophenolate mofetil are used as steroid-sparing agents for long-term management of chronic ocular inflammation. They help maintain remission and reduce the need for prolonged corticosteroid use.

Biologic agents, including TNF-α inhibitors (e.g., adalimumab, infliximab) and other targeted therapies, have shown significant efficacy in managing refractory ocular inflammation associated with various rheumatic diseases. They are particularly useful in cases resistant to conventional immunosuppressive treatments.

Emerging Therapies and Future Directions

Research into novel therapeutic approaches for rheumatic eye inflammation is ongoing. Promising areas include the development of more targeted biologic agents, local drug delivery systems, and gene therapy. These advancements aim to provide more effective and safer treatment options for patients with rheumatic eye diseases.

As our understanding of the pathogenesis of rheumatic eye inflammation continues to evolve, so too will our treatment strategies. The future holds promise for more personalized approaches to therapy, potentially leading to better outcomes and improved quality of life for patients with these challenging conditions.

Inflammatory conditions of the eye associated with rheumatic diseases

Inflammatory conditions of the eye associated with rheumatic diseases

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• Published: October 2001

• Natalie A. Afshari MD¹,
• Mehran A. Afshari MD, MPH¹ &
• C. Stephen Foster MD, FRCS¹ 

Current Rheumatology Reports
volume 3, pages 453–458 (2001)Cite this article

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Abstract

Ocular inflammation occurs in many patients with systemic rheumatic disease. The best examples are rheumatoid arthritis, juvenile rheumatoid arthritis, temporal arteritis, systemic lupus erythematosus, Wegener’s granulomatosis, polyarteritis nodosa, relapsing polychondritis, and Adamantiades-BehÇet’s disease. Ocular inflammation may precede the symptoms of the systemic disease and can be helpful in systemic diagnosis. After diagnosis, ocular inflammation can mark the severity of the systemic condition. Thus, prompt diagnosis and treatment of inflammatory conditions of the eye are warranted and may be sight- and life-saving.

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References and Recommended Reading

1. Rothova A, Suttorp-van Schulten MS, Frits Treffers W, et al.:Causes and frequency of blindness in patients with intraocular inflammatory disease. Br J Ophthalmol 1996, 80:332–336.

   Article 
   PubMed 
   CAS 

   Google Scholar 

2. “>

   Ellwein LB, Fletcher A, Negrel AD, Thulasiraj RD: Quality of life assessment in blindness prevention interventions. Int Ophthalmol Clin 1994, 18:263–268.

   Google Scholar 

3. Vedot E, Barth E, Billet P: Epidemiology of uveitis: preliminary results of a prospective study in Savoy. In Uveitis Update. Edited by Sarri KM. Amsterdam: Elsevier; 1984:13.

   Google Scholar 

4. Foster CS, O’Brien JM: Anterior uveitis. In Principles and Practice of Ophthalmology. Edited by Albert and Jakobiec. Philadelphia: WB Saunders; 1999:1198. This chapter describes disease entities, many of them rheumatologic, that lead to anterior uveitis.

   Google Scholar 

5. Harper SL, Foster CS: The ocular manifestations of rheumatoid disease. Int Ophthalmol Clin 1998, 38:1–19.

   Article 
   PubMed 
   CAS 

   Google Scholar 

6. Mody GM, Hill JC, Meyers OL: Keratoconjunctivitis sicca in rheumatoid arthritis. Clin Rheumatol 1988, 7:237.

   Article 
   PubMed 
   CAS 

   Google Scholar 

7. Alspaugh MA, Talal N, Tan EM: Differentiation and characterization of autoantibodies and their antigens in Sjogren’s syndrome. Arthritis Rheum 1976, 19:216–222.

   Article 
   PubMed 
   CAS 

   Google Scholar 

8. Moutsopoulos HM, Mann DL: Genetic differences between primary and secondary sicca syndrome. N Engl J Med 1979, 301:761.

   Article 
   PubMed 
   CAS 

   Google Scholar 

9. Williamson J: Incidence of eye disease in cases of connective tissue disease. Trans Ophthal Soc UK 1974, 94:742.

   PubMed 
   CAS 

   Google Scholar 

10. Sainz de la Maza M, Foster CS, Jabbur NS: Scleritis associated with rheumatoid arthritis and with other systemic immunemediated diseases. Ophthalmology 1994, 101:1281.

