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Swollen lymph nodes rheumatoid arthritis: Are Your Swollen Glands a Symptom of RA? Signs and Symptoms

Rheumatoid Arthritis and Lymphoma: What’s the Link?

Sure, it’s scary to see an ad on TV that says your RA drugs might make you more likely to get lymphoma, a type of cancer in your lymph nodes. But that’s not something for most people to worry about, says Eric L. Matteson, MD, chair of rheumatology at the Mayo Clinic in Rochester, MN.

“The majority of this risk is related to RA, rather than the drug,” Matteson says. The disease increases the activity in your white blood cells and changes how they interact with bacteria or viruses, like the Epstein-Barr virus, in your blood. That’s what puts you at a slightly higher lymphoma risk.

Take Your Meds

Scientists have studied the links between RA drugs and lymphoma. They found that people with very active disease had a higher risk. Those whose RA was well controlled were less likely to get it.

Your drugs will help you stay healthy and active, Matteson says. “I tell patients that the benefits of their medications on disease control, quality of life, length of life, and long-term RA complications far outweigh these cancer risks.

What’s the Link?

If you have RA, you’re twice as likely to get non-Hodgkin’s lymphoma as someone without the disease. But even then, it’s “is still really rare,” says Vivian Bykerk, MD, a rheumatologist at the Hospital for Special Surgery in New York.

So what’s the connection for people with RA?

“The answer is simple. Inflammation,” says John J. Cush, MD, director of clinical rheumatology at the Baylor Research Institute in Dallas. “In some studies, we see that the worse the RA, the more inflammation and greater the risk of cancer.”

If your RA is severe and you’re not managing it well, or if you’ve had the disease for many years, you’re more likely to get lymphoma. But the chance of cancer goes up with age even in people who don’t have RA.

What Are the Signs?

If you’re worried about lymphoma, have an honest conversation with your doctor, says Amanda Niskar, scientific director of the Arthritis Foundation.

Continued

Lymphoma is just one disease that can come along with RA. Don’t overlook other, more common health problems like heart disease, she says.

Some signs of lymphoma to watch for:

If you have these, or if a test leads your doctor to think you might have lymphoma, they’ll probably refer you to a specialist for more information and tests. Make sure you get regular checkups as well as cancer screening tests like a colonoscopy or Pap smear, Cush says.

If you have a family member who had lymphoma, that doesn’t increase your risk of getting it and shouldn’t deter you from taking your RA drugs.

“These diseases are not that closely genetically linked,” Cush says.

What is adult-onset Still’s disease (AOSD)?

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Adult Onset Still’s Disease (AOSD) is an auto-immune disease. The condition affects the joints and internal organs and has some symptoms and treatments in common with RA.  

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Case History 

Ruth was a 24-year-old postgraduate student who had come from the USA to Oxford to do research. She had been fit and well with no serious childhood illnesses and no family history of any significant diseases. She had participated in sport and enjoyed dance. Ruth woke up one morning with a high temperature, a sore throat and muscle pains. Both she and her GP, whom she consulted, considered that she had a bout of flu. She took paracetamol and drank plenty of fluids. By the mid-afternoon, her temperature had resolved, and she felt somewhat better. This pattern of high fever and pains repeated, and for the next 10 days, Ruth was unable to work. The fever seemed to be worse in the afternoon or evening. Her muscles continued to feel painful and were worse with the fever, and her joints became uncomfortable, particularly her wrists and knees. She also noted a pale pink rash which seemed much worse when she had her fever. Her GP found that she had numerous swollen lymph glands, particularly in her neck and under her arms. Ruth lost her appetite and lost weight. By day 10 of her illness, she was admitted to hospital with a “fever of unknown origin”. In hospital, it was found that she had swollen joints, a high swinging fever and blood tests that were consistent with severe inflammation. The Rheumatology specialists were called, and a diagnosis of Adult-Onset Still’s Disease was made. 

Introduction 

Adult Onset Still’s Disease (AOSD) is an auto-inflammatory disease. This means that the inflammation is generated by a disturbance in immune function. The immune system generates inflammation, without the usual stimulus to inflammation, such as infection or injury. The condition affects the joints and internal organs. It is usually present before the age of 40 years. Women are slightly more commonly affected than men. There are no known risk factors, and there is usually no family history. Occasionally a virus may trigger the illness; however, a sore throat is also a symptom of the illness, and therefore there may be confusion over whether this is the cause or the start of the illness.  

Symptoms of Adult Onset Still’s Disease 

The main features of this condition are fever, joint pains and rash. It is not uncommon, though for the arthritis to not be present at the start of the illness. The patient may simply be very unwell with very high levels of inflammation in their blood, and no other cause found. It is for this reason that patients with AOSD often present to the ‘infectious diseases’ department. The fever comes on quickly, usually once a day in the afternoon or evening and then spontaneously resolves, often going below normal. The temperature may be associated with flushing. The rash, which often but not always accompanies the fever is a salmon pink, blotchy, non-itchy rash. It can, however, mimic many other rashes and on occasion may be itchy and appear like raised lumps. It is often on the upper arms, abdomen and thighs. When the patient has a fever, they feel very miserable, with a headache, severe muscle pain and often a very sore throat. Serositis, which is inflammation of the lining of the lungs (pleura), the lining of the heart (pericardium) and lining of the abdominal cavity (peritoneum) may occur. This would account for severe chest pain, particularly when taking in a deep breath. The lymph nodes, which are swollen and tender, are often widespread. This may suggest the possibility of lymphoma (cancer of the lymph nodes). Biopsy of the lymph nodes shows only reactive changes and no evidence of cancer. Other diagnoses which need to be excluded include rare infections and inflammatory bowel disease. If the joint symptoms present early, then it is less likely there will be a diagnostic delay.  

Diagnosing the condition 

Blood tests such as ESR and CRP confirm a high level of inflammation. Other rheumatoid arthritis tests, such as rheumatoid factor and anti-CCP antibody, as well as the other auto-antibodies, are all negative. Very often, the full blood count will show a high white blood cell count and platelet count, but there will be anaemia (low haemoglobin). This is because the high level of inflammation suppresses the manufacture of red blood cells and the utilization of iron in the marrow. In contrast, the ferritin, which is the iron storage protein, will be very high, and this is often used as a diagnostic test. X-rays of the joints in the early stage are very unlikely to show any abnormality. Although joint swelling can be seen on x-ray, ultrasound would be more useful as a test to visualize inflammation of the joints. A chest x-ray may show an enlarged heart due to inflammation of the heart lining and because there may be fluid around the heart, which can also appear in the lung cavity. The spleen, which is essentially a big lymph node, can be enlarged. 
 
Once the diagnosis has been made, treatment needs to be commenced in order to relieve symptoms and suppress inflammation. This is important because it helps the patient to feel better but also so that damage to the joints can be prevented. It is very difficult in the early stages to predict the course of the illness. A third of patients will have a mono-phasic illness. This means that the illness lasts a few months and then fades away with treatment and does not recur. A third of individuals will have a relapsing course with intermittent flare-ups over subsequent years. These flare-ups are often less severe than the first episode. A further third of individuals, however, will have a disease course which lasts a long time. They will require major immuno-suppressant drug therapy for control, and there may be some effect on major organs. The joints that are involved are similar to those affected in rheumatoid arthritis, and once the fevers and rashes have settled it may be difficult to differentiate the rheumatoid “hand” from an AOSD disease “hand”. The wrists are predominately involved as well as the small joints. Occasionally early damage to a large joint such as the hip may occur. This may in part be due to the very high doses of steroids that were used to control the inflammation at the start of the illness (as steroids can cause osteoporosis if used in high doses/for long periods of time).   
 
There is much research underway to understand the mechanism behind the auto-inflammatory disease and what generates the inflammation. It is known that high levels of the inflammatory proteins interleukin-1 and interleukin-6 are present. The biological agents (monoclonal antibodies to these proteins) such as anakinra and tocilizumab are consequently used increasingly for the treatment of this condition. 

Treatments 

Early treatment is aimed at controlling the symptoms of fever and arthritis with anti-inflammatory drugs such as ibuprofen, naproxen and even high dose aspirin. These may be prescribed before the definitive diagnosis has been made. Painkillers such as paracetamol, codeine and tramadol may also be helpful. Corticosteroids such as prednisolone are very often used to control inflammation and fever and to improve anaemia. The anaemia that occurs is not responsive to iron supplementation. When steroids are used, they will often be given with other drugs to help to prevent side-effects. These might include protection against stomach ulcers (omeprazole or lansoprazole) and bone protection to prevent osteoporosis (alendronate and calcium). The aim is to use as low a dose of steroid as possible to control the inflammation, but in the early stages, it is often high doses, often intravenously, that is required. 
 
