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Rheumatoid Arteritis


Presentation

  • Two patients with rheumatoid arthritis (RA) and polyarteritis nodosa (PN) presented with abdominal pain. Both revealed necrotizing vasculitis of the gallbladder and the appendix respectively.[ncbi.nlm.nih.gov]
  • CONCLUSION: In about 10% of patients the correct diagnosis of LORA, PMR, and TA in those presenting with PMS may be delayed due to similarities in initial clinical presentation. Longterm followup is essential to establish correct diagnosis.[jrheum.org]
  • CRC Press, 15.02.1994 - 640 Seiten Presenting an overview of the specific clinical problems that may be secondary to underlying immunological processes, this comprehensive reference details practical approaches for diagnosing and treating critically ill[books.google.de]
  • The present study only examined linear correlations. With larger data sets, future studies can use information theory to investigate non-linear causal–effect relationships.[bmjopen.bmj.com]
Fever
  • Other general symptoms include fever, weakness, anemia and weight loss. People with giant cell arteritis usually start off with flu like symptoms such as fatigue, fever, and loss of apetite.[ypo.education]
  • Patients present with fever, headache, tenderness and sensitivity on the scalp and recurrent jaw pain evoked especially by chewing.[medigoo.com]
  • Other general symptoms include weight loss, fever, tiredness and anaemia. The exact cause of polymyalgia rheumatica is not known.[irheum.org]
  • Patients may feel headaches, jaw pain, diffuse achiness, an unexplained fever or experience visual changes. Diagnosis is made by a good history, physical examination, labs and often an arterial biopsy done near the temple.[sarheumatology.com]
Weight Loss
  • Patient 2 was a 64-year-old man who presented initially with right temporal headache, decreased right eye visual acuity, weight loss of 19 kg and night sweats.[rheumatology.oxfordjournals.org]
  • Sometimes vasculitis can lead to weakness and weight loss. Vasculitis affecting the skin can cause rashes, skin discoloration, and ulcers. Vasculitis affecting the muscles can cause muscle pain.[medicinenet.com]
  • Other general symptoms include weight loss, fever, tiredness and anaemia. The exact cause of polymyalgia rheumatica is not known.[irheum.org]
  • loss Otorhinologic – jaw claudication Ophthalmologic – transient visual changes, diplopia, visual field cuts, permanent vision loss Cardiovascular – arm claudication, thoracic artery aneurysm Neurologic – headache, temporal artery pain, mononeuropathy[arupconsult.com]
Malaise
  • […] ischemic disease – most common in the optic nerve Can lead to vision loss, caused primarily by occlusive vasculopathy Granulomas form in arterial media Often associated with polymyalgia rheumatica Clinical Presentation Constitutional – fever, fatigue, malaise[arupconsult.com]
  • Generally, vasculitis causes fatigue and malaise. Sometimes vasculitis can lead to weakness and weight loss. Vasculitis affecting the skin can cause rashes, skin discoloration, and ulcers. Vasculitis affecting the muscles can cause muscle pain.[medicinenet.com]
  • Additional symptoms include depressed affect, fatigue, malaise, anorexia and weight loss. These systemic complaints are nonspecific and also occur with other disease processes in the elderly.[aafp.org]
  • […] pain, especially affecting the jaw, that may be felt when eating pain in the tongue, throat, or face pain or swelling on top of the head, or scalp blurry or double vision A flu-like feeling, with a loss of appetite, weight loss, sweating, fever, and malaise[medicalnewstoday.com]
Pathologist
  • The book is geared to pathology residents and practicing surgical pathologists and focuses on illustrated practical diagnosis, including differential diagnosis.[books.google.de]
Camping
  • Parathyroid hormone stimulates receptor activator of NFkappa B ligand and inhibits osteoprotegerin expression via protein kinase A activation of cAMP-response element-binding protein.[rheumres.org]
Periodontitis
  • Other leading identified risk factors for RA, including smoking, air pollution, periodontal disease, occupational exposures to silica and low oestrogens, 5 , 7 , 8 cannot easily explain the spatial or the temporal variations.[bmjopen.bmj.com]
Vascular Disease
  • The osteoprotegerin/ RANK/ RANKL system: a bone key to vascular disease. Expert Rev Cardiovasc Ther. 2006; 4(6): 801-11. doi: 10.1586/14779072.4. 6.801. Kanis JA, Melton LJ, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis.[rheumres.org]
  • Cannabis arteritis (CA) resembles thromboangiitis obliterans (TAO) (aka Buerger’s disease) and both should be considered in young adults less than age 50 presenting with peripheral vascular disease.[rheumnow.com]
  • Thoracic aortic aneurysms have also been related to systemic vascular diseases such as temporal arteritis. Laboratory Studies The ESR is the most useful serum laboratory test for diagnosing polymyalgia rheumatica and temporal arteritis.[aafp.org]
  • Noncardiac vascular disease in rheumatoid arthritis: increase in venous thromboembolic events? Arthritis Rheum. 2012;64(1):53–61. Epub 2011/09/10. pmid:21905005; Central PMCID: PMC3474372. View Article PubMed/NCBI Google Scholar 15.[journals.plos.org]
Joint Swelling
  • RA causes joint swelling, which leads to pain and loss of physical function, and GCA causes headaches, jaw pain, and vision problems as the walls of the arteries become inflamed.[belmarrahealth.com]
  • ANS. main trouble is rheumatoid artheritis, unable to wakeup, unable to walk, effected areas are knee joint swelling, both wrists, now new symptoms on neck and shoulder joints, duration of the trouble is all the day but severe from night to morning and[abchomeopathy.com]
Palpable Purpura
  • Findings by Vessel size: Large vessel: Blood pressure difference in extremities, upper extremity claudication, aortitis, aortic aneurysm Medium vessels: supply gut abdominal pain, testes pain, infarct Small vessels: Skin causing palpable purpura.[thecurbsiders.com]
Peripheral Neuropathy
  • The occurrence of peripheral neuropathy due to direct vasculitic involvement from GCA is disputed, but if it exists, it is rare [ 1 ].[rheumatology.oxfordjournals.org]
  • Less often, neurological symptoms, such as peripheral neuropathies [39] [40], strokes [41], scalp necrosis [42] and dementia [43] [44] have all been attributed to GCA.[eyewiki.aao.org]

