CONNECTIVE TISSUE AND COLLAGEN DISORDERS
Define systemic lupus erythematosus
Systemic lupus erythematosus is a chronic inflammatory, autoimmune, multisystem disorder.
In which the body’s immune system mistakenly attacks its own tissue. Due to which a large amount of inflammation and tissue damage is seen.
Systemic lupus erythematosus mainly affects skin, joint, kidney, blood cell, brain, heart, lung.
Write causes and risk factor of systemic lupus erythematous (Write cause of systemic lupus erythematosus)
The exact cause of systemic lupus erythematosus is unknown. But it occurs due to genetic, hormonal and environmental factors.
Write sign and symptoms of systemic lupus erythematosus
Skin rash : Butterfly shape rash across the cheek and nose
Joint Pain and Swelling
Fatigue
Tyranny
Photosensitivity
Fever
Hair loss
Kidney problem
Swelling in leg and fit
High blood pressure
Raynaud phenomenon
Mouth Sore
Chest pain
Head one
Dizziness
Caesar
Memory loss
Enlargement of lymph nodes
Anemia
Low white blood cells
Low platelet count
Write diagnostic evaluation of systemic lupus erythematosus
History Collection
Physical Examination
Blood tests (anti-nuclear antibody (ANA) test, anti-dsDNA, anti-Smith antibody)
Urine test (check for kidney involvement)
Biopsy (in some cases)
Write management of systemic lupus erythematosus
✓ Medication:
Non-steroidal anti-inflammatory drugs: Non-steroidal anti-inflammatory drugs are given to relieve inflammation and pain.
Antimalarial drug: Use an antimalarial drug such as hydroxychloroquine to control lupus and joint symptoms and prevent flares.
Corticosteroids: Using a corticosteroid drug such as prednisolone to reduce inflammation.
Immunosuppression: Using immunosuppression drugs to suppress immunity. such as methotrexate
Biologics: Biologics are used when all other treatments have failed. Targets specific parts of the immune system.
✓ Life style changes:
Regular Exercise: Do regular exercise. Which maintains joint flexibility and muscle strength.
Healthy Diet: Advising the patient to have a healthy and well-balanced diet intake.
Sun Protection: Use sun screen and protective clothing to get protection from the sun.
Stress Management: Use yoga, meditation and relaxation techniques for stress management.
Avoid Smoking: Avoiding smoking.
Define scleroderma
Scleroderma is also known as ‘systemic sclerosis’ and ‘crest syndrome’.
Scleroderma is a chronic autoimmune condition characterized by excessive collagen production leading to hardening and tightening of the skin and connective tissue.
Scleroderma mainly occurs between the ages of 30 and 50. Also it affects women more.
Write causes of scleroderma
The exact cause of scleroderma is unknown. But it occurs due to genetic, environmental and immunological factors.
Genetic factors (genetic predisposition)
Autoimmunity (body mysteriously attacks own tissue)
Environmental factors (exposure to toxins, chemicals – silica, dust, vinyl chloride, bleomycin, aromatic hydrocarbons)
Hormonal factor (hormonal imbalance)
Write sign and symptoms of scleroderma (Write sign and symptoms of scleroderma)
Calchinosis : Deposition of calcium in skin
Raynaud’s Phenomenon: Abnormal blood flow during contact with stress and cold
Esophageal Dysfunction: Difficulty in swallowing
Sclerodactyly: Tightening of skin on the fingers and toes
Telangiectasia : Red spot on hand, forearm, palm, face
Swelling and puffiness
Shiny skin
Ulcer and Sore
Joint Pain and Stiffness
Muscle weakness
Shortness of breath
Irregular heart beat
Fatigue
Write diagnostic evaluation of scleroderma
History Collection
Physical Examination
Blood test (ANA-antinuclear antibody, ACA-anticentromere antibody, anti-scI-70 – antitopoisomerase I antibody)
Skin biopsy
Electrocardiogram
Pulmonary function test
x ray
Urine analysis
Write management of scleroderma
Immunosuppressant: Use of immunosuppressant drugs like methotrexate, cyclophosphamide to suppress immunity.
Corticosteroids: Using corticosteroid drugs to reduce inflammation.
Calcium channel blockers: Calcium channel blockers are used to treat Raynaud’s phenomenon and to control high blood pressure. such as nifedipine
Antacids (H2 blockers): Use proton pump inhibitors or H2 blockers to manage gastroesophageal reflux disease.
Pain Management: Use of analgesic, non-steroidal anti-inflammatory medicine to relieve pain.
Skin Care: Keep the skin moisturized regularly. So that the screen remains soft and hydrated. Protect the skin from trauma and avoid exposing the skin to extreme temperatures.
Physical therapy: Use range of motion exercises and stretching exercises to maintain joint flexibility and prevent contractures.
Pulmonary Rehabilitation: Lung involvement is seen in some cases. Hence to arrange a pulmonary rehabilitation program. Providing education on deep breathing exercises, techniques to improve respiratory function, lung health etc.