Due to the long-term impact that steroids can have on the body, the disease will also need steroid-sparing medication for control. Methotrexate which is the most commonly used disease-modifying drug in rheumatoid arthritis, is also used in AOSD. Cyclosporine is also sometimes used to prevent and treat a rare complication of AOSD called macrophage activation syndrome (MAS). This rare complication is associated with a precipitous drop in blood count and can potentially be very serious. Biological therapies that are often used include the anti-TNF agents infliximab and adalimumab and also, tocilizumab and anakinra. Methotrexate is used together with these agents in order to prevent the development of antibodies against these drugs. Once disease control has been achieved, the drugs will be reduced very cautiously. It is usually not possible to predict outlook until at least 1 year after the onset of disease. 
 
For some of these drugs, monitoring, in the form of regular blood tests may be required to check for potential side-effects. 
 
Once the disease is controlled and the individual feels well again, there is no reason why they should not be able to work and function extremely well in everyday life. The steroids may have caused some side effects such as weight gain and mood change, but this will reduce and disappear as the steroid dose is tailored down. 

Conclusion 

As with all chronic illness, and particularly this disease, which has such an impact when it hits, frustration and low mood may occur and much understanding, support and encouragement will be needed for the patient and their family. Low self-esteem and self-consciousness are not unusual when individuals have put on weight due to the steroids, missed work or education and feel excluded from life. It takes time to “recalibrate” and this is important to recognize. The transition from being a healthy individual to being one who needs to take tablets, attend hospital appointments and have life-adjustments needs to be taken into account. 

Further reading 

NRAS article on osteoporosis 
NRAS article on Disease Modifying Anti-Rheumatic Drugs (DMARDs) 
NRAS booklet on biologic drugs 

Still’s disease causes 

Updated: 20/05/2019

Next review: 20/02/2019

Increased Risk of Lymphoma With Rheumatoid Arthritis

An increased risk of lymphoma has been associated with rheumatoid arthritis (RA). Various studies have linked the two conditions but it has never been completely clear whether disease activity or the treatments used to battle rheumatoid arthritis cause the increased risk of lymphoma. Research is ongoing but some studies have shed light on the problem.

 SoumenNath / Getty Images

Lymphoma Risk In RA Patients

Lymphoma is cancer of the lymphatic system (lymph nodes, spleen, and other organs of the immune system) that starts in white blood cells (leukocytes). The connection between an increased risk of lymphoma in rheumatoid arthritis patients concerns researchers, doctors, and patients.

Here’s what current research tells us:

RA patients have twice the lymphoma risk as the general population. Still, the percentage of RA patients who develop lymphoma is low. In one study of nearly 125,000 Europeans with RA, only 533 lymphoma cases were reported.

An older Swedish study had similar results, looking at 75,000 RA patients and finding 378 lymphoma cases.

Of the two main types of lymphoma, Hodgkin’s and non-Hodgkin’s, the latter appears to me far more common in RA patients. In the European study, 9 out of 10 lymphoma cases were non-Hodgkin’s.

While the risk for developing lymphoma is higher with RA, once diagnosed, the prognosis for the cancer is no different than the general population.

Lymphoma Causes in RA Patients

Three main theories behind the lymphoma-RA connection have been studied over the years: Genetic predisposition, RA medications, and the disease itself.

For now, there appears to be no genetic cause of lymphoma in patients with RA.

There has been some connection made between certain RA medications and increased lymphoma risk, but the increase is low. One study of 12,656 RA patients found no increase in lymphoma risk from two common RA medications, methotrexate and the “biologic” tumor necrosis factor inhibitors.

The main cause of lymphoma in RA patients appears to be the RA itself.

Research has shown that the more severe the case of RA with high levels of prolonged inflammation, what doctors call the “highest activity,” the greater the lymphoma risk. Chronic high levels of inflammation are to blame, with two types of leukocyte (the lymphocytes B- and T-cells) causing inflammation and eventually becoming malignant in lymphoma.

Or, to quote one study, “The impact of continuing disease activity and immune stimulation appears to be the most significant in lymphomagenesis.”

Early, aggressive treatment of RA is important, as lower inflammation levels mean lower lymphoma risk over time.

Lymphoma Symptoms in RA Patients

People with RA should be vigilant. Lymophoma has specific signs, though it’s impossible to know at what stage the cancer may be until it is diagnosed and staged. The following lymphoma symptoms are common:

  • Swollen lymph nodes in the neck, armpits, or groin, usually not painful
  • Unexplained weight loss (10% or more of body weight over six months)
  • Swollen abdomen (with or without pain, which could be from enlarged spleen or liver, or fluid buildup)
  • Fatigue
  • Chills, fever, or night sweats
  • Early satiety (feeling full after a small amount of food)
  • Shortness of breath and/or cough (possibly from swollen lymph nodes in the chest compressing the trachea)
  • Chest pain
  • Easy bruising

Your doctor will be able to advise you of your lymphoma risk based on how severe your RA is and has been over time, and what steps you can take to mitigate that risk.

Swollen lymph glands (MPKB)

Lymph nodes play a criticial role in removing bacteria, abnormal cells and other matter as part of the immune system reaction to invasion by pathogens.

Lymphadenopathy (enlarged, swollen, or tender lymph nodes) is usually a sign of infection and is quite common in autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis, and sarcoidosis. The |Wikipedia article on lymphadenopathy covers the range of causes. Note the distinction between infection and “autoimmuneA condition or disease thought to arise from an overactive immune response of the body against substances and tissues normally present in the body” disease, one which according to the Marshall PathogenesisA description for how chronic inflammatory diseases originate and develop., is trivial.

Lymphadenopathy can occur anywhere there are lymph nodes. Lymphadenopathy can often be detected by low-tech means: visually or by touch. Lymph nodes deep in the groin or beneath the ribs in the chest can be monitored with imaging such as chest x-ray, CT or PET scan.

Treating chronic disease with the Marshall ProtocolA curative medical treatment for chronic inflammatory disease. Based on the Marshall Pathogenesis. means that symptoms usually get worse before they get better, due to immunopathologyA temporary increase in disease symptoms experienced by Marshall Protocol patients that results from the release of cytokines and endotoxins as disease-causing bacteria are killed.. It is common for lymph nodes to increase in size, tenderness, and/or number as part of the immunopathology of recovery. This is evident when palpated or visible lymph nodes wax and wane with antibiotic administration. As the MP treats the underlying cause of sarcoidosis and lymphadenopathy, it may take many months for lymph nodes to return to normal size (reported to be 1 cm or less).

In the case of sarcoidosis, most patients with lymphadenopathy had tests which ruled out lymphoma (cancer) before they were diagnosed with that illness.

Patients and doctors who do not understand the nature of immunopathology that occurs during the Marshall Protocol may become alarmed when lymph nodes increase in size or do not decrease. Doctors may want to reassure themselves or the patient by doing additional biopsies to, once again, rule out lymphoma. However, this invasive procedure is rarely necessary. Since lymphoma develops very slowly, a “watch and wait” tactic is more appropriate. Slowing down immunopathology or, if necessary, taking a break from the Protocol can also be done if anyone needs immediate reassurance that inflammation is responsible for emergent or increased lymphadenopathy while on the MP.

[After an antibiotic break…] I am also happy to tell you all that the surgeon could not find the node it shrunk from 3.8cm to to small to safely do a punch biopsy. The vacation did it’s job beautifully. The oncologist does not even want me for a follow up.

Hey this thing works.

Bill, MarshallProtocol.com

I was also concerned about the growth of my lymph nodes, as were my oncologist and pulmonologist, from December 2003-February 2004. They felt sure that I had lymphoma from the PET scan and the increased size and number found from numerous CT scans. The mediastinoscopy in February revealed the sarcoidosis. I had already begun Benicar; and after the surgery, I started the minocycline. The rest is history: The Marshall Protocol saved my life!

I had scans after surgery for three 3-month periods and then 6-month periods until last summer, which then became on a yearly basis. When I questioned several times about what “normal” would be, they said that it is usually anything 1 cm or less.

Carole, MarshallProtocol.com

Lumps were one of the big reasons I went to my doc for assistance. No-one seemed to be able to figure out what they were. After I met with my current doc he told me about the MP.

My lumps I think may be a mixture of enlarged lymph glands, lipomas, fat deposits.. .maybe granulomatous fibrosis or scarring. (?) Don’t really know without a biopsy. I guess I’ve come to an uneasy acceptance that it doesn’t matter….MP will hopefully address them all.

