Disease SLE
Summary systemic lupus
erythematosus -- is a disease
of the immune system.
Normally, the immune
system protects the body
from infection. In lupus,
however, the immune system
inappropriately attacks
tissues in various parts of the
body.
approximately 1.5 million
people in the U.S. have lupus.
People of African, Asian, and
Native American descent are
more likely to develop lupus
than are Caucasians.
The cause(s) of SLE is (are)
unknown, however, heredity,
viruses, ultraviolet light, and
drugs all may play some role.
Female hormones are
believed to play a role in the
development of lupus
because women are affected
by lupus much more often
than men. This is especially
true of women during their
reproductive years, a time
when hormone levels are
highest.
RA OA
Rheumatoid arthritis (RA) is an Osteoarthritis is a joint
inflammatory disease that inflammation that
causes pain, swelling, stiffness, results from cartilage
and loss of function in the joints. degeneration, can be
It occurs when the immune caused by aging,
system, which normally defends heredity, and injury
the body from invading from trauma or
organisms, turns its attack disease.
against the membrane lining the
joints. The most common
symptom of
rheumatoid arthritis generally osteoarthritis is pain
occurs in a symmetrical pattern, in the affected joint(s)
meaning that if one knee or after repetitive use.
hand is involved, the other one Other osteoarthritis
also is. symptoms and signs
include
The disease often affects the
wrist joints and the finger joints swollen joints,
closest to the hand. It can also joint stiffness,
affect other parts of the body joint creaking, and
besides the joints. In addition, loss of range of
people with rheumatoid arthritis motion.
may have fatigue, occasional
fevers, and a general sense of There is no blood test
not feeling well. for the diagnosis of
osteoarthritis.
about 1.3 million people, or
about 0.6 percent of the U.S. Before age 45,
adult population, have osteoarthritis occurs
rheumatoid arthritis. more frequently in
males. After 55 years
 Factors that may contribute
to the development of lupus
include viruses,
environmental chemicals and
a person's genetic makeup.
Drug-induced lupus can occur
after the use of some
prescription medications
(such as hydralazine and
procainamide). These
symptoms generally improve
after the drug is
discontinued.
Sign and Lupus symptoms and
Symptomps signs include
butterfly rash on the
face,
appetite loss,
hair loss,
fever,
fatigue,
photosensitivity,
Raynaud's
phenomenon,
pleuritis, and
pericarditis.
Like some other forms of
arthritis, rheumatoid arthritis
occurs much more frequently in
women than in men. About two
to three times as many women
as men have the disease.
Rheumatoid arthritis is also a
systemic disease
Rheumatoid arthritis is a
destructive joint disease that is
caused by inflammation in the
tissue that normally produces
lubrication fluid for joints. When
this tissue remains inflamed, it
leads to deformity by loosening
joint ligaments and to joint
destruction by eroding away
cartilage and bone.
White blood cells, the agents of
the immune system, travel to
the synovium and cause
inflammation (synovitis),
characterized by warmth,
redness, swelling, and pain --
typical symptoms of rheumatoid
arthritis.
of age, it occurs more
frequently in females.
Osteoarthritis
commonly affects the
hands, feet, spine, and
large weight-bearing
joints, such as the hips
and knees
It is not a systemic
disease..
Osteoarthritis is a non-
autoimmune-
inflammatory joint
disease whereby the
cartilage of the joint
thins, typically
asymmetrically -- so
only one knee or hand
may be affected.
Primary osteoarthritis,
osteoarthritis not
resulting from injury
or disease, is partly a
result of natural aging
of the joint. With
aging, the water
content of the
cartilage increases,
and the protein
As rheumatoid arthritis
progresses, the inflamed
synovium invades and destroys
the cartilage and bone within
the joint. The surrounding
muscles, ligaments, and tendons
that support and stabilize the
joint become weak and unable
to work normally. These effects
lead to the pain and joint
damage often seen in
rheumatoid arthritis.
Regardless of the exact trigger,
the result is an immune system
that is geared up to promote
inflammation in the joints and
occasionally other tissues of the
body. Immune cells, called
lymphocytes, are activated and
chemical messengers (cytokines,
such as tumor necrosis
factor/TNF, interleukin-1/IL-1,
and interleukin-6/IL-6) are
expressed in the inflamed areas.
makeup of cartilage
degenerates as a
function of biologic
processes. Eventually,
cartilage begins to
degenerate by flaking
or forming tiny
crevasses. In advanced
osteoarthritis, there is
a total loss of the
cartilage cushion
between the bones of
the joints. Repetitive
use of the worn joints
over the years can
mechanically irritate
and inflame the
cartilage, causing joint
pain and swelling. Loss
of the cartilage
cushion causes friction
between the bones,
leading to pain and
limitation of joint
mobility. Inflammation
of the cartilage can
also stimulate new
bone outgrowths
(spurs, also referred to
as osteophytes) to
form around the
joints. Osteoarthritis
occasionally can
develop in multiple