    Google Scholar 

11. Watson PG, Hayreh SS: Scleritis and episcleritis. Br J Ophthalmol 1976, 60:163.

    Article 
    PubMed 
    CAS 

    Google Scholar 

12. Tauber J, Sainz de la Maza M: An analysis of therapeutic decision making regarding immunosuppressive chemotherapy for peripheral ulcerative keratitis. Cornea 1990, 9:66.

    Article 
    PubMed 
    CAS 

    Google Scholar 

13. Messmer EM, Foster CS: Destructive corneal and scleral disease associated with rheumatoid arthritis. Cornea 1995, 14:408.

    Article 
    PubMed 
    CAS 

    Google Scholar 

14. Jabs DA, Rosenbaum JT, Foster CS, et al.
    Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel. Am J Ophthalmol 2000, 130:492. This paper provides an expert panel of physician recommendations of immunosuppressive drugs for treatment of patients with ocular inflammatory disorders. The side-effects and complications of corticosteroids support the rationale for immunosuppressive treatment. The treatment regimen with immunosuppressive agents should be individualized and the patients monitored regularly.

    Article 
    PubMed 
    CAS 

    Google Scholar 

15. Cassidy JT, Levinson JE: A study of classification criteria for a diagnosis of juvenile rheumatoid arthritis. Arthritis Rheum 1986, 29:274.

    Article 
    PubMed 
    CAS 

    Google Scholar 

16. Chylack LT, Biengang DC: Ocular manifestations of juvenile rheumatoid arthritis. Am J Ophthalmol 1975, 79:1026.

    PubMed 

    Google Scholar 

17. Wolf MD, Lichter PR, Ragsdale CG: Prognostic factors in the uveitis of juvenile rheumatoid arthritis. Ophthalmology 1987, 94:1242.

    PubMed 
    CAS 

    Google Scholar 

18. Rosenberg AM, Oen KG: The relationship between ocular and articular disease activity in children with juvenile rheumatoid arthritis and associated uveitis. Arthritis Rheum 1986, 29:797.

    Article 
    PubMed 
    CAS 

    Google Scholar 

19. “>

    Southwood TR, Ryder CA: Ophthalmological screening in juvenile arthritis: should the frequency of screening be based on the risk of developing chronic iridocyclitis? Br J Rheumatol 1992, 31:633.

    Article 
    PubMed 
    CAS 

    Google Scholar 

20. Kanski JJ: Anterior uveitis in juvenile rheumatoid arthritis. Arch Ophthalmol 1977, 95:1794.

    PubMed 
    CAS 

    Google Scholar 

21. O’Brien JM, Albert DM: Therapeutic approaches for ophthalmic problems in juvenile rheumatoid arthritis. Rheum Dis Clin North Am 1989, 15:413.

    PubMed 

    Google Scholar 

22. Foster CS, Barrett F: Cataract development and cataract surgery in patients with juvenile rheumatoid arthritisassociated iridocyclitis. Ophthalmology 1993, 100:809–817.

    PubMed 
    CAS 

    Google Scholar 

23. Brewerton DA, Caffrey M: Acute anterior uveitis and HLA27. Lancet 1973, 2:994.

    Article 

    Google Scholar 

24. Linssen A: B27+ disease versus B27-disease. Scand J Rheumatol 1990, 87:111.

    Article 
    CAS 

    Google Scholar 

25. Nusenblatt RE, Whitcup SM, Palestine AG: Uveitis Fundaments and Clinical Practice. St Louis: Mosby; 1996:270–273.

    Google Scholar 

26. Spaeth GL: Corneal staining in systemic lupus erythematosus. N Engl J Med 1967, 276:1168.

    Article 
    PubMed 
    CAS 

    Google Scholar 

27. Gold DH, Morris DH, Henkind P: Ocular findings in systemic lupus erythematosus. Br J Ophthalmol 1972, 56:800.

    Article 
    PubMed 
    CAS 

    Google Scholar 

28. Stafford-Brady FJ: Lupus retinopathy: patterns, associations, and prognosis. Arthritis Rheum 1988, 31:1105.

    Article 
    PubMed 
    CAS 

    Google Scholar 

29. Foster CS: Systemic lupus erythematosus. In Principles and Practice of Ophthalmology. Edited by Albert and Jakobiec. Philadelphia: WB Saunders; 1999:4563. This chapter summarizes clinical findings of systemic lupus erythematosus and its ophthalmic findings in detail.