Well, during phase I and much of Modified Phase II, which I’m on now (approx 9 months total on MP) has seen an increase in lumps/lymph etc. Often these are very tender for a while, then eventually seem to become painless, though still enlarged or swollen. In the last month I have noticed that the chain of lumps/lymph on my right leg have truly begun to decrease. I didn’t quite believe it at first as it was a very slow process. But they have absolutely become smaller….either getting softer and then fading away or getting smaller and becoming very hard, like the tip of a pin for sewing with those little knobs on top. Then, they seem to get absorbed. This has been SO reassuring to me. Even as I see that I may have more swellng/enlargement throughout MP, as I still am experiencing now in other parts of my body, I can feel reassured that there is a good chance they will eventually dissolve/be reabsorbed/melt away…whatever. Helps much with my anxiety about the whole thing, too. 🙂

SherryH, MarshallProtocol.com

Understanding Sarcoidosis

Nicole Saddic Thomas, MD, FACR

A 40-year-old gentleman came to me complaining of fevers, night sweats,10 pounds unintentional weight loss, and swollen ankles. He had high calcium levels and very high levels of inflammation noted on his blood tests. There were no clear-cut infections to account for the inflammation. To investigate further, I obtained x-rays, which revealed many swollen lymph nodes in his chest. I was concerned about malignant cancer and consulted with hematology/oncology colleagues who shared my concern. We arranged a lymph node biopsy and, fortunately, there was no cancer found. What the lymph node biopsy report did reveal was “sarcoidosis.”

Sarcoidosis is an autoimmune condition that causes the body to form nodules consisting of inflamed tissue, called granulomas, in the body’s organs. Sarcoidosis can affect almost any organ in the body. It usually involves the lungs, but the skin, eyes, nose, muscles, heart, liver, spleen, gut, kidney, nerves, lymph nodes, joints, and brain can all be involved.

We do not know the exact cause of sarcoidosis. The prevailing theory is that there is an environmental trigger in a genetically susceptible person that leads to the development of the disease. Sarcoidosis is not contagious and is more common in African-American, German, Irish, Scandinavian, Asian and Puerto Rican patients. Sarcoidosis generally occurs between the ages of 20 and 40 but can be diagnosed at any age.

Because sarcoidosis can affect so many different organs, it can be challenging to diagnose. The symptoms also may vary depending on the organs involved. Some people may have no symptoms and sarcoidosis only becomes apparent when a routine chest X-ray comes back as abnormal, showing evidence of lymph node swelling from sarcoid involvement. Other patients may experience weight loss, fatigue and fevers. If the lungs
are involved, coughing, breathlessness or chest pain may occur. Patients may experience painful, red eyes or vision loss if sarcoidosis involves the eyes. Skin nodules, ulcers or flat areas of discolored skin can develop in sarcoidosis patients, usually near the nose or eyes, or on the back, arms, legs and scalp. Tender bumps also may appear on the ankles and shins. Sarcoidosis can cause swollen cheeks and dry mouth. It also can cause swollen lymph nodes, sometimes occurring within the chest, but also may occur under the chin, in the armpit area or in the groin. Sarcoidosis also may cause elevated calcium levels or abnormal blood cell counts. Rarely, sarcoidosis may interfere with the heart’s electrical system and cause irregular heart rhythms or affect the brain or nerves causing
neurological dysfunction.

There is no single test to diagnose sarcoidosis and its diagnosis generally depends on the organ system involved. Imaging studies, especially a chest x-ray, can be helpful. A blood test called an ACE (angiotensin converting enzyme) level is used to determine elevated levels related to sarcoidosis. However, it is possible to have sarcoidosis with a normal ACE test and ACE levels also can be elevated due to other conditions, so it’s not a perfect test. If possible, a biopsy of the swollen area is ideal to confirm a diagnosis of sarcoidosis and rule out other causes of swelling such as infections, cancers or other medical conditions.

Because sarcoidosis can affect so many different organs, it can be challenging to diagnose. The symptoms also may vary depending on the organs involved. Some people may have no symptoms and sarcoidosis only becomes apparent when a routine chest X-ray comes back as abnormal, showing evidence of lymph node swelling from sarcoid involvement. Other patients may experience weight loss, fatigue and fevers. If the lungs are involved, coughing, breathlessness or chest pain may occur. Patients may experience painful, red eyes or vision loss if sarcoidosis involves the eyes. Skin nodules, ulcers or flat areas of discolored skin can develop in sarcoidosis patients, usually near the nose or eyes, or on the back, arms, legs and scalp. Tender bumps also may appear on the ankles and shins. Sarcoidosis can cause swollen cheeks and dry mouth. It also can cause swollen lymph nodes, sometimes occurring within the chest, but also may occur under the chin, in the armpit area or in the groin. Sarcoidosis also may cause elevated calcium levels or abnormal blood cell counts. Rarely, sarcoidosis may interfere with the heart’s electrical system and cause irregular heart rhythms or affect the brain or nerves causing neurological dysfunction.

Some people with sarcoidosis require no treatment. If the inflammation is leading to organ damage, corticosteroid medications and sometimes further immunosuppressant medications are needed. Your rheumatologist can help you test for sarcoidosis and determine the best course for you.

For more details visit WashingtonArthritis. com

 

Swollen glands | NHS inform

Swollen lymph glands are usually a sign of infection and tend to go down when you recover. However, they can sometimes have a more serious cause and may need to be seen by a doctor.

Lymph glands (also called lymph nodes) are pea-sized lumps of tissue that contain white blood cells. These help to fight bacteria, viruses and anything else that causes infection. They are an important part of the immune system and are found throughout the body.

The glands can swell to more than a few centimetres in response to infection or disease. Swollen glands, known medically as lymphadenopathy, may be felt under the chin or in the neck, armpits or groin, where they can be found in larger clumps.

Many different types of infection can cause swollen glands, such as a cold or glandular fever. Less commonly, swollen glands may be caused by a non-infectious condition, such as rheumatoid arthritis or even cancer.

When to see your GP

See your GP if you have swollen glands and:

  • they haven’t gone down within a few weeks or are getting bigger
  • they feel hard or don’t move when you press them
  • you also have a sore throat and find it difficult to swallow or breathe
  • you also have unexplained weight loss, night sweats or a persistent high temperature (fever)
  • you don’t have an obvious infection and don’t feel unwell

If necessary, your GP may request some tests to help identify the cause. These can include blood tests, an ultrasound scan or computerised tomography (CT) scan, and/or a biopsy (where a small sample of fluid is taken from the swelling and tested).

Common causes of swollen glands

Swollen glands are usually caused by a relatively minor viral or bacterial infection, including:

The glands in the affected area will often become suddenly tender or painful. You may also have additional symptoms, such as a sore throat, cough, or fever.

These infections usually clear up on their own, and the swollen glands will soon go down. You will normally just need to drink plenty of fluids, rest and relieve the symptoms at home using over-the-counter medicines such as paracetamol or ibuprofen.

See your GP if your symptoms don’t improve within a few weeks.

Less common causes of swollen glands

Less often, swollen glands may be the result of:

  • rubella – a viral infection that causes a red-pink skin rash made up of small spots
  • measles – a highly infectious viral illness that causes distinctive red or brown spots on the skin  
  • cytomegalovirus (CMV) – a common virus spread through bodily fluids, such as saliva and urine
  • tuberculosis (TB) – a bacterial infection spread that causes a persistent cough 
  • syphilis – a bacterial infection usually caught by having sex with someone who is infected
  • cat scratch disease – a bacterial infection caused by a scratch from an infected cat
  • HIV – a virus that attacks the immune system and weakens your ability to fight infections
  • lupus – where the immune system starts to attack the body’s joints, skin, blood cells and organs
  • rheumatoid arthritis – where the immune system starts to attack the tissue lining the joints
  • sarcoidosis – where small patches of red and swollen tissue, called granulomas, develop in the organs of the body

Click on the links above for more information on these conditions.

Could it be cancer?

Occasionally, swollen glands can be a sign of cancer that has started elsewhere in the body and spread to the lymph nodes, or a type of cancer affecting the white blood cells, such as non-Hodgkin lymphoma or chronic lymphocytic leukaemia.

Swollen glands are more likely to be caused by cancer if they:

  • don’t go away within a few weeks and slowly get bigger
  • are painless and firm or hard when you touch them
  • occur with other symptoms, such as night sweats and weight loss

See your GP if your glands have been swollen for more than a couple of weeks. The swelling is probably the result of a non-cancerous condition, but it’s best to be sure by getting a proper diagnosis.

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  • 90,000 Arthrosis-arthritis – treatment, symptoms, causes, diagnosis

    Often, the terms arthrosis and arthritis are confused, and also called arthrosis-arthritis. But these terms have fundamentally different meanings and different diseases. They are united by the root (artron) – meaning joint. Arthritis is an inflammatory disease of the joint (s) and the inflammatory process, in one way or another, affects other organs and systems of the whole body due to autoimmune (for example, rheumatological diseases such as rheumatoid arthritis, SLE) or other disorders.With metabolic disorders (for example, with gout or diabetes mellitus), joints are affected and, in such cases, the term arthropathy is used. The term arthralgia is used to refer to joint pain of various origins. Arthrosis or osteoarthritis means degenerative changes in the joints that occur over the age of 45-50 years due to natural wear and tear. Thus, the fundamental difference between arthritis and arthrosis is that arthritis is an inflammatory disease, while arthrosis is degenerative changes in the cartilage due to involutional changes in the body and natural wear and tear of the cartilage tissue of the joints.

