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At least 19 recordsLinked to original sources
PubMed1989

Approach to rheumatic diseases.

Rheumatic diseases are the most prevalent of the chronic painful disorders in the world today. The specialty of rheumatology is one of the most clinically orientated. Hence the approach to rheumatic diseases must be clinical. Proper history taking and physical examination including that of the musculoskeletal system cannot be overemphasized. Special attention must be paid to the skin, mucous membrane, the eyes, the gastrointestinal and genitourinary systems. Laboratory tests are meant to supplement a thorough history and physical examination and never in place of them. Because there is so much overlap in the clinical manifestations of the different rheumatic diseases, a precise diagnosis may be difficult in the early stages. Management goals must therefore be bipartite. Short term goal is aimed at symptomatic relief, gaining the patient's confidence and preventing disability. Long term goal requires the physician's attention to diagnosis and prognosis, drug toxicity, negotiating with the patient regarding an acceptable life-style and degree of relief and finally prolonging or protecting life. In fact the modern approach to health care delivery in rheumatic diseases must be based on the team concept. The team should consist of the physician/rheumatologist, the orthopaedic surgeon and a spectrum of arthritis health professionals composed of physical therapists, occupational therapists, nurses, psychologists, social workers, dietitians, bioengineers and administrators.

Health Services Needs and Demand↗
PubMed1976

[Psychsomatic aspects of rheumatic, especially soft tissue rheumatic diseases].

Rheumatic diseases may be connected to varying degrees with psychic factors. On the one hand, rheumatic diseases may produce psychic reactions, while on the other hand rheumatic symptoms--especially in extra-articular rheumatism--may be induced by psychosomatic hysteric pararheumatic diseases and depressive mechanisms. Special reference is made to psychosomatically induced extra-articular rheumatic diseases in which not only the complex genesis but also the clinical symptomatology are discussed. During therapy more attention should be directed to psychic factors than in the past, as only an intensive psycho and/or psychopharmacotherapy can influence the disease.

Adult↗
PubMedDate not supplied

Orofacial manifestations in the rheumatic diseases.

Rheumatic diseases will often affect the temporomandibular joint, but other orofacial tissues may also show manifestations. This article, based on a lecture given at the Royal National Hospital for Rheumatic Diseases, Bath, is intended to help the dental practitioner recognize and treat these symptoms.

Adult↗
PubMed1990

Introduction to rheumatic disease.

Rheumatic diseases are very common. They comprise one of the commonest causes of consultation by patients with general practitioners and hospital specialists. There are considerable financial implications for the community, as well as morbidity for the patient. Inflammatory and non-inflammatory categories are the major subdivisions of this group of over 200 diseases. They involve the joints, the bones, the muscles and connective tissue throughout the body.

Female↗
PubMed1986

Antibodies to type IV collagen in rheumatic diseases.

Rheumatic disease sera were examined by a sensitive and specific enzyme linked immunosorbent assay (ELISA) for antibodies to native and to denatured type IV collagen from basement membranes of bovine anterior lens capsules or human placenta. The frequency of antitype IV collagen antibodies depended on the antigen and the disease studied. No controls had human type IV collagen antibodies and only 5.6% had antibody to bovine type IV collagen. Antibody to one or more of our 4 antigens was seen in 20% of children with juvenile rheumatoid arthritis (JRA), 35% of patients with mixed connective tissue disease (MCTD), 40% of those with juvenile dermatomyositis (DM), 52% of adults with rheumatoid arthritis (RA), 56% of patients with scleroderma and 60% of patients with systemic lupus erythematosus (SLE). Antibodies to native human type IV collagen were rare (0-10%) except in SLE (45%). Antibodies to denatured human type IV collagen were commoner in RA, scleroderma and SLE. Antibodies to native bovine type IV collagen occurred in 8-20% of patient sera, and to denatured antigen in 25-26% of scleroderma, MCTD and DM patients. Antibovine type IV collagen activity measured by ELISA could be absorbed from positive sera by preincubation of the sera with bovine type IV collagen but not bovine type I collagen or native human placental type IV collagen, indicating that the antibodies were specific for bovine type IV collagen.

Adult↗
PubMed1988

Neoplastic associations of rheumatic diseases and rheumatic manifestations of cancer.