    Google Scholar 

30. Kearns TP: Collagen and rheumatic diseases: ophthalmic aspects. In The Eye and Systemic Disease. Edited by Masolf FA. St Louis: Mosby; 1975:105.

    Google Scholar 

31. “>

    Rynes RI, Mika P, Bartholomew LE: Development of giant cell (temporal) arteritis in a patient “adequately” treated for polymyalgia rheumatica. Ann Rheum Dis 1977, 36:88.

    Article 
    PubMed 
    CAS 

    Google Scholar 

32. Hollenhorst RW, Rown JR, Wagener HP, Shick RM: Neurologic aspects of temporal. Neurology 1960, 10:490.

    PubMed 
    CAS 

    Google Scholar 

33. Afshari NA, Afshari MA, Lessell S: Temporal arteritis. Int Ophthalmol Clin 2001, 41:151–158. This paper summarizes temporal arteritis and its ocular findings.

    Article 
    PubMed 
    CAS 

    Google Scholar 

34. Huston KA, Hunder FF, Lie JT, et al.: Temporal arteritis: a 25-year epidemiological, clinical and pathologic study. Ann Intern Med 1978, 8:162.

    Google Scholar 

35. Bullen CL, Liesegang TJ, McDonald TJ, et al.: Ocular complications of Wegener’s granulomatosis. Ophthalmology 1983, 90:279.

    PubMed 
    CAS 

    Google Scholar 

36. Fauci AS, Haynes BF, Katz P, Wolff SM: Wegener’s granulomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years. Ann Intern Med 1983, 98:76–85.

    PubMed 
    CAS 

    Google Scholar 

37. Wise GN: Ocular periarteritis nodosa. Arch Ophthalmol 1952, 47:1–11.

    Google Scholar 

38. Moore GJ, Sevel D: Corneo-scleral ulceration in periarteritis nodosa. Br J Ophthalmol 1966, 50:651–655.

    Article 
    PubMed 
    CAS 

    Google Scholar 

39. “>

    Purcell JJ, Birkenkamp R, Tsai CC: Conjunctival lesions in periarteritis nodosa. Arch Ophthalmol 1984, 102:736.

    PubMed 

    Google Scholar 

40. Dolan DL, Lemmon GB Jr, Teitelbaum SL: Relapsing polychondritis chondritis. Am J Med 1966, 41:285–299.

    Article 
    PubMed 
    CAS 

    Google Scholar 

41. Zeuner M, Straub RH, Rauh G, et al.: Relapsing polychondritis: clinical and immunogenetic analysis of 62 patients. J Rheumatol 1997, 24:96–101.

    PubMed 
    CAS 

    Google Scholar 

42. Isaak BL, Liesegang TJ, Michet CJ Jr: Ocular and systemic findings in relapsing polychondritis. Ophthalmology 1986, 93:681–689.

    PubMed 
    CAS 

    Google Scholar 

43. “>

    Messmer EM, Foster CS: Vasculitic peripheral ulcerative keratitis. Surv Ophthalmol 1999, 43:379–396. This paper describes in detail the clinical findings and management of vasculitic conditions such as rheumatoid arthritis, systemic lupus erythematosus, WG, RP, and PAN associated with peripheral ulcerative keratitis, as PUK may be the first sign of systemic necrotizing vasculitis.

    Article 
    PubMed 
    CAS 

    Google Scholar 

44. Bhisitkul RB, Foster CS: Diagnosis and ophthalmological features of BehÇet’s disease. Int Ophthalmol Clin 1996, 36:127.

    Article 
    PubMed 
    CAS 

    Google Scholar 

Download references

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   Natalie A. Afshari MD, Mehran A. Afshari MD, MPH & C. Stephen Foster MD, FRCS

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Costochondritis: Causes, symptoms, and treatment

Costochondritis is an inflammation of the cartilage connecting the ribs to the breastbone. It can cause a stabbing, burning, or aching pain in the chest wall, especially around the second to fifth ribs. Coughing and a blow to the chest are among the causes.