    Arthritis . This term is often used to describe a group of over 100 diseases.

    These diseases can affect joints, muscles, tendons and ligaments, as well as the skin and some internal organs.

    Osteoarthritis is a normal degenerative condition associated with aging. It affects mainly cartilage tissue, which becomes thinner, thicker and loses functionality. Changes in cartilage can lead to pain, impaired mobility, and decreased muscle strength.

    Arthritis

    About 350 million people worldwide have arthritis. For example, in the United States, it is noted that almost 22 percent of the population (40 million, including 250 thousand children) has some form of arthritis and often other terms are used to refer to the inflammatory process in the joints, such as arthralgia, arthropathy or arthrosis …

    Facts

    • Arthritis is inflammation of one or more joints.
    • Symptoms of arthritis include pain and limited joint function.
    • Arthritis can hurt both men and women, both adults and children.
    • Arthritis is treated by a rheumatologist.
    • Early diagnosis can help prevent permanent damage and disability.

    The disease is often accompanied by joint pain (arthralgia). There are many different reasons for the development of the inflammatory process in the joints. These can be injuries (osteoarthritis), metabolic disorders (for example, gout or pseudogout), hereditary factors, direct and indirect influence of infections (bacterial or viral), disorders in the immune system with an autoimmune component (for example, in rheumatoid arthritis and systemic lupus erythematosus) …Common to all types of arthritis is that there is damage to both joints and tendons, muscles of ligaments, cartilage, and often internal organs are affected. In some types of arthritis, especially of autoimmune genesis, internal organs (heart, lungs, kidneys) are affected and the patient may have general symptoms such as fever, chronic fatigue, weight loss, and swollen lymph nodes.

    Symptoms

    Symptoms of arthritis include pain and limited range of motion in the joints.Joint inflammation is characterized by stiffness, swelling, redness, and a local increase in temperature around the joint. There may also be soreness in the joint area. In many types of arthritis, symptoms occur from other organs not directly related to the joints. Thus, patients with arthritis may have symptoms such as fever, swollen lymph nodes, weight loss, and symptoms of dysfunction of organs such as the lungs, heart, or kidneys.

    Diagnostics

    The first step in diagnosing arthritis is to consult a rheumatologist.The doctor analyzes the history of the disease, symptoms, examines the joints, determines the presence of inflammation in the joint area, the presence of deformity, and also checks for somatic problems that may cause the development of joint inflammation. Various methods are used to diagnose arthritis, such as laboratory tests, X-rays, and ultrasound examinations. In some cases, the diagnosis of the type of arthritis requires repeated visits to a rheumatologist, who is a specialist directly dealing with arthritis.Timely diagnosis allows you to prescribe adequate treatment and avoid serious complications, both from the joints and often internal organs.

    It should be noted that both before and especially after the diagnosis of arthritis, maintaining communication with the doctor is of great importance, since it allows you to control both changes in the course of the disease and the possibility of adjusting the treatment and the safe use of drug treatment (some drugs have a number of side effects). actions).

    Treatment

    Treatment for arthritis depends on the specific type of arthritis. As a rule, an integrated approach is used, including both medication methods of treatment (NSAIDs, pain relievers to affect the immune system) and non-medication methods of treatment (physiotherapy, exercise therapy).

    For most forms of arthritis, diet plays little or no role in treatment, but a positive role for the omega-3 fatty acids found in fish has been noted. At the same time, for some types of arthritis (for example, gout), eating a number of foods high in purines (red meat, shellfish) or foods such as beer can exacerbate the disease.With a disease like celiac disease, eating foods that contain gluten (wheat, barley, rye) can lead to increased joint pain.

    The prognosis for patients with arthritis depends on the severity of the inflammatory processes, the presence of complications, and the presence of concomitant lesions of internal organs. For example, rheumatoid arthritis often leads to damage to the lungs, kidneys, eyes, etc. Chronic joint inflammation can lead to permanent joint damage and loss of joint function, making movement in the joint difficult or impossible.

    Since most forms of arthritis are genetically determined, there is no real prevention. However, trauma-related arthritis or infection-related arthritis (eg, septic arthritis, reactive arthritis, Whipple’s disease) can be prevented.

    Osteoarthritis

    Compared to arthritis, it is not an inflammatory joint disease. However, damage to the articular cartilage occurs. The cause can be both involutional changes and trauma or wear of the cartilaginous tissue due to excessive loads.Osteoarthritis can be manifested by swelling and pain. Also, in some cases, the disease can lead to changes in other organs and systems. It can lead to both a decrease in the range of motion and the range of motion. Most often, arthrosis affects the hip joints, knee joints, and spinal joints. Arthrosis, an infrequently used term to describe degenerative joint diseases. To understand, it is important to first understand the anatomy of the joint. The ends of the bones that form the joint have a smooth surface called the subchondral bone.Behind it is the articular cartilage, which is a strong but elastic connective tissue that protects bones, facilitates movement between surfaces, and also acts as a shock absorber. It is this cartilage that forms the articular surface, and not the bones themselves. The joint has synovial membranes that secrete synovial fluid into the joint space, which lubricates the articular surfaces and acts as a shock absorber. The outer capsule of the joint provides strength to the joint.

    Cartilage is an elastic connective tissue.Cartilage cells (chondroblasts) produce and secrete a large number of different substances, such as collagen, into the extracellular matrix. It is this matrix that is responsible for the properties of cartilage, namely for its strength and flexibility. Sometimes chondroblasts remain inside the matrix and are called chondrocytes. Cartilage is constantly subject to wear and tear. Cartilage cells constantly replenish the cartilage matrix and thus maintain the integrity of the cartilage.

    With age, the ability to regenerate any tissue decreases, but does not stop altogether.Even in young people, the body’s ability to repair tissue is limited by time. If there is constant and excessive wear and tear on the articular cartilage that exceeds the time required for repair, then the cartilage will weaken. This is the reason why the disease is more common in older people and more often in those who lead an active lifestyle. There are other factors that complicate the regenerative processes, such as inflammatory mediators, which affect the normal regeneration of cartilage when there is even mild inflammation.Likewise, if there are some medical conditions (such as diabetes mellitus) that slow down or stop the activity of cartilage cells, the cartilage will gradually wear out. When the cartilage is weakened, the cartilage breaks and the fragments can float in the joint cavity. Bone tissue is also affected in arthrosis and a condition called osteoarthritis occurs.

    Symptoms

    Symptoms develop very slowly. In the early stages of cartilage erosion, there may be no symptoms.In addition, arthrosis is a degenerative disease rather than an inflammatory condition and therefore may not appear for a long time. After the onset of symptoms, the condition gradually worsens, also over a long period of time. The leading symptom in arthrosis is pain.

    Pain, usually isolated in the affected joint. The pain usually increases during and after movement in the affected joint. In milder cases, pain does not appear during movement, but only some time after the load.There may also be pain on palpation in the joint area. But pain in arthrosis is usually not accompanied by edema, as is the case with inflammation in the joint (for example, with rheumatoid arthritis).

    Joint stiffness is another common symptom. This is most noticeable when waking up in the morning and after a long period of rest. Movement can relieve stiffness, but excessive movement will ultimately lead to pain. Joint stiffness tends to get worse over time as the disease progresses.Even when joint stiffness decreases, normal range of motion is not restored. Over time, this leads to a significant decrease in physical activity. The joint may also experience a crunching sound when moving, especially as the disease progresses. Usually, the articular cartilage at the ends of the bones rub against each other, but due to the smooth surface and good lubrication of the synovial fluid, this friction does not lead to the appearance of sounds. In arthrosis, the cartilaginous surface is not so smooth and this leads to the appearance of sounds when moving in the joint (crunching, grinding).Consolidation – Large joints such as knees become tighter to the touch. Bone growths that occur with arthrosis (osteophytes) are formed over time and can be felt under the skin in the form of

    Diagnostics

    As a rule, the diagnosis does not present any particular difficulties and is based on a set of examination data and instrumental data (X-ray, CT, MRI, ultrasound of the joints). But given that arthritis also develops changes in the cartilage tissue, a careful differential diagnosis of degenerative changes in the joints with the consequences of a prolonged inflammatory process is necessary.Therefore, laboratory diagnostics is also necessary in the diagnosis of arthrosis.

    Treatment

    The disease is more often observed in the elderly and therefore the treatment is most often symptomatic. The key to conservative treatment is to reduce fighting symptoms and improve the functionality of the joints. Medication (eg, NSAIDs) should be prescribed taking into account the underlying medical conditions in older people. A good effect is provided by intra-articular injection of synovial fluid endoprostheses (fermatron, ostenil, etc.)which can reduce friction in the joint, improve joint function and reduce pain. Intra-articular administration of long-acting steroids (for example, diprospan) is also possible. Recently, prolotherapy has begun to be used, which consists in the introduction of substances into the tissues that improve the regeneration of connective tissue.