Workup

  • Eye retinopath Basic lab workup: CBC, BMP, LFTs, UA (for protein, hematuria), ESR /- CRP, TSH, SPEP Workup, how broadly to check labs: “There are no labs specific to a large vessel vasculitis.”[thecurbsiders.com]
  • ESR was 4 mm/h and CRP was 1 mg/l; the remainder of his laboratory workup was normal. His symptoms resolved over 2 weeks and an NCS performed after resolution was normal.[rheumatology.oxfordjournals.org]
  • ., ultrasonography or MRI of the temporal arteries, F18 PET scan) has received increasing attention but it remains uncertain how they should best be integrated into the diagnostic workup.[orpha.net]
  • A new Doppler ultrasound of the four limbs was similar to the first one done at the initial workup, in addition to aneurysms of the lower limbs arteries.[omicsonline.org]

Treatment

  • “This is important because not all currently available treatments work in all patients, and some patients may spend years cycling through different treatments without achieving their treatment goals.[valuebasedrheumatology.com]
  • […] sort through interrelated medical conditions and diagnoses focuses on acute management issues rather than on chronic therapy for rheumatic and immunological diseases provides an exhaustive review of drug overdosage and toxicity delineates successful treatment[books.google.de]
  • Treatment of giant cell arteritis Treatment aims to stop any more damage to the affected tissues.[betterhealth.vic.gov.au]
  • If GCA is a possibility, treatment should start right away.[medicalnewstoday.com]
  • Unlike the treatment for PMR, which requires only low-dose corticosteroids (also called glucocorticoids), GCA treatment usually involves high doses of corticosteroids.[rheumatology.org]

Prognosis

  • Prognosis The disease is chronic and the clinical course is highly variable. Approximately 50% of patients experience subsequent disease flares. Visual loss is the most feared complication.[orpha.net]
  • Prognosis The visual prognosis is highly dependent on the rapidity with which steroids are started, and the status of the patient’s vision upon presentation.[eyewiki.aao.org]
  • Mononeuritis multiplex predicts the need for immunosuppressive or immunomodulatory drugs for EGPA, PAN and MPA patients without poor-prognosis factors . Autoimmun Rev 2014 ; 13 : 945 – 53 . 3 et al. .[rheumatology.oxfordjournals.org]
  • What is the prognosis for people with vasculitis? There are various outcomes for people with vasculitis. For many people, vasculitis, especially if confined to the skin, may be annoying but never life-threatening.[resources.lupus.org]
  • […] arteries [4] Diagnostic method Based on symptoms and blood tests, confirmed by biopsy of the temporal artery [4] Differential diagnosis Takayasu arteritis, [5] stroke, primary amyloidosis [6] Treatment Steroids, bisphosphonates, proton pump inhibitor [4] Prognosis[en.wikipedia.org]