The ribs are connected to the breastbone by tough, protective tissue called cartilage. When this cartilage becomes inflamed, the condition is known as costochondritis or chest wall pain.

While this condition is usually temporary, it can be alarming, as the pain can become so significant it mimics a heart attack.

Doctors may also refer to costochondritis as costosternal syndrome or costosternal chondrodynia. The condition will usually resolve on its own with home treatments.

Fast facts on costochondritis

• In many cases, doctors do not know what causes costochondritis.
• Pain in the chest and breastbone area is the chief symptom of costochondritis.
• The pain may be so severe that the person feels they are having a heart attack.
• Treatment includes anti-inflammatory medications.

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Share on PinterestUsually costochondritis will resolve itself with home treatment, and is a temporary condition.

Though causes are often unknown, in some instances, the condition can be the result of one or more of the following:

• history of an illness that causes a lot of coughing
• heavy lifting or strenuous exercise, involving the upper extremities and chest wall
• carrying heavy bags, such as a heavy backpack on one side or the other
• having large breasts
• history of chest injuries or chest infections
• undergoing surgery that affects the chest wall, such as cardiac bypass

Doctors call costochondritis that has no known causes idiopathic costochondritis.

Chest discomfort and pain may be stabbing, burning, or aching in nature. The ribs most affected are the second to fifth ones.

The condition most commonly affects those older than age 40, according to an article in the journal American Family Physician. An estimated 13-36 percent of those who seek emergency medical attention for chest pain are experiencing costochondritis.

The following activities usually worsened the pain associated with costochondritis:

• significant amount of coughing
• strenuous exercise
• physical activity using the upper arms, such as lifting boxes

The pain associated with costochondritis usually occurs on the left side of the body but can affect both sides.

Tietze syndrome

There is a variation of costochondritis called Tietze syndrome. This condition causes pain associated with costochondritis, as well as swelling of the rib cartilage.

The swelling of Tietze syndrome affects at least one of the upper four ribs, usually the second or third ribs. While the pain associated with costochondritis may subside with time, some people with Tietze syndrome will still experience the swelling.

Although doctors have not defined how prevalent this condition is, they do consider it to be a rare disorder. Other than pain and discomfort, it does not cause any long-term harmful effects.

Share on PinterestThe symptoms of costochondritis can be worsened by certain activities, such as lifting heavy objects, or strenuous coughing.

Doctors usually treat costochondritis conservatively. Resting and avoiding strenuous exercise that affects the chest wall can help. So can over-the-counter pain relievers, such as ibuprofen or acetaminophen.

Children under age 18 should not take aspirin due to the increased risk for Reye’s syndrome.

In rare instances, a doctor may recommend injections of lidocaine or corticosteroids to reduce pain and inflammation. Other treatments that may help to relieve chest pain include:

• Applying moist heat by way of warm compresses.
• Taking cough suppressants to ease coughing and reduce pressure to the cartilage.
• Physical therapy to ease tension in the chest wall.

If these treatments do not reduce a person’s incidence of costochondritis, they should seek a follow-up with their doctor.

If a person is having chest pain, they should not try to determine for themselves if it is a heart-related issue or costochondritis. Instead, they should seek immediate medical attention.

If a younger person who is not at risk of heart attack experiences these symptoms, they should seek emergency attention if their chest pain is sharp and does not improve with rest.

If someone has gone to a doctor for their symptoms and has been diagnosed with costochondritis, there are still some instances when a person should seek immediate medical attention again. These include:

• feeling faint, dizzy, or lightheaded
• feeling as if the heart is beating irregularly or too fast
• pain that worsens over time or cannot be relieved by pain medicine
• having a shortness of breath
• a fever that is higher than 100. 4 °F in an adult
• coughing up dark-colored sputum or blood

If the chest pain is radiating to the arms, neck, shoulder, jaw, or back, a person should seek immediate medical attention.

Share on PinterestSome conditions may seem similar to costochondritis, including an injured shoulder or neck, or arthritis of the surrounding joints.

Doctors often diagnose costochondritis by ruling out other potential causes of the chest pain and discomfort connected with the condition. For example, if a person is older than 35, a doctor may first want to rule out coronary artery disease (CAD), as a potential cause.

Individuals who are at risk of CAD, such as those with a family history, those who are obese, or those with a history of smoking, should usually have an electrocardiogram (ECG or EKG) and chest X-ray to check for CAD.