    Physiotherapy can effectively reduce pain, reduce inflammation.

    exercise therapy. Dosed physical activity allows you to preserve the functionality of the joints, but the loads must be selected carefully, since excessive loads lead to increased pain.

    Surgical treatment. With severe arthrosis of large joints (for example, coxarthrosis or gonarthrosis) and significant joint dysfunction and persistent pain syndrome, arthroplasty is recommended.

    90,000 symptoms, treatment and prevention of the disease

    Arthritis: symptoms, treatment and prevention of the disease

    13 May 2013

    Arthritis is a condition that causes inflammation and pain in joints. Joint arthritis is manifested by swelling and changes in the appearance of the joint.The most common types of arthritis are osteoarthritis and rheumatoid arthritis.

    Osteoarthritis is an inflammatory arthritis that develops relatively slowly, over several months or years. Most often, osteoarthritis affects the knee joints, the hip joint, and the joints of the hand.

    Rheumatoid arthritis is a type of inflammatory arthritis, which also includes gout and inflammatory arthritis. Rheumatoid arthritis is a chronic connective tissue disorder that is autoimmune in nature and predominantly affects small joints such as the joints of the hand.

    The disease occurs in patients aged 35-50 years, and may also be in younger patients. Recent studies prove a genetic predisposition to rheumatoid arthritis. The consequences of arthritis can be joint deformation and impairment of their function.

    The following are the symptoms of arthritis and general signs of the disease:

    • enlarged lymph nodes;
    • marked exhaustion in the patient, fatigue;
    • a slight increase in body temperature due to inflammatory processes;
    • Joint stiffness in the morning, lasts about an hour;
    • An important feature that characterizes rheumatoid arthritis is symmetrical joint damage: the right and left elbow or knee joints are affected by arthritis at the same time.

    Rheumatoid arthritis is also characterized by lesions of the periarticular tissues, inflammation of the tendons, damage to the ligamentous apparatus, resulting in increased mobility and deformation of the ligaments.

    Medicines for the treatment of arthritis

    For the treatment of arthritis, drugs of three groups are used: non-steroidal anti-inflammatory drugs, basic drugs and glucocorticosteroids.

    The non-steroidal anti-inflammatory drugs used to treat arthritis are meloxicam, nimesulide and celecoxib.They act as pain relievers, relieve inflammation and have minimal side effects.

    In this case, the dosage of the admission is prescribed by the doctor, excluding the possibility of combining two or more drugs from this group, since the effectiveness of this combination will not increase, but the likelihood of side effects will increase.

    Basic drugs for the treatment of arthritis are used immediately after diagnosis. Basic therapy for rheumatoid arthritis includes the following drugs: D-penicillamine, methotrexate, sulfasalazine, cyclophosphamide, aminoquinoline drugs, cyclosporine A (sandimmune), azathioprine, enbrel (etanercept), remicade (inflixidinomab), voblogenzimab.

    Ineffective drugs from this list should be replaced after 2-3 months of administration, or used in combination with low doses of hormones (the third group of drugs). After six months, a course of effective basic therapy should be developed. To do this, it is necessary to carefully monitor the possible side effects of drugs and changes in the course of the disease.

    Hormone therapy and glucocorticosteroids are used to treat acute forms of arthritis with high inflammatory activity.Also, hormones are used as anti-inflammatory therapy with low efficacy of other drugs.

    The hormonal drug diprospan is used in some cases for local therapy with prolonged action.

    Ointments and gels based on non-steroidal drugs are also used as local therapy: ibuprofen, ketoprofen, diclofenac, piroxicam. They are applied in the form of applications to the affected joints to relieve inflammation. To enhance the effect, they can be combined with applications of dimethyl sulfoxide (solution diluted 1: 2).

    Adjunctive therapy in the treatment of arthritis

    An important measure in the treatment of arthritis is the restoration of calcium balance in the body in order to reduce its excretion from the body. To do this, the patient must follow a diet with a high calcium content, take calcium supplements with vitamin D.

    Patients with rheumatoid arthritis are recommended to carry out annual spa treatment, but only in the absence of an exacerbation of inflammatory processes.

    Laser therapy is successfully used in the early stages of treatment. The recommended course is no more than fifteen procedures. To reduce pain, cryotherapy is used in a course of 15-20 procedures.

    Spa treatment of patients with rheumatoid arthritis is recommended to be carried out annually outside the exacerbation phase.

    Rheumatoid arthritis | ChUZ “KB” RZD-Medicine “Voronezh”

    Rheumatoid arthritis is a systemic disease of connective tissue with a predominant lesion of small joints of the type of erosive-destructive polyarthritis of unknown etiology with complex autoimmune pathogenesis.

    The causes of the disease are currently unknown. Indirect data: an increase in the number of leukocytes in the blood and the erythrocyte sedimentation rate (ESR) – indicate the infectious nature of the process. It is believed that the disease develops as a result of an infection that causes disorders of the immune system in hereditarily susceptible individuals; in this case, the so-called immune complexes are formed (from antibodies, viruses, etc.), which are deposited in the tissues and lead to damage to the joints.But the ineffectiveness of antibiotic treatment for RA is most likely indicative of the incorrectness of this assumption.

    Factors for the development of rheumatoid arthritis:

    1. Genetic predisposition

    • Hereditary tendency to autoimmune reactions.
    • More common in carriers of a certain antigen class MHC II: HLA – DR1, DR4

    2. Infectious factor Hypothetical triggers of rheumatic diseases

    • – paramyxoviruses – viruses of mumps, measles, respiratory syncytial infection
    • – hepatoviruses – hepatitis B virus
    • – herpes viruses
    • – retroviruses

    3.Trigger factor (hypothermia, hyperinsolation, intoxication, mutagenic drugs, endocrinopathies, stress, etc.). For women, the duration of breastfeeding decreases the likelihood of developing RA. Breastfeeding for 24 months or longer reduces the risk of developing RA by half.

    Clinic for rheumatoid arthritis:

    Rheumatoid arthritis progresses in three stages. In the first stage, periarticular edema of the bursae occurs, causing pain, localized fever, and swelling around the joints.The second stage is the rapid division of cells, which leads to a thickening of the synovium. In the third stage, inflamed cells release an enzyme that damages bones and cartilage, often leading to deformation of the affected joints, increased pain and loss of motor function.

    As a rule, at first the disease proceeds slowly, with a gradual development of clinical symptoms over several months or years, much less often – subacute or acute. About 2/3 of cases are manifested by polyarthritis, the rest – by mono- or oligoarthritis, and the articular syndrome often has no clinical specificity, which greatly complicates the differential diagnosis.Articular syndrome is characterized by the presence of morning stiffness for more than 30 minutes and similar manifestations in the second half of the night – symptoms of “tight gloves”, “corset”; constant spontaneous joint pain, aggravated by active movements. The disappearance of stiffness depends on the activity of the process: the more activity, the longer the duration of the stiffness. The articular syndrome in rheumatoid arthritis is characterized by monotony, duration, and preservation of residual effects after treatment.

    Prodromal clinical manifestations are possible (minor transient pain, connection of pain with meteorological conditions, autonomic disorders). Allocate “joints of defeat” and “joints of exclusion.” The former include (in order of frequency of occurrence): II and III metacarpophalangeal, proximal interphalangeal metatarsophalangeal, knee and wrist, ulnar and ankle. The “joints of exclusion” are as follows: distal interphalangeal, I metacarpophalangeal (thumb).

    Classification of rheumatoid arthritis:

    Stages of clinical manifestations

    • – very early: duration up to 6 months;
    • – early: 6 – 12 months;
    • – expanded: more than a year;
    • – late: more than two years.

    Disease Activity (DAS28)

    90 016 90 017 0 (remission): DAS28 less than 2.6;

  • 1 (low): DAS28 2.6 – 3.2;
  • 90 017 2 (average): DAS28 3.2-5.1;

  • 3 (high): DAS28 is greater than 5.1.
  • Instrumental characteristic

    • Presence of erosion
    • X-ray stage (1-4)

    Immunological characteristics

    • Rheumatoid factor: sero-positive / sero-negative;
    • Anti-CCP: gray-positive / gray-negative.

    Functional class

    • I retention of self-service, non-professional and professional activities
    • II retention of self-service, not professional, violation of professional activity
    • III retention of self-service, violation of professional and non-professional activities
    • IV violation of all types of activities

    Diagnosis of rheumatoid arthritis:

    Currently, the diagnosis of the disease is based on a biochemical blood test , changes in the joints visible on x-rays, and on the use of the main clinical markers, which include: joint syndrome as such, as well as in combination with general clinical manifestations – fever, weakness, weight loss and others .