Diagnosis & 11 lupus symptoms and 7 RA symptoms and signs
Manifestation signs (1987)
Common lupus complaints
and symptoms and signs
include
1. fatigue or feeling
tired,
2. low-grade fever,
3. loss of appetite,
4. muscle aches,
5. hair loss (alopecia),
6. arthritis,
7. ulcers of the mouth
and nose,
8. facial rash
("butterfly rash"),
9. unusual sensitivity
to sunlight
(photosensitivity),
members of the same
family, implying a
hereditary (genetic)
basis for this
condition.
Osteoarthritis is
therefore felt to be a
result of a
combination of each
of the above factors
that ultimately lead to
a narrowing of the
cartilage in the
affected joint.
1. Joint Stiffness >1hour,
before improvement
2. Artritis in 3 or more
joints simultaneously
3. 1 artritis at hand joint
4. Simetric artritis
5. Nodul rheumatoid
subcutan at a bone
spike
6. Serum rheumatoid (+)
7. X-ray:
erosion/decalcification
at joint or its area
 10. chest pain caused
by inflammation of Four areas are covered in the
the lining that diagnosis:[54]
surrounds the lungs
(pleuritis) and the joint involvement,
heart (pericarditis), designating the
and metacarpophalangeal joints,
11. poor circulation to proximal interphalangeal
the fingers and toes joints, the interphalangeal
with cold exposure joint of the thumb, second
(Raynaud's through fifth
phenomenon). metatarsophalangeal joint and
wrist as small joints, and
Skin manifestations are shoulders, elbows, hip joints,
frequent in lupus and can knees, and ankles as large
sometimes lead to joints:
scarring. In discoid lupus, o Involvement of
only the skin is typically 1 large joint gives 0 points
involved. The skin rash in o Involvement of
discoid lupus often is found 210 large joints gives 1 point
o Involvement of
on the face and scalp. It
13 small joints (with or
usually is red and may have
without involvement of large
raised borders. Discoid joints) gives 2 points
lupus rashes are usually o Involvement of
painless and do not itch, 410 small joints (with or
but scarring can cause without involvement of large
permanent hair loss joints) gives 3 points
(alopecia). Over time, 5%- o Involvement of
10% of those with discoid more than 10 joints (with
lupus may develop SLE. involvement of at least 1
small joint) gives 5 points
 serological parameters
including the rheumatoid
factor as well as ACPA
"ACPA" stands for "anti-
citrullinated protein
antibody":
o Negative RF
and negative ACPA gives 0
points
o Low-positive
RF or low-positive ACPA
gives 2 points
o High-positive
RF or high-positive ACPA
gives 3 points
acute phase reactants:
1 point for elevated
erythrocyte sedimentation
rate, ESR, or elevated CRP
value (c-reactive protein)
duration of arthritis: 1
point for symptoms lasting six
weeks or longer

Rheumatoid factor (RF):

Rheumatoid factor is an
antibody that is present
eventually in the blood of
most people with rheumatoid
arthritis. (An antibody is a
special protein made by the
immune system that normally
 helps fight foreign substances
in the body.)
Not all people with
rheumatoid arthritis test
positive for rheumatoid
factor, and some people test
positive for rheumatoid
factor, yet never develop the
disease.