Other medical conditions that may closely resemble costochondritis include:

• arthritis of the shoulder or nearby joints
• chest wall infections or cancer
• fibromyalgia, a condition that causes nerve pain
• slipping rib syndrome, when there is too much mobility in the cartilage supporting the ribs
• injuries to the shoulder or neck that causes pain to refer or travel to the chest wall

A physical examination to detect tenderness of the cartilage to the touch may also be performed. If a person is having a heart attack or has another type of heart condition, the cartilage in the chest is not usually sensitive to the touch.

A doctor will also listen to the heart and lungs, as well as examine the skin for any signs of infection. An X-ray or other imaging studies will not show signs of costochondritis.

Doctors can usually diagnose a child, adolescent, or young adult by asking questions about their medical history and by conducting a physical exam. The doctor will often check for tenderness in the chest cartilage, as part of this.

According to American Family Physician, costochondritis can last anywhere from a few weeks to months. It may also recur if it has been caused by physical exercise or strain.

The condition does not usually last longer than one year. However, adolescents with costochondritis can sometimes have a longer period of symptoms.

Secrets of Comandante Women, wealth and style of Fidel Castro : Phenomena: Values: Lenta.

ru

Lenta.ru continues a series of articles about the life of dictators. Last week we covered Jean-Bedel Bokassa. This time we will talk about the commandant from the Island of Freedom. Many hated him, many loved him, but no one was indifferent to Fidel Castro. Americans saw him as a ruthless dictator who would stifle any dissent. In the Soviet Union, his image was always surrounded by a romantic halo, and this veil has not dissipated until now: no matter what the commandant does, no matter what mistakes he makes, he always remained our friend. What secrets did Castro hide, Lenta.ru found out.

Secret life

“Comandante was God to me. I was always ready to die for him. However, everything changed when I once heard his conversation with Colombian drug dealers,” the book “The Double Life of Fidel Castro” begins with these words, the reaction to the publication of which could be compared to the effect of an exploding bomb.

Its author, former bodyguard of the Cuban leader Juan Reinaldo Sanchez, who served as Comandante for 17 years, fled in 2008 from Liberty Island to Mexico and from there to the USA. He said that the leader of the Cuban revolution had a lot of real estate. In particular, he owned the private island of Cayo Piedra. There, he had at his disposal a private villa with ivory-decorated furniture, a turtle breeding farm and a personal dolphinarium. Fidel Castro’s estate in Havana had its own medical center, basketball court, private jetty, and even a rooftop bowling alley.

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When Forbes ranked the ten richest dictators in 2006, Comandante Fidel was on the list. The publication claimed that his fortune is estimated at 900 million dollars. Castro himself launched into an angry tirade, promising to bring to justice all those responsible for spreading filthy slander. Comandante claimed that the figure given by the Western media is real – 900, but not millions and not dollars, but pesos (about $ 43) per month. Castro claimed to live the same way as the rest of the Cubans. From the real estate he has – a “fisherman’s hut” and an ordinary apartment in Havana. “This is a lie, in this hut he only receives those who come to him on official visits, in fact, he lives in a huge villa outside the city,” says Sanchez.

In total, a fugitive bodyguard counted twenty luxury properties from the leader of the Cuban revolution. Comandante sailed to his private island on his own yacht Aquarama II. According to the bodyguard, valuable species of Angolan wood were used in the design of its interiors. That’s just about how this yacht ended up at the disposal of the Cuban leader, conflicting information comes. According to one version, this is a gift from Soviet leader Leonid Brezhnev. According to another, Castro bought it himself.

It’s no secret that the Soviet leaders liked to send presents to the Comandante. In Castro’s garage there was an open ZIL-111V car donated by Nikita Khrushchev, as well as an army SUV GAZ-69. However, foreign cars were also present in the fleet. Castro’s bodyguard claims that the leader of the Cuban revolution loved his Mercedes most of all.

As for clothes, usually in his youth Castro appeared in public in a military jacket and cap with a wide khaki peak. At an advanced age, he began to wear a tracksuit. However, this does not mean at all that he did not like expensive accessories, says Sanchez. According to him, the Comandante had a large collection of luxurious Swiss Rolex watches. Yes, at 19In 63, during a visit to the Soviet Union, two expensive Rolexes flaunted on Castro’s hand at once. However, then the journalists were explained that it was only a necessary measure: one of the clocks showed Havana time, others – Moscow time.