    In the blood test , ESR, rheumatoid factor (rheumatic factor), platelet count, etc. are examined. The most progressive analysis is the titer of antibodies to cyclic citrulline-containing peptide – ACCP, anti-CCP, anti-CCP (Mazurov, 2005, p. 103). The specificity of this indicator is about 90% (ibid.), While it is present in 79% of sera from RA patients.

    Diagnostically important clinical features are the absence of changes in skin color over the inflamed joints, the development of flexor or extensor tendosynovitis of the fingers of the fingers and the formation of amyotrophies, typical hand deformities, the so-called “rheumatoid hand”.

    The criteria for an unfavorable prognosis are:

    • early involvement of large joints and the appearance of rheumatoid nodules
    • enlarged lymph nodes
    • involvement of new joints with subsequent exacerbation
    • systemic nature of the disease
    • persistent disease activity in the absence of remission for more than a year
    • persistent increase in ESR
    • early appearance (within the first year) and high titers of rheumatoid factor
    • early (up to four months) radiological changes in the affected joints – rapid progression of destructive changes
    • Detection of antinuclear antibodies and LE cells
    • carriage of HLA-DR4 antigens; poor tolerance to basic drugs

    Symptoms

    Rheumatoid arthritis can begin in any joint, but most often starts in small joints on the fingers, hands, and wrists.Usually, the damage to the joints is symmetrical, that is, if the joint on the right hand hurts, then the same joint on the left should hurt. The more joints are affected, the more advanced the stage of the disease.

    Other common symptoms:

    • Fatigue, asthenovegetative syndrome
    • Morning stiffness. Usually, the longer the stiffness lasts, the more active the disease.
    • Weakness
    • Flu-like symptoms, including mild fever.
    • Pain during prolonged sitting
    • Outbreaks of disease activity accompanied by remission.
    • Muscle pain
    • Loss of appetite, depression, weight loss, anemia, cold and / or sweaty hands and feet
    • Disruption of the salivary and lacrimal glands, causing insufficient production of tears and saliva.

    Treatment of rheumatoid arthritis:

    In the presence of infection or suspicion of it (tuberculosis, yersiniosis, etc.), therapy with an appropriate antibacterial drug is necessary. In the absence of bright extra-articular manifestations (for example, high fever, Felty’s syndrome or polyneuropathy), treatment of the articular syndrome begins with the selection of nonsteroidal anti-inflammatory drugs (NSAIDs).At the same time, corticosteroid drugs are injected into the most inflamed joints. The immunocomplex nature of the disease makes it indicated to conduct courses of plasmapheresis, which in most cases gives a pronounced effect. The instability of the results of this therapy is an indication for the addition of the so-called basic funds. These drugs act slowly, so they should be used for at least 6 months, and with a clear positive effect, their treatment will necessarily continue further (for years).

    An important point in the treatment of rheumatoid arthritis is the prevention of osteoporosis – restoration of disturbed calcium balance in the direction of increasing its absorption in the intestine and reducing its excretion from the body.A necessary component in the complex of anti-osteoporotic measures is a diet with a high calcium content. Sources of calcium are dairy products (especially hard cheese containing from 600 to 1000 mg of calcium per 100 g of product, as well as processed cheese; to a lesser extent, cottage cheese, milk, sour cream), almonds, hazelnuts and walnuts, etc., and also calcium preparations in combination with vitamin D or its active metabolites.

    Physical therapy aimed at maintaining maximum joint mobility and maintaining muscle mass is of great importance in treatment.

    Physiotherapeutic procedures (electrophoresis of non-steroidal anti-inflammatory drugs, phonophoresis of hydrocortisone, applications of Dimexidum) and spa treatment are of secondary importance and are used only with a slight severity of arthritis.

    With persistent mono- and oligoarthritis, synovectomy is performed either by injecting isotopes of gold, yttrium, etc. into the joint, or by surgery. For persistent deformities of the joints, reconstructive operations are performed.

    Modern therapy

    Systemic drug therapy includes the use of four groups of drugs:

    1. symptom-modifying drugs – non-steroidal anti-inflammatory drugs and glucocorticosteroids,
    2. disease-modifying (basic) antirheumatic drugs,
    3. genetically engineered biological (disease-controlling) drugs with cytostatic immunosuppressants.

    Lymph node inflammation, Israel | Israel Medical Centers Association

    Home> Hematology Oncology Center> Inflammation of the lymph nodes

    Treatment of inflammation of the lymph nodes in Israel is carried out in parallel with the therapy of the disease that caused lymphadenitis (painful enlargement of the lymph nodes). The Israeli clinic “Rambam” is a medical institution in which patients are provided with highly qualified medical care, giving hope and restoration of health.

    Lymph nodes are small nodules ranging in size from a few millimeters to 2 cm, which are part of the lymphatic system. The purpose of the lymph nodes is to protect the body from the spread of infections, parasites, and cancer cells. They form protective cells – lymphocytes, which destroy foreign substances and cells. When the immune system is activated, the lymph nodes begin to produce a large number of lymphocytes, which leads to their swelling and is an indicator of an inflammatory or pathological process in the area for which this group of lymph nodes is responsible.Normally, the submandibular, axillary, inguinal lymph nodes can be palpated even in a healthy person. They are painless, small in size, of soft consistency, and are not adhered to each other and to the skin.

    Inflammation of the lymph nodes is characteristic of many diseases and may require further clinical examination. Examination of the lymph nodes for cancer cells is extremely important in determining the stage of cancer and the degree of its invasiveness. The detection of cancer cells in the lymph nodes indicates a possible risk of developing metastases in distant organs of the patient.

    Lymph nodes are located throughout the body, a large number of lymph nodes are localized in the abdominal and chest cavity, in the neck, at the elbow, in the armpit, in the knee bend, in the groin (cervical, tonsillar, submandibular, sublingual, bronchopulmonary, supraclavicular, parotid, axillary, inguinal, femoral, popliteal). The location of the lymph nodes in these areas helps the body create a barrier against various infections and cancers.

    Symptoms of inflammation of the lymph nodes

    Lymphadenitis is a painful enlargement of the lymph node, which indicates that it has become inflamed, because it cannot cope with harmful bacteria and is attacked by microbes, viruses, and foreign substances.As a rule, this happens either due to a decrease in immunity, or with the development of a severe infection. The inflammation can be catarrhal or purulent. With inflammation, the lymph nodes increase in size, soreness appears during palpation, the skin over the node becomes hyperemic (reddened), and at the same time the body temperature may rise. Unlike lesions in malignant diseases, inflamed lymph nodes are not fused to the underlying tissues – they are mobile and soft to the touch.

    Inflammation of the lymph nodes in cancer is characterized by their painless enlargement, the nodes become dense, adhered to nearby tissues and inactive. Inflammation of the lymph nodes can be observed in various diseases, from the common cold to a malignant tumor.

    The most common causes of swollen lymph nodes are a number of immune, infectious, oncological diseases, as well as some parasitic and fungal infections.Inflammation of the lymph nodes is observed in breast cancer, leukemia, Hodgkin’s disease, non-Hodgkin’s lymphoma, skin melanoma and squamous cell carcinoma of the skin, rectal cancer, vulvar cancer, thyroid cancer, laryngeal cancer, tongue cancer, lymphosarcoma, etc.

    Lymphadenitis occurs in infectious diseases caused by bacteria and viruses such as: ARVI, influenza, chickenpox, tonsillitis, measles, scarlet fever, diphtheria, tuberculosis, typhoid fever, brucellosis, etc. lupus, rheumatoid arthritis, HIV infection.The development of lymphadenitis is facilitated by parasitic infections: toxoplasmosis, filariasis. Swollen lymph nodes can manifest itself as a reaction to a vaccine or become a side effect when taking certain medications. Inflammation of the lymph nodes also occurs when the body is affected by histoplasmosis (fungal disease).

    Treatment of inflammation of the lymph nodes in Israel

    With the development of lymphadenitis, you should seek medical help and carry out a course of treatment prescribed by a doctor, which will help prevent the development of complicated forms of the course of the disease and prevent the transition of the disease to a chronic form.The choice of therapy for lymphadenitis in Israel depends on the cause of the inflammation of the lymph nodes. After treating the underlying disorder, the lymph nodes should return to their normal size.

    Treatment may include:

    • Pain relievers
    • antibiotics
    • anti-inflammatory drugs
    • Physiotherapy

    Pain medications such as Tylenol and non-steroidal anti-inflammatory drugs such as Edvil will be prescribed to relieve the patient’s condition.After determining the patient’s sensitivity to antibiotics, the doctor prescribes the most effective drug in this group individually.

    In case of manifestation of symptoms of intoxication arising from purulent lymphadenitis, accompanied by pain, high fever, chills, edema and redness of the skin, as well as increased sweating, headache, weakness, an incision and removal of pus and dead tissue is shown.