Associations between rheumatic diseases and malignant neoplasms are still inferential and based largely on epidemiologic data. Rheumatoid arthritis predisposes weakly to the occurrence of lymphoreticular neoplasms. This is more clearly true of Sjögren's disease, whether or not it is associated with RA. A subset of DM/PM which becomes manifest in close temporal proximity to a neoplasm may be a paraneoplastic reaction, but DM/PM, in general, does not predispose to neoplasia. Scleroderma in its early phase is associated with the development of breast cancer in women, and after a decade or longer, if pulmonary fibrosis has developed, with lung cancer. Of the drugs that have been used to treat these diseases, cyclophosphamide is most strongly implicated as a carcinogenic agent, particularly inducing lymphoreticular neoplasms and carcinoma of the bladder. Musculoskeletal symptoms that may be clues to the existence of cancer may either be caused by invasion of the neoplasm or be mediated by unidentified neurohumoral mechanisms. Except for multiple myeloma, primary neoplasms of skeletal tissues tend to occur under the age of 50 years. Metastatic disease occurs congruently with the age incidence of the primary neoplasm. Metastases may mimic mono- or oligoarticular arthritis if they happen to be periarticular or synovial. These metastases result most often from carcinoma of the lung or, in women, carcinoma of the breast. Hypertrophic pulmonary osteoarthropathy usually is due to carcinomas of the lung other than the small cell variety, and infrequently from other intrathoracic primary or secondary neoplasms. RA may be mimicked. Both skeletal metastases and HPOA are detected with greater sensitivity, but not specificity, by isotopic scanning techniques than by radiography. Of the other paraneoplastic musculoskeletal syndromes, neuromyopathy is the most frequent. It must be distinguished from cachexia, polymyositis, polymyalgia rheumatica, and the myasthenic syndrome. Both neuromyopathy and Eaton-Lambert (myasthenic) syndrome are predominantly associated with small cell carcinoma of the lung and both are best diagnosed by electromyography. Carcinomatous polyarthritis and the palmar fasciitis-arthritis syndrome occur with various neoplasms, although the latter appears to be particularly associated with ovarian carcinomas. The paraneoplastic arthritides test negatively for the rheumatoid factor, but no reliable positive immunochemical clues have as yet been identified.

Adolescent↗
PubMed1977

[Biochemistry of collagen and the locomoter apparatus (Hereditary connective tissue diseases and rheumatic diseases. Part I].

The elementary collagen molecule consists of three chains rolled into a spiral and ending in nonhelical telopeptides. In cutaneous collagen, there are two types of chains, in cartilaginous collagen there is only one. In the synthesis, several enzymes play successive parts: proline hydroxylase, lysine hydroxylase, then pro-collagen peptidase and finally, lysine oxidase and hydroxylysine oxidase; their coordinated actions ultimately allow the chains to establish the transverse intra and intermolecular links which give the collagen fiber its cohesion. The type and number of these transverse links vary from one tissue to another. Specific collagenases make collagen degradation possible.

Animals↗
PubMed1975

[Circulation of antibodies to dispiral RNA and ribosomal RNA in patients with allergies, rheumatic disease, and rheumatic arthritis].

A study was made of the incidence of antibodies to bispiral synthetic polynucleotide (poly E, poly C). In patients with allergoses and in healthy persons antibodies to bispiral RNA were revealed in 14% of cases, in patients with rheumatism--in 40.9% and with rheumatoid arthritis--in 50% of cases. It is supposed that more frequent detection of antibodies to bispiral RNA in patients with rheumatism and rheumatoid arthritis is associated with persistence of the RNA-containing viruses.

Antibodies↗
PubMed1992

Nutrition and pediatric rheumatic diseases. Hypothesis: cytokines modulate nutritional abnormalities in rheumatic diseases.

Growth abnormalities are common in pediatric rheumatic diseases. Studies suggest that effects of inflammation such as anorexia, and adipose and muscle tissue breakdown contribute to the nutritional and growth aberrations. The effects of the various cytokines produced during inflammation create a vicious cycle of anorexia and increased catabolism, and may be responsible for the nutritional deficits seen. In future, specific treatment with anticytokine monoclonal antibodies may block these effects, minimizing the nutritional consequences of inflammation.