Fidel Castro’s visit to Moscow in 1963. Khrushchev and Brezhnev are in the same car with him

Photo: Central Press / Hulton Archive / Getty Images

The book also said that the Comandante neglected Cuban rum produced in the country, preferring Scotch whiskey. True, the locals loved cigars: whatever one may say, there are no better Cuban cigars. At the same time, he allegedly kept valuable Angolan diamonds in a cigar box.

Castro could lead such a luxurious life in secret from completely subordinate ordinary Cubans, according to his deserter guard, on the money he received from the smuggling of cocaine and marijuana. For drug traffickers, Cuba was a transshipment point: drugs came from Latin America and were then transported to the United States. Sanchez is sure that the Comandante personally led this process on the island. Drug dealers, with his blessing, floated drugs to Florida, came to Castro to share the proceeds.

Our man in Havana

Fidel Castro came from a relatively wealthy white plantation family. Unlike many of his associates, who lived in poverty since childhood, he was imbued with leftist ideas only at the law faculty of the University of Havana. Avidly reading the works of Stalin, Lenin and Trotsky, he began to participate in demonstrations in front of the American embassy, ​​to defend poor peasants in court. Castro tried to overthrow the Dominican dictator Trujillo, but did not succeed. Finding himself quite by accident in the capital of Colombia, Bogotá, during the uprising, he realized two things: what terrible power the people’s anger can have and how quickly it will fade if there is no one to lead the people.

In the early 1950s, the dictator Fulgencio Batista came to power in Cuba as a result of a coup. Castro and his comrades tried to provoke an uprising against Batista, but the operation failed. The court sentenced the future commandant to 15 years in prison. At the trial, he delivered his famous, later disassembled into quotes, speech, ending it with the words: “History will justify me.” However, the Batista regime turned out to be too complacent towards dissidents: two years later, Fidel was able to leave under an amnesty.

Once free, Castro left for Mexico. There, he immediately began to gather a detachment of supporters to go to Cuba already in arms. In 1956, he returned with a handful of supporters on the motor yacht Granma and in a few months was able to seize power in the country. In his political program “Manifesto Number One”, he proclaimed the transfer of land to the peasants, industrialization, the nationalization of industry and free education. Once in power, Fidel naturally and quickly quarreled with the United States, made friends with the Soviet Union, and also shook up the whole of Cuba, building a “state of justice” on the island – in his understanding, of course.

Cigars in a box signed by Castro’s hand were sold at Julien’s auction house in New York

Photo: Brendan McDermid / Reuters

According to eyewitnesses, Castro was an amazing person: he could ignite the crowd from the first words and then keep them for hours her attention. In this case, the commander, of course, was not a pacifist and did not differ in a complacent attitude towards dissidents, which cost Batista’s power. After the communists came to power in Cuba, thousands (and according to Castro’s opponents, tens of thousands) of his political opponents, rebellious peasants and supporters of the Batista regime were shot.

The new government had to be defended: for example, in 1961, the famous operation in the Bay of Pigs took place, when, with the support of the Americans, 1.5 thousand troops of Cuban emigrants who had undergone military training in camps in Nicaragua landed on the coast of Cuba. Apparently, this was a “reconnaissance in force” organized by the United States: when they saw in America that the landing force was defeated by the Cubans under the leadership of the commandant, who, like Chapaev of the new era, himself flew into the attack “on horseback” on a Soviet self-propelled gun, they retreated. At 19In 1962, the Americans demanded the imposition of sanctions against Cuba, but things did not go beyond economic pressure: the USSR, represented by Khrushchev, quite convincingly brandished missiles with atomic warheads, thus resolving the Caribbean Crisis.

Fidel Castro was repeatedly tried to kill: according to the Americans, there were about a hundred attempts, the Cubans counted over 600. They tried to kill him with bullets, poison and explosives, which were supplied by the agents of the US Central Intelligence Agency. However, excellent health and fate kept the commandant.