Etiology

  • Each chapter includes eight to ten gross and microscopic photographs with legends highlighting the pathologic features of the disease, as well as succinct text covering etiology, clinical aspects, and differential diagnosis.[books.google.de]
  • Etiology The etiology of giant cell arteritis is unknown. Studies have linked genetic factors, infectious agents and a prior history of cardiovascular disease to the development of giant cell arteritis.[orpha.net]
  • 抄録 The etiology of rheumatoid arthritis has not been fully understood. Genetic factors have been pointed out to be involved in pathogenesis of RA because of many clinical and experimental facts.[jstage.jst.go.jp]
  • Causes and Risk factors: The exact etiology of this disease remains unknown. This disease is a chronic, systemic vasculitis primarily affecting the elastic lamina of medium- and large-sized arteries.[medigoo.com]
  • The etiology of CA is poorly understood. The main active ingredient in cannabis is Δ9-transtetra- hydrocannabinol (THC).[rheumnow.com]

Epidemiology

  • RHEUMATOLOGY EPIDEMIOLOGY This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and[bmjopen.bmj.com]
  • Summary Epidemiology GCA is the most common adulthood vasculitis with an annual incidence of 1/3,000-1/25,000 adults over 50 years old. It is more frequent in populations of northern European background.[orpha.net]
  • […] myopathy Osteoarthritis Other vasculitic disease Granulomatosis with polyangiitis (formerly Wegener granulomatosis) Eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome) Microscopic polyangiitis Polyarteritis nodosa Background Epidemiology[arupconsult.com]
  • An epidemiologic and histopathologic analysis. Arthritis Rheum 1994;37:1007-1012.fckLR Larsson K, Mellstron, D, Nordborg, E, Oden, A, Nordborg, E.[eyewiki.aao.org]
  • Patients and Methods This was a retrospective population-based study performed using resources of the Rochester Epidemiology Project (REP) medical record linkage system [ 9 ].[journals.plos.org]
Sex distribution
Age distribution

Pathophysiology

  • Vascular calcification in rheumatoid arthritis: prevalence, pathophysiological aspects and potential targets. Atherosclerosis. 2012; 224(2): 283-90. doi: 10.1016/j.atherosclerosis.2012.04.008.[rheumres.org]
  • .; most common primary vasculitis in older patients Age – peak age 70-80 years Rare – Sex – M Ethnicity – more common in Caucasians than African or Asian Americans; rare in Hispanic population (Weyand, 2014) Pathophysiology Medium- and large-vessel vasculitis[arupconsult.com]
  • The Heart in Rheumatic, Autoimmune and Inflammatory Diseases: Pathophysiology, Clinical Aspects and Therapeutic Approaches. Academic Press. p. 367. ISBN 9780128032688.[en.wikipedia.org]
  • (See Pathophysiology .) Age and female sex are established risk factors for GCA, a genetic component seems likely, and infection may have a role (see Etiology ).[emedicine.medscape.com]
  • Pathophysiology The most common ocular manifestation of GCA is visual loss, most commonly secondary to AAION. [28] In these cases, the short posterior ciliary arteries are occluded by intimal hyperplasia. [28] [29] [30] [31] [32] Once occluded, the short[eyewiki.aao.org]

Prevention

  • The findings by a rare collaboration of physicists and medical researchers suggest a relationship between the solar outbursts and the incidence of these diseases that could lead to preventive measures if a causal link can be established.[sciencedaily.com]
  • Prevention There is no way to prevent GCA since the cause is unknown. Giant cell arteritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Available at: . Updated May 30, 2016. Accessed July 10, 2018.[lahey.org]
  • Giant Cell Arteritis (GCA) is a medical emergency that must be treated very quickly and aggressively to help prevent serious consequences including blindness and stroke.[rheuminfo.com]
  • Treatment with steroids -- usually in the form of prednisone -- is mandatory for temporal arteritis to prevent serious complications, such as blindness. Low doses of steroids are often successful in treating polymyalgia rheumatica.[webmd.com]

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