    Seek medical help if the lymph node has increased in size or if a month after the treatment, the node has not shrunk.

    Psoriatic arthritis | Clinical Rheumatology Hospital No. 25

    Psoraitic arthritis is a form of chronic inflammatory lesion of the joints that develops in patients with psoriasis.

    Clinical signs and symptoms psoriatic arthritis

    Arthritis in 68-75% of cases develops in patients with psoriasis, or occurs simultaneously with skin changes; in 12-25% of cases, arthritis precedes the appearance of signs of dermatosis.From the onset of skin lesions to the development of arthritis, as well as from the onset of arthritis to dermatosis, a different period passes – from 2 weeks to 10 years or more. Dermatosis can be widespread, but often limited, localized on the scalp, extensor surfaces of the elbows, knee joints, around the navel, under the mammary glands, in the gluteal and inguinal folds. In some cases, it begins with damage to the nails. Point depressions appear on the surface of the nails (a symptom of a “thimble”), the nail plates become cloudy, longitudinal or transverse grooves are visible on them, sometimes the nails thin and atrophy (onycholysis), but more often they thicken and crumble, as in a fungal infection, which requires the exclusion of mycosis.

    The onset of arthritis is most often imperceptible, gradual, but it can also be “acute”.

    Five types of joint damage in PA can be distinguished, which are not mutually exclusive and can be combined:

    • Arthritis affecting the distal interphalangeal joints;
    • mono-oligoarthritis;
    • polyarthritis similar to rheumatoid;
    • mutating arthritis;
    • spondyloarthritis.

    The classic type is inflammation of the distal interphalangeal joints of the hands and feet, the lesion is usually multiple, but at the onset of the disease, asymmetric mono-oligoarthritis may develop.In particular, cases of isolated arthritis of the distal joints of the big toes have been described. Palpation of joints in PA is moderately painful, the swelling is usually dense, usually extending beyond the joint. The skin over the affected joints is bluish or purplish. The change in the shape of the end joints, simultaneously with the peculiar coloration of the skin, creates a picture of a “radish” deflection of the finger. Arthritis of the distal interphalangeal joints, as a rule, is combined with trophic changes in the nails.

    An “axial” lesion is also considered characteristic of PA – a simultaneous lesion of the distal, proximal interphalangeal and metacarpophalangeal joints of the same finger up to the development of ankylosis of these joints. Similar changes in the joints of the toes cause their diffuse swelling and redness of the skin – “sausage fingers”. In 5% of patients, a disfiguring (mutating) form of PA is observed, when, as a result of the osteolytic process, the fingers are shortened, bent, multiple subluxations and ankylosis of the joints are found.Asymmetry and disorder (chaos) of these changes are characteristic: on the same hand, for example, flexion and extension contractures of the fingers, displacement of their axes in different directions can be found.

    The variants of classic psoriatic arthritis described above are found only in 5-10% of patients with psoriasis. In 70% of patients, mono or oligoarthritis of large joints – knee, ankle, very rarely hip is revealed. More than three joints are affected in 15% of patients.In this case, any articulation can be affected, including the temporomandibular joints. Usually, the asymmetric nature of polyarthritis is quite clearly expressed, although there may be processes that are extremely reminiscent of the clinical picture of RA. In 5% of patients, a clinical and X-ray picture of ankylosing spondylitis develops, as in ankylosing spondylitis, although asymptomatic sacroiliitis is radiologically detected in 50-60% of patients. PA can be combined with eye damage (more often conjunctivitis, iritis, less often episcleritis).The simultaneous occurrence of ulcerative lesions of the oral mucosa and genital organs brings the clinical picture of the disease closer to Reiter’s disease.

    Lesions of internal organs become distinct with a particularly severe (malignant) variant of PA. It develops only in males, mainly young people (up to 35 years old) and, as a rule, suffering from atypical psoriasis (pustular psoriasis or universal psoriatic erythroderma). This variant is characterized by high fever of the hectic type with chills and increased sweating.The articular syndrome is manifested by multiple arthritis with a pronounced exudative component of inflammation, excruciating pain, sometimes even requiring the administration of drugs. At the same time, progressive weight loss, the formation of trophic ulcers, pressure ulcers, increased hair loss, amyotrophy, generalized enlargement of the lymph nodes, especially the inguinal ones, are detected. Of the internal organs, the heart is most often affected by the type of myocarditis, which is manifested by a moderate expansion of the boundaries of the heart, a weakening of the I tone, systolic murmur, tachycardia that does not correspond to fever, rhythm disturbances and diffuse changes in the myocardium according to ECG data.Development of hepatitis, hepatolienal syndrome is possible. At the height of the disease, there are sometimes signs of diffuse glomerulonephritis, and with a protracted course – renal amyloidosis. In the malignant variant of PA, encephalopathy can be observed with a predominant involvement of subcortical formations in the process, epileptic seizures and delirium. Sometimes peripheral neuritis and polyneuritis develop.

    Laboratory data are not specific. In the general analysis of blood, the acceleration of ESR is determined, which correlates with the activity of arthritis.

    X-ray changes are the most significant in differential diagnosis.

    How is psoriatic arthritis treated?

    Treatment of psoriatic arthritis has similar principles to the treatment of rheumatoid arthritis.

    1. Non-steroidal anti-inflammatory drugs (NSAIDs).

    Monotherapy of NSAIDs is indicated only with relatively favorable variants of PA (oligoarthritis, damage to the distal interphalangeal joints).With the ineffectiveness of NSAIDs, the appointment of basic anti-inflammatory drugs is indicated. In some cases, NSAIDs lead to an exacerbation of cutaneous psoriasis.

    2. Glucocorticoids (GC).

    Prescribing HA in low doses (10-15 mg / day) is rarely used. Potential indications are generalized peripheral arthritis with severe functional insufficiency of the joints, high activity of the inflammatory process, ineffectiveness of NSAIDs, the presence of systemic manifestations (aortitis, diffuse glomerulonephritis, malignant form).Local therapy of HA is indicated for limited joint damage and enthesopathy (damage to the ligamentous apparatus).

    3. Basic anti-inflammatory drugs (DMARDs).

    a) Methotrexate – indicated for a high degree of disease activity in combination with a progressive stage of generalized psoriasis and for atypical dermatosis (pustular and erythrodermic).

    b) Cyclosporine – has no advantages over methotrexate in its therapeutic potential, but causes more severe side reactions (nephrotoxicity, the development of arterial hypertension).

    c) Sulfasalazine – has a moderate effect on joint and skin lesions, but does not affect the clinical manifestations of spinal lesions and the progression of arthritis.

    g) Leflunomide (Arava) is a promising drug, the effectiveness of which has been proven in randomized clinical trials.

    4. Genetically engineered biological preparations (GIBP)

    Currently, more and more new biological drugs are being developed that have a more pronounced therapeutic potential, but at the same time can cause severe adverse reactions, which requires special monitoring before prescribing these drugs.

    The most common treatment for psoriatic arthritis in Russia in the last decade has been infliximab (remicade), which is effective in the most severe patients who are resistant to standard therapy.

    One of the auxiliary methods of psoriasis treatment is HIRUDOTHERAPY – treatment with leeches, especially if physiotherapy is contraindicated for the patient.

    More details about the work of a rheumatologist and the procedure for applying can be found on the pages “Patients” and “Procedure”.

    CONSULTATION OF DOCTOR RHEUMATOLOGIST

    90,000 causes and mechanism of development, symptoms, diagnosis, treatment

    Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by autoimmune damage mainly to small joints, ligaments, skin, blood vessels and internal organs.

    Contents:

    Inflammation and subsequent destruction of the joints ultimately leads to early disability and disability.Rheumatoid arthritis most often affects women, with the peak incidence in 40-50 years. The onset of the disease is often associated with trauma, hypothermia, a viral infection or severe psycho-emotional stress. Timely diagnosis and adequate treatment are critical to the outcome of rheumatoid arthritis.

    Reasons for the development of rheumatoid arthritis

    The true causes of RA have not been established. Possible reasons contributing to the development of rheumatoid arthritis include:

    • family predisposition;
    • viral infections: Epstein-Barr virus, lymphotropic T-cell virus, parvovirus B19.

    The development of the disease is based on excessive, malfunctioning of the immune system, when immune cells begin to perceive their own tissues as foreign. Under the influence of external causes, immune cells actively produce special proteins (cytokines) that cause inflammation in the lining of the joints, blood vessels and cartilage. Subsequently, foci of chronic inflammation are formed, which leads to the slow destruction of connective tissue, which is the basis of cartilage, bones, blood vessels and the skeleton of internal organs.

    Symptoms of rheumatoid arthritis

    Early symptoms of RA may include weight loss and low-grade fever (37-38C), morning stiffness, and joint tension or soreness. All symptoms of arthritis are divided into articular and extra-articular manifestations.