During the years of Fidel Castro’s rule, the stratification of society has reached catastrophic proportions. Only those who are connected with the tourism industry (including men and women involved in prostitution and human trafficking), as well as representatives of the ruling elite, have led and lead a normal life on the island. At the same time, as promised, Castro introduced free medicine and education; in Soviet times, some young Cubans studied in the USSR.

Recently, Cuba has been gradually changing. Cubans now have mobile phones with Internet access, not only American rarities of the 50s and 60s (under Fidel, the population could only own cars produced before Castro came to power) and Soviet Zhigulis now drive through the streets, but also modern cars decent quality.

One of the most significant historical figures of the 20th century, Fidel Castro, died in 2016 at the age of 90. He retired from business 10 years earlier, transferring authority to his younger brother Raul, who had previously been his right hand and confidant. In many countries, especially in Latin America, Castro, even after his death (and a very noisy funeral that turned into an international event), continues to be an idol. The debate about who he was: a bloody dictator or a great and almost disinterested fighter against American imperialism will probably not subside for a very long time.

Castro banned the erection of monuments to himself, but remained a symbol of the Cuban Revolution

November 25, 2017, 14:01

Death of Fidel Castro

November 25 marks the one year anniversary of the death of the leader of the Cuban Revolution, Fidel Castro. The politician, whose biography is surrounded by many legends, passed away at the age of 90. The debate between those who share Castro’s ideals and those who blame the late Comandante for the hardships that befell his fellow citizens is unlikely to ever subside. However, the scale of Fidel’s personality is recognized even by his ill-wishers. To remain in history, he did not need monuments. How Cubans said goodbye to the former leader of their country, what he spoke about religion a few days before his death, and why the square named after him is located in Moscow, and not in Havana – in the TASS material.

A thousand kilometers and thousands of people

The history of the Cuban Revolution is rich in vivid symbols. The Granma yacht, which brought the Castro brothers with their guerrilla comrades-in-arms to the island, their olive-colored uniform, a photograph of Ernesto Che Guevara in a beret with a five-pointed star, and even Fidel’s beard – all this is remembered as soon as it comes to the events of those years. A year ago, the former Cuban leader, who led the country for a little less than half a century, ceased to be our contemporary, but remained, perhaps, the main symbol of the political system operating in the Caribbean state.

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Farewell to Castro in late November – early December 2016 revived the memory of the first triumphant days of the revolution. After leaving Havana and driving more than a thousand kilometers, the funeral procession with the ashes of the former Cuban leader arrived at his burial place in the city of Santiago de Cuba, along the same route that in January 1959 the rebel army led by the legendary Comandante made a victorious procession after the overthrow of the dictatorship of Fulgencio Batista. Only this time the movement was in the opposite direction. On the way of the cortege he was met – and seen off – by hundreds of thousands of Cubans of all ages. Among them were ardent supporters of Castro, who considered it necessary to personally say goodbye to the leader of the Cuban Revolution, and people who simply did not want to miss an undeniably historic event.

The former head of the island state was buried on December 4, 2016 in the ancient cemetery of Santa Ifigenia. The necropolis located in Santiago de Cuba is known as the burial place of prominent figures of Cuban history – in particular, its main national hero Jose Marti (1853-1895) is buried there – a poet, thinker and leader of the struggle for independence from Spain. The urn with the ashes of Castro was placed in a rectangular cavity in a rounded gray stone. After that, the hole was covered with a dark green plate on which only one word was placed – “Fidel”. According to the weekly Trabajadores, from December 2016 to the middle of this month, about 600 thousand people visited the grave of Castro.

“It seemed to me that Fidel was immortal”

A few days after Castro’s death, the Cuban state television broadcast for the first time the song “Fidel’s Last Journey” (a free translation from the Spanish Cabalgando con Fidel – TASS note), dedicated to the memory of the late leader. During the official mourning, which lasted nine days, this song could be heard almost every hour. For many who visited Cuba before the Comandante’s funeral, one of the strongest impressions was precisely this melody and video clip, which was created using archival footage from half a century ago. “We used to consider you eternal,” four young performers sang to the accompaniment of a chamber orchestra.

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More confusedly and in slightly different words, many residents of Cuba repeated the same idea. “I heard about this [Castro’s death] from people on the street, and my first reaction was surprise. I thought it was not true,” Barbaro Farias, a resident of the Cuban city of Trinidad, told a TASS correspondent. “Fidel was such an impressive, such an important figure for us that at a certain moment it seemed that he was immortal, you know? That is why it was hard to believe what happened,” he added.