Anti-CCP antibodies: This

blood test detects antibodies
to cyclic citrullinated peptide
(anti-CCP). This test is positive
in most people with
rheumatoid arthritis and can
even be positive years before
rheumatoid arthritis
symptoms develop
Treatment & Steroids. Steroid creams can Four of these drugs,
Medication be applied directly to rashes. etanercept (Enbrel2),
The use of creams is usually golimumab (Simponi),
safe and effective, especially infliximab
for mild rashes. (Remicade), and
adalimumab (Humira),
Plaquenil reduce inflammation
(hydroxychloroquine). by blocking tumor
Commonly used to help keep necrosis factor (TNF),
mild lupus-related problems, a cytokine or immune
such as skin and joint disease, system protein that
under control. This drug is triggers inflammation
also effective at preventing
lupus flares.

Cytoxan (cyclophosphamide).
A chemotherapy drug that
has very powerful effects on
reducing the activity of the
immune system.
Imuran (azathioprine). A
medication originally used to
prevent rejection of
transplanted organs.
Rheumatrex (methotrexate).
Another chemotherapy drug
used to suppress the immune
system, for disease that have
not responded to
quinone/prednison
Benlysta (belimumab). This
drug weakens the immune
system by targeting a protein
that may reduce the
abnormal B cells thought to
contribute to lupus.
CellCept (mycophenolate
mofetil). A drug that
suppresses the immune
system and is also used to
prevent rejection of
transplanted organs.
during normal immune
responses.
Anakinra (Kineret),
works by blocking a
cytokine called
interleukin-1 (IL-1)
that is seen in excess
in patients with
rheumatoid arthritis.
Rituximab (Rituxan)
stops the activation of
a type of white blood
cell called B cells.
This reduces the
overall activity of the
immune system, which
is overactive in people
with rheumatoid
arthritis.
Abatacept (Orencia)
blocks a particular
chemical that triggers
the overproduction of
white blood cells
called T cells that play
a role in rheumatoid
arthritis inflammation.
Most people who have
rheumatoid arthritis take
medications. Some medications
(analgesics) are used only for
pain relief; others
Rituxan (rituximab). A
biologic agent used to treat
lymphoma and rheumatoid
arthritis. It is used to treat the
most serious features of
lupus when other therapies
are not effective.
People with SLE need more
rest during periods of active
disease. Researchers have
reported that poor sleep
quality was a significant
factor in developing fatigue in
people with SLE.
Nonsteroidal anti-
inflammatory drugs (NSAIDs)
are helpful in reducing
inflammation and pain in
muscles, joints, and other
tissues. Examples of NSAIDs
include aspirin, ibuprofen
(Motrin), naproxen
(Naprosyn), and sulindac
(Clinoril).
Sometimes, medications that
prevent ulcers while taking
NSAIDs, such as misoprostol
(Cytotec), are given
simultaneously.
[corticosteroids and
nonsteroidal anti-inflammatory
drugs (NSAIDs)] are used to
reduce inflammation. Still
others, often called disease-
modifying antirheumatic drugs
(DMARDs), are used to try to
slow the course of the disease.
The newest and perhaps most
promising class of arthritis
medications are the biologic
response modifiers. These are
genetically engineered
medications that help reduce
inflammation and structural
damage to the joints by
interrupting the cascade of
events that drive inflammation.
Joint replacement: Joint
replacement involves removing
all or part of a damaged joint
and replacing it with synthetic
components.
Arthrodesis (fusion):
Arthrodesis is a surgical
procedure that involves
removing the joint and fusing
the bones into one immobile
unit, often using bone grafts
from the person's own pelvis.
Tendon reconstruction:
Rheumatoid arthritis can
Corticosteroids are more
potent than NSAIDs in
reducing inflammation and
restoring function when the
disease is active.
Corticosteroids are
particularly helpful when
internal organs are affected.
Hydroxychloroquine
(Plaquenil) is an antimalarial
medication found to be
particularly effective for SLE
people with fatigue, skin
involvement, and joint
disease.
Get enough rest.
Eat well.
Avoid alcohol.
Don't smoke.
Play it safe in the sun.
Treat fevers.
damage and even rupture
tendons, the tissues that attach
muscle to bone. This surgery,
which is used most frequently
on the hands, reconstructs the
damaged tendon by attaching an
intact tendon to it. This
procedure can help to restore
hand function, especially if the
tendon is completely ruptured.
Synovectomy: In this surgery,
the doctor actually removes the
inflamed synovial tissue.
Synovectomy by itself is seldom
performed now because not all
of the tissue can be removed,
and it eventually grows back.
Calcium and vitamin D
supplements or other
treatments to prevent potential
osteoporosis.