    Articular manifestations:

    • Morning stiffness and limitation of joint mobility after physical activity.
    • Pain and swelling in the affected joints.
    • Weakening of the force of compression in the hand.
    • In the future, deformities, subluxations and ankylosis (immobility) of the joints develop.
    • When the larynx joints are involved in the process, coarsening of the voice, shortness of breath, swallowing disorder develop.
    • Bursitis (inflammation of the joint capsule) and tendosynovitis (inflammation of the synovial membrane of the tendon).

    Symmetrical involvement of the joints of the hands and feet – specific for rheumatoid arthritis. Isolated lesions of other joints are less common.

    Extra-articular manifestations:

    • General symptoms: weakness, weight loss, fever and weight loss.
    • Cardiosclerosis is the proliferation of fibrous tissue in the heart, leading to chronic heart failure.
    • Rheumatoid nodules are painless subcutaneous foci of inflammation.
    • Cutaneous vasculitis is an inflammation of the small vessels of the skin. It is characterized by the appearance of rashes, ulcers, in rare cases, it can lead to the development of gangrene.
    • Generalized amyotrophy (loss of muscle mass), myopathy (damage to muscle fibers).
    • Amyloidosis is a violation of protein metabolism, characterized by the deposition in blood vessels and tissues of special protein complexes that disrupt the normal functioning of organs. The kidneys and heart are most often affected. One of the first manifestations of amyloidosis may be an increase in protein in the urine.
    • Neuropathy (nerve damage).
    • Generalized lymphadenopathy (enlarged lymph nodes), hepatosplenomegaly.
    • Pleurisy, pericarditis.
    • Glomerulonephritis (kidney disease).
    • Sjogren’s syndrome, accompanied by dry mucous membranes.
    • Eye damage: scleritis, episcleritis, retinal vasculitis.
    • Raynaud’s syndrome, accompanied by cold, bluish skin in the area of ​​the fingers, sometimes the development of gangrene.

    Symptoms of rheumatoid arthritis are persistent and do not go away without treatment. Sometimes the course of the disease has an undulating character with periods of improvement and deterioration.

    Diagnosis of rheumatoid arthritis

    To verify the diagnosis, carry out:

    General examination and collection of anamnesis. Mobility, soreness or swelling of the joints, skin condition are assessed, lymph nodes, liver and spleen are probed. The patient’s data on possible injuries, stresses and previous infections are clarified.

    Prescribe a number of laboratory tests:

    • General blood test (estimate the number of erythrocytes, leukocytes and platelets, hemoglobin level, ESR).
    • General urine analysis.
    • Urine analysis according to Nichiporenko (according to indications).
    • Biochemical blood test (estimates of ALT, AST, urea, creatinine, alkaline phosphatase, total protein, cholesterol, bilirubin, glucose, C-reactive protein).
    • Determination of rheumatoid factor in blood serum.
    • Determination of antibodies to cyclic citrullinated peptide (ACCP).
    • Coagulogram.
    • ELISA or PCR diagnostics of infections (hepatitis, HIV, chlamydia, gonorrhea, Trichomonas, Epstein-Barr virus).

    Instrumental studies are carried out:

    • Radiography of hands and feet, pelvic bones and other joints as indicated.
    • Joint ultrasound and joint puncture followed by assessment of joint fluid.
    • Arthroscopy (examination of the joint cavity using a special device) with biopsy and subsequent morphological examination of the tissue.
    • Chest X-ray.
    • ECHO-KG and ECG.
    • Ultrasound of the abdominal cavity and kidneys.
    • FGDS.
    • CT and MRI.

    If necessary, consultations are held with other narrow specialists (ophthalmologist, orthopedic traumatologist).

    Treatment of rheumatoid arthritis

    Treatment of rheumatoid arthritis is aimed at reducing the severity of the manifestations of the disease, preventing the destruction of joints and reducing their function, improving the quality of life and increasing life expectancy.

    Drug-free treatment:

    • Purpose of a balanced diet: an adequate intake of foods containing polyunsaturated fatty acids (fish oil, olive oil, etc.) is required.
    • Physiotherapy exercises.
    • Physiotherapy: ultrasound, laser therapy, etc.

    Medication is the main treatment for rheumatoid arthritis.

    • cytostatic drugs, immunosuppressants, etc. The result of treatment with these drugs develops slowly (over 2-6 months or more), but is very persistent.
    • Biotechnological drugs (R – Mab) are high-tech biological drugs with a powerful anti-inflammatory effect, which have a point effect on any link in the process of inflammation.
    • Targeted synthetic drugs also have a targeted effect on a specific inflammatory mechanism.
    • Glucocorticosteroids – have a strong anti-inflammatory effect, act quickly, but the therapeutic effect is unstable.
    • Non-steroidal anti-inflammatory drugs.They have a quick analgesic effect, but their anti-inflammatory effect is weak. They are prescribed at an early stage in the treatment of the disease to correct symptoms in combination with basic anti-inflammatory treatment. In addition to the systemic administration of drugs, their intra-articular administration is possible.

    Starting treatment at an early stage of the disease allows achieving good results, maintaining the ability to work and the quality of life. To achieve the best effect of therapy, it is necessary to abandon bad habits (smoking, drinking alcohol), try to avoid psychoemotional overstrain, and prevent infections.

    90,000 Lymphatic system, lymph nodes. Swollen lymph nodes. The reasons.

    The lymphatic system is a network of organs, vessels and nodes located throughout the body. A large number of lymph nodes are located in the head and neck area. Most often, it is in these zones that they increase, as well as in the groin and axillary regions.

    Lymph nodes, also called lymph glands, play an important role in the fight against various infections.They work on the principle of filters, trapping viruses, bacteria and other factors of the disease before they reach the rest of the organs and systems. Enlarged lymph nodes are most commonly found in places such as the neck, chin, armpits, and groin.

    Swollen lymph nodes (lymphadenopathy) usually occurs due to the presence in the body of an infectious process, viral or bacterial. In childhood, we are more susceptible to infections, therefore, lymph nodes in children are enlarged more often than in adults.

    Symptoms.

    Enlarged lymph nodes are a signal that something in the body is not going according to plan. If this is the first time you encounter this phenomenon, pay attention to the following:

    – Is there any tenderness or pain in the lymph node.

    – How enlarged the lymph node is – up to the size of a pea, bean or walnut.

    The following symptoms are also important:

    – Runny nose, sore throat, fever, and other signs of acute respiratory infection.

    – Systemic enlargement of lymph nodes throughout the body. In this case, infections such as HIV, infectious mononucleosis, or diseases of the immune system (systemic lupus erythematosus, rheumatoid arthritis) may occur.

    – Hard, immobile, rapidly growing lymph nodes may be associated with cancer or lymphoma.

    – Fever.

    – Sweating during night sleep.

    When to see a doctor.

    Some enlarged lymph nodes return to their normal state when a concomitant disease, such as an infection, ends. Medical assistance is needed if enlarged lymph nodes:

    – Appeared for no apparent reason.

    – Continue to increase or not decrease for two to four weeks.

    – Hard or bumpy to the touch, does not move when pressed.

    – Combined with fever, night sweats, or unexplained weight loss.

    Call an ambulance immediately if you have difficulty swallowing or breathing!

    Reasons.

    The most common cause of swollen lymph nodes is any respiratory viral infection. It should also be noted:

    1. Common infections.

    – Streptococcal sore throat.

    – Measles.

    – Ear infections.

    – Caries.

    – Mononucleosis.

    Infections of the skin and subcutaneous fat (eg erysipelas).

    – HIV.

    – Tuberculosis.

    2. Rare infections .

    – Syphilis.

    – Toxoplasmosis.

    – Cat scratch disease or felinosis.

    3. Diseases of the immune system .

    – Systemic lupus erythematosus is a chronic inflammatory disease that affects the joints, skin, kidneys, blood, heart and lungs.

    – Rheumatoid arthritis.

    4. Oncological diseases.

    – Lymphoma is a type of cancer that affects the lymphatic system.

    – Leukemia is a blood cancer affecting the bone marrow and lymphatic system.

    – Other types of oncology, in which metastasis to the lymph nodes occurs.

    Complications.

    If the cause of an enlarged lymph node is an infectious process, an abscess can form – a localized formation of pus (consisting of fluid, white blood cells, dead tissue and bacteria).An abscess requires drainage and antibiotics.

    Treatment.

    If the swollen lymph nodes are caused by a respiratory viral infection, normal size will return in two to four weeks without special treatment. In the case of a bacterial process accompanying lymphadenopathy, the doctor will prescribe an antibacterial drug.

    In some situations, it takes more than a month for the lymph node to shrink to its normal size.

    https: // www.aboutkidshealth.ca/Article?contentid=777&language=English

    https://www.mayoclinic.org/diseases-conditions/swollen-lymph-nodes/symptoms-causes/syc-20353902

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