Rumors that Castro supposedly died were spread countless times during his long life. It is not surprising that the Cubans, who learned the news of the Comandante’s death not from official sources, but from their relatives and acquaintances, at first took it with disbelief. “I couldn’t believe it until it became obvious that this was not false news. Everyone was talking about it,” recalled Laritsa de Armas Perez, a high school teacher from Sancti Spiritus province.

Her neighbor Daimy Gonzalez heard about Castro’s death from her father. “In the morning he went out for bread and returned with a completely crazy look. That day he didn’t even work in the field, although he really likes it. It was too shocking what happened,” she said.

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“It seemed to me that Fidel is immortal. Although I never met him personally, but his presence was always felt. It was very difficult for me and “I think all of our people should believe that he is no more. It still seems to me that this is not true. I will never get used to the idea that Fidel is dead. Although already old, and Raul [Castro in 2006] replaced him [at the head of the Council of State and the Council of Ministers of Cuba], but Fidel was still our “commander in chief. ” We were not ready for this loss,” she added.

According to Gonzalez, she felt as if she had lost someone close to her. “For me, Fidel was an idol. Since the time when my grandfather talked about him, about everything he did. He was always where he was needed and where it was dangerous, where there was a war or a hurricane. When something bad happened, he was always with the people,” she said. And then she thought and added: “And he was so handsome!”

A man, not a monument

Castro himself did not consider himself immortal and spoke quite calmly about the possibility of passing away. “Soon I’m going to be 90 years, the thought of this would never have crossed my mind, and it was not the result of any effort, but only a whim of fate. Soon I will suffer the same fate as everyone else. One day, the turn of each of us will come … “, – he said, speaking at the closing of the congress of the Communist Party of Cuba in April 2016. These words were later called almost prophetic by supporters of the leader of the Cuban revolution. But, most likely, the point is only that, in the twilight of his life, Castro retained his sanity and a realistic attitude towards himself.0003

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The former Cuban leader did not want to be immortalized in bronze or granite. His brother, Chairman of the State Council and the Council of Ministers of Cuba, Raul Castro, speaking at a rally in memory of the Comandante the day before the funeral, said that the deceased asked not to be named after the square and the street, and also not to erect monuments in his honor. “The leader of the revolution rejected any manifestations of the cult of personality and was consistent in this matter until the last hours of his life,” – this is how the head of the island state explained the will of the deceased.

Later, deputies of the National Assembly of People’s Power (unicameral parliament) of Cuba adopted a special law that regulates the use of the name and image of Fidel Castro. The document prohibits naming institutions, squares, parks, streets, avenues and other public places after the leader of the Cuban Revolution, as well as including his name in the title of prizes and awards. The use of the image of Fidel Castro in the construction of monuments, busts, statues and commemorative plaques has also been outlawed.

However, despite the Comandante’s last will, at least one public space named after him nevertheless appeared – only not in Cuba, but in Moscow. Fidel Castro Square is located in the Russian capital at the intersection of 2nd Peschanaya and Novopeschanaya streets. On March 1, 2017, a corresponding sign was installed there. In the same area is the street of Salvador Allende – President of Chile (1970 – 1973), who was a friend of Castro. Nearby is also a street named after another staunch supporter of socialist ideas – Venezuelan President Hugo Chavez (1999 – 2013). In addition, there is a complex of CSKA buildings nearby – during one of his visits to Moscow, Castro attended a hockey match with the participation of this club and cheered for it.

“The obscure fate of the human race”

In the last years of his life, Castro rarely appeared in public, but his articles were regularly published on the pages of the Gramna newspaper, the official publication of the Communist Party of Cuba. The last material signed by the Comandante was released on October 9, 2016 under the heading “The Unclear Fate of the Human Race”. In his opinion columns, the leader of the Cuban Revolution often addressed issues of international politics and science, but he devoted this article almost entirely to religion.

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“Religious principles contain more positive aspects than purely political ones, despite the fact that the latter formulate life ideals of the physical and material plane. In addition In addition, many of the most inspired works of art were created by the hands of religious people, and this phenomenon is universal,” Castro noted in his message and added that he devoted a lot of time to studying biblical stories.