Arthritis, Juvenile↗
PubMed1989

How to evaluate patients for rheumatic diseases.

The rheumatic diseases encompass many common and uncommon disorders. The information derived from a careful history and physical examination can help define the urgency of the problem, classify the disease, provide diagnosis, and permit optimal therapy.

Arthritis↗
PubMed1985

Terminal complement component deficiencies and rheumatic disease: development of a rheumatic syndrome and anticomplementary activity in a patient with complete C6 deficiency.

Hereditary deficiencies of early complement components have usually been associated with the development of rheumatic diseases like systemic lupus erythematosus (SLE), while terminal component deficiency is well known to predispose to recurrent neisserial infection. In contrast, only recently have patients been reported with rheumatic disease and hereditary deficiency of a terminal component. The clinical syndrome in these patients has been characterised as 'SLE-like'. We describe here a third patient with complete C6 deficiency and a systemic rheumatic illness characterised by fever, anaemia, lymphadenopathy, hepatosplenomegaly, episcleritis, and asymmetric arthritis. After blood transfusion her serum became anticomplementary; IgG antibody to human C6 was found to be the cause of anticomplement activity. Persistent absence of C6 in this patient and production of anti-C6 antibody after antigenic challenge indicate hereditary C6 deficiency. This case supports an association between hereditary deficiency of a terminal complement protein and the development of systemic rheumatic disease.

Complement Activation↗
PubMed1991

Diet and disease symptoms in rheumatic diseases--results of a questionnaire based survey.

Experiences with food intake, diet manipulations and fast were registered in rheumatic patients. The study was a questionnaire-based survey in which 742 patients participated. It comprised 290 patients with rheumatoid arthritis, 51 patients with juvenile rheumatoid arthritis, 87 patients with ankylosing spondylitis, 51 patients with psoriatic arthropathy, 65 patients with primary fibromyalgia and 34 patients with osteoarthritis. One third of the patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthropathy reported aggravation of disease symptoms after intake of certain foods while 43% of the patients with juvenile rheumatoid arthritis and 42% of the patients with primary fibromyalgia stated the same. Twenty-six percent of the patients with juvenile rheumatoid arthritis and 23% of the patients with rheumatoid arthritis, ankylosing spondylitis and primary fibromyalgia had previously tried certain diets in the attempt to alleviate disease symptoms, whereas 13% of the patients with psoriatic arthropathy and 10% with osteoarthritis had tried diet therapy. Less pain and stiffness were reported by 46% of the patients and 36% reported reduced joint swelling. Similar beneficial effects of diet were also reported in other rheumatic disease groups. Fifteen percent of the patients with rheumatoid arthritis and ankylosing spondylitis had been through a fasting period. Less pain and stiffness were reported by 2/3 of the patients in both groups and half of the patients in both groups reported a reduced number of swollen joints.

Adolescent↗
PubMed1986

The ninth complement component in rheumatoid arthritis, Behçet's disease and other rheumatic diseases.

Using an immunoradiometric assay with two monoclonal antibodies plasma C9 levels were measured in 49 patients with rheumatoid arthritis, eight patients with Behçet's disease, six patients with ankylosing spondylitis, nine patients with psoriatic arthropathy, six patients with systemic lupus erythematosus, five patients with erosive osteoarthritis and four patients with acute gout. Plasma C9 levels were also followed sequentially in four patients with Behçet's disease to show fluctuation during disease activity. The upper limit of normal for plasma C9 was 90 mg/l, 2 standard deviations above the known mean value. Significantly raised levels were found in active rheumatoid arthritis (119.7 +/- 28.3), Behçet's disease (177.9 +/- 26.2) and ankylosing spondylitis (116.1 +/- 23.1). In Behçet's disease the raised C9 levels normalized during disease quiescence suggesting that C9 is a good monitor of disease activity. CRP and ESR values were also measured. In rheumatoid arthritis C9 was more consistently elevated in active disease than CRP or ESR. As there was no association between these measures on mathematical analysis it was concluded that plasma C9 is a better indicator of disease activity in rheumatoid arthritis.

Arthritis, Rheumatoid↗