Heart Health Management: Regular monitoring of heart function. Taking prescribed medicine to manage high blood pressure and arrhythmias. To arrange cardiac rehabilitation program.
Define polymyositis
Polymyositis is a rare autoimmune condition. In which inflammation is seen in the connective tissue and muscle fibers. Due to which muscle weakness is seen.
Which affects the skeletal muscles on the other side of the body.
Write causes of polymyositis
The exact cause of polymyositis is unknown but is believed to be caused by genetic factors, infectious agents, environmental triggers, and certain drugs.
Write sign and symptoms of polymyositis
Muscle weakness (predominant symptom)
Weakness occurs especially in the muscles near the trunk. Like shoulder, hip, thigh, upper arm
Muscle pain and stiffness
Tenderness
Difficulty in rising from a seated position
Joint pain
Difficulty in swallowing
Skin Recess
Fever
Unintentional weight loss
Irregular heart rhythm
Write diagnostic test for polymyositis
History Collection
Physical Examination
Blood test (muscle enzyme-creatine kinase, aldolase)
Electromyography
Muscle biopsy
CT scan
MRI
Pulmonary function test
The Swallowing Study
Write management of polymyositis
Corticosteroids: Corticosteroid drugs such as prednisone are given to reduce inflammation and muscle weakness.
Immunosuppressive drug: Immunosuppressive drug is given along with corticosteroid to suppress the immunity. E.g. Methotrexate, mycophenolate
Intravenous immunoglobulin: Some patients are given intravenous immunoglobulin when there is no response to other treatments.
Biologic agents: Biologic agents are given in refractory cases and when other treatments cannot be tolerated. For example Rituximab
Physiotherapy: Exercises to improve muscle flexibility, strength and function.
Speech Therapy: Providing speech therapy to patients with swallowing difficulties. Because speech therapy improves swallowing function.
Define ankylosing spondylitis
Ankylosing spondylitis is also known as Bechterew’s disease.
Ankylosing spondylitis is a chronic inflammatory disorder. In which mainly axial skeletal is affected.
Ankylosing spondylitis is a type of inflammatory arthritis that mainly affects the spine and large joints (sacroiliac joint).
Write causes and risk factors of ankylosing spondylitis
The exact cause of ankylosing spondylitis is unknown. But it is believed to be due to genetic factors.
HLA-B27 antigen is present in such people.
Ankylosing spondylitis occurs mainly in men and develops in late adolescence or early adulthood.
Write sign and symptoms of ankylosing spondylitis
Chronic back pain and stiffness
Pain typically starts in the lower back and buttocks
Reduce flexibility of spine
Stiffness and loss of flexibility of spine
Difficulty in bending and twisting the spine
Kyphosis and Stooped Posture
Pain and swelling in other joint
Sacroiliitis (Inflammation in Sacroiliac Joint)
Peripheral arthritis
Enthesitis (inflammation at the site where tendons and ligaments attach to the bone
Chest pain
uveitis
Iritis
Fever
Fatigue
Weight loss
Write diagnostic evaluation of ankylosing spondylitis
History Collection
Physical Examination
x ray
CT scan
MRI
HLA-B27 testing
Inflammatory markers (CRP, ESR)
Write management of ankylosing spondylitis
✓ Pharmacological management:
Nonsteroidal anti-inflammatory drug:
Use of nonsteroidal anti-inflammatory drugs to reduce pain and inflammation. Like Ibuprofen, Diclofenac
Tumor Necrosis Factor Inhibitors:
Use tumor necrosis factor inhibitors in cases where NSAIDs are ineffective. which reduces inflammation and prevents disease progression. Ex. Infliximab, Golimumab,
Interleukin 17 (IL-17) Inhibitors :
Interleukin 17 inhibitors are given in patients who do not respond to tumor necrosis factor inhibitors.
Corticosteroids:
Intraarticular and topical corticosteroids are used to reduce inflammation and suppress immunity.
✓ Surgical intervention:
Joint Replacement Surgery:
In severe cases in which the joint is significantly damaged, joint replacement surgery is performed.
Spinal Surgery:
Spinal surgery is rarely performed to correct spinal deformities and fractures.
✓ Physical therapy and exercise:
Physical Therapy:
Maintaining posture, flexibility and mobility is a curricular part of the management of AS. Hence tailor exercises should be performed which strengthen the back and abdominal muscles and improve posture.
Exercise:
Performing activities like swimming, walking, strengthening regularly. Which improves spinal mobility and reduces stiffness.
✓ Life style modification:
Postural Training:
Training the patient to maintain good posture and making the patient aware about it. Especially while sitting, standing and sleeping.
Smoking Session:
Smoking increases the symptoms so smoking should be avoided.
Healthy Diet:
Eat a balanced diet to maintain a healthy weight and reduce joint strain.
Define fibromyalgia
Fibromyalgia is also known as a pain syndrome.
Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, sleep issues, and mood disturbances.
Write causes of fibromyalgia
The exact cause of fibromyalgia is unknown but appears to be due to a combination of genetic, environmental and psychological factors such as:
Abnormalities in pain processing in the central nervous system
Neurotransmitter Imbalance
Genetic abnormality
Physical or emotional trauma
Hormonal changes
Write sign and symptoms seen in fibromyalgia
Widespread musculoskeletal pain
Aching, burning or stabbing pain throughout the body
Fatigue
Persistent tiredness
Sleep disturbances
Cognitive difficulties (problems in memory, concentration, attention)
Enzyty
Mood swings
Multiple tender points (like back of head, top of shoulder, chest, hip, knee, outer elbow)
Numbness and tingling sensation in hand and fit
Head one
Digestive problems (irritable bowel syndrome, hypoglycemia)
Write diagnostic evaluation of fibromyalgia
History Collection
Physical Examination
Widespread Pain Index (WPI)
Symptoms Severity Scale (SSS)
Write management of fibromyalgia
Pain relievers: Use the over-the-counter pain medicine acetaminophen or a nonsteroidal anti-inflammatory drug to relieve pain.
Antidepressant: Using antidepressant drug duloxetine, amitriptyline. which relieves pain, improves sleep and relieves symptoms of depression and anxiety associated with fibromyalgia.
Muscle relaxants: Muscle relaxants are useful in relieving muscle spasm.
Physical therapy: Stretching exercises, low impact aerobic exercises and strength training. By which muscles flexibility, strength can be improved.
Cognitive Behavioral Therapy: Cognitive behavioral therapy is useful in helping the individual develop coping strategies, change negative thought patterns, and dress management.
Define gout
Gout is also known as ‘gouty arthritis’.
Gout is a type of arthritis characterized by recurrent attacks of inflammatory arthritis.
In this condition, the level of uric acid in the blood increases due to the formation of urate crystals, these urate crystals are deposited in the joint and cause pain and inflammation.
Gout mainly affects the big toe and other joints are also affected.
Uric acid is an end product of purine metabolism and is excreted by the kidneys. Write type of gout
There are two types of gout:
1) Primary gout
2) Secondary gout
1) Primary Gout:
Primary gout is found to be inherited. In which there is an error in purine metabolism due to which over production of uric acid is seen and uric acid level increases and uric acid retention is seen.
2) Secondary Gout :
Secondary gout is mainly caused by another disease condition or due to certain medications. Like chronic renal failure, diabetic ketoacidosis, hemolytic anemia. Medicines like cyclosporine, ethambutol
Write causes of gout
Alcohol consumption
Regular intake of sea food, red meat
Obesity
Chronic kidney disease
Hemolytic anemia
Hyper tension
Diabetes mellitus
Diabetic ketoacidosis
Malignancy
Metabolic syndrome
Cyclosporine
Salicylate
Diuretic
Write sign and symptoms of gout
Severe joint pain: Sudden and severe joint pain. In which the big toe (podagra) is mainly affected, besides ankle, knee, elbow, wrist and finger joints are affected.
Lingering Discomfort: Even after the pain has subsided, there is discomfort in the joint for days and weeks.
Inflammation and redness: The affected joint is swollen and red and feels warm to the touch.
Limited range of motion: Pain and swelling in the affected joint leads to reduced mobility.
Tophi Formation: In cases of chronic gout, urate crystals deposit under the skin and form a lump-like structure known as tophi. These tophi are painless but become inflamed during a gout attack.
Fever and Malaise: Some patients experience fever during a severe attack of gout.
Write diagnostic evaluation of gout
History Collection
Physical Examination
Serum uric acid level
Joint Fluid Analysis
x ray
Erythrocytes sedimentation rate
Kidney function test
Write management of gout
✓ Acute gout attack management:
Non-Steroidal Anti-Inflammatory Drug:
NSAIDs are the drug of choice for the treatment of acute gout attacks. Ex. Ibuprofen, Naproxen
Colchicine:
Colchicine is an antigout agent. It is used to reduce the symptoms of inflammation caused by uric acid crystals. Colchicine is mainly taken at the onset of a gout attack.
Corticosteroids:
Corticosteroid drugs are used in cases when NSAIDs and colchicine are ineffective or contraindicated. Ex. Prednisolone. Corticosteroids are injected orally or directly into the joint.
✓ Uric Acid Lowering Agent :
Xanthine oxidase inhibitors: Xanthine oxidase inhibitors are used to reduce the production of uric acid. Ex. Allopurinol, febuxostat
Uricosuric agents:
A uricosuric agent increases the excretion of uric acid through urine and decreases the level of uric acid in the blood. Ex. probenecid
Recombinant uricase : Recombinant uricase is used in severe cases which breaks down uric acid.
✓ Life Style Modification :
Avoiding purine rich diet. Like red meat, seafood, alcohol
Using low fat dairy products and vegetables in the diet.
Intake plenty of fluid. So that uric acid can be diluted and crystal formation can be prevented.
Maintaining a healthy weight can reduce gout attacks.