RHEUMATIC

AND

GRANULOMATOUS

DISEASES

RHEUMATIC DISEASES

DEFINITION:

Painful conditions usually caused by

inflammation, swelling and pain in the

joints or muscles, including loss of

function of one or more connecting or

supporting structures of the body.

AREAS AFFECTED: joints, tendons,

ligaments, bones and muscles.

CAUSES:

1. Genetic

2. Environmental

- excessive stress on the joint

- repeated injury

- infection e.g. virus: Eptein-Barr

Virus and Lupus

3. Gender Factor / Hormonal Factor

- Lupus, RA, Scleroderma and

Fibromyalgia – more common

among women

- RA occurs 2-3x more often in women than

in men

- Scleroderma – more common in women

- 80 – 90% diagnosed with fibromyalgia are

women

- Gout is more common in males than

women; after menopause, the incidence of

gout for women begins to rise

- SLE – more common in women

WHO IS AFFECTED BY

RHEUMATIC DISEASE?

1. OSTEOARTHRITIS (OA)

• most common type

• affects both the cartilage

and underlying bone

• there is damage to the

cartilage (fraying and

wearing)

• joint pain and stiffness

• disability results when

the disease affects the

spine and the weight

bearing joints (knees and

hips)

EXAMPLES OF RHEUMATIC DISEASES

2. RHEUMATOID ARTHRITIS (RA)

• inflammatory disease of the immune system

• targets first the synovium, resulting in pain,

stiffness,

swelling,

joint damage

and loss of

function

• affects joints

of the hands

and feet

• symmetrical

3. JUVENILE ARTHRITIS

• most common form in

childhood

• may be associated with rashes

or fever

• may affect various parts of the

body

• pain stiffness, swelling, loss of

function

4. FIBROMYALGIA

• chronic disorder

• pain throughout the tissues that

support and move the bones

and joints (muscles and

tendons)

• patients may also experience

fatigue and sleep

disturbances

5. SYSTEMIC LUPUS ERYTHEMATOSUS

(SLE)

• autoimmune disease

• results in inflammation of and damage of

the joints, skin, kidneys, heart, lungs, blood

vessels and brain

6. SCLERODERMA

• also known as

systemic sclerosis

• “hard skin”: affects the

skin, blood vessels and

joints; may also affect the

lungs and kidneys

• abnormal and excessive

production of collagen in

the skin and internal

organs

7. SPONDYLOARTHROPATHY

• principally affects the spine

a) ankylosing spondylitis – affects people in

late adolescence or early childhood

b) reactive arthritis –

develops after an

infection involving

the lower urinary

tract, bowel or other

organs; commonly

associated with

eye problems, skin

rashes & mouth

sores

8. INFECTIOUS ARTHRITIS

e.g. parvovirus arthritis

gonococcal arthritis

9. GOUT

• results from deposits of

needle-like crystals of uric

acid in the joints.

• episodic inflammation,

swelling & pain in the

affected joint often the big

toe

10. POLYMYALGIA RHEUMATICA

• involves tendons, muscles,

ligaments and tissues

around the joint

11. POLYMYOSITIS

• inflammation and

weakness in the muscles

• may affect the whole body

and cause disability

12. PSORIATIC ARTHRITIS

• occurs in patients

with psoriasis

(scaling skin

disorder)

• affects the joints

at the ends of the

fingers and toes

accompanied by

changes in the

fingernails and

toenails.

13. BURSITIS

• inflammation of

the bursae (small

fluid – filled sac

that help reduce

friction between

bones and other

moving

structures in the

joint

14. TENDINITIS (TENDONITIS)

• inflammation

of tendons

• caused by

overuse,

injury or

rheumatic

condition

15.PAGET’S DISEASE

(OSTEITIS DEFORMANS)

• chronic condition of bone

characterized by disorder of the

normal bone remodeling process

BONE REMODELING: normal bone

can lay down new bone and take up

old bone

- essential for normal Ca++ levels in

our blood

• bone remodeling is disturbed and not

synchronized: bone formed is

abnormal, enlarged, not as dense,

brittle and prone to fracture

CAUSE: unknown

S/S: • commonly, no symptoms and

is often an incidental finding in X-

ray

• bone pain, deformity,

fracture and arthritis

• affects spines, femur,

pelvis, skull, clavicle and

humerus

16. SJOGREN’S SYNDROME

• autoimmune

• attacks glands that secrete fluid, such as

tear and salivary glands

• inflammation within the glands reduces the

production of tears and saliva dry

mouth and dry eyes

A. PRIMARY – when the condition develops by

itself

B. SECONDARY – when the condition

develops in combination with another

autoimmune condition (lupus or RA)

CAUSES: unknown

TRIGGERED BY: genetic

environmental

hormonal

CLASSIFICATION OF

SJOGREN’S SYNDROME

• common condition: 3-4% of adults in

U.K.

• second most common autoimmune

condition after RA

• most cases seen in ages 40-60

years old

• 90% of cases are women

WHO IS AFFECTED?

• eye and mouth dryness:

artificial tears and saliva

• good eye and mouth

hygiene to prevent corneal

ulcers and tooth decay

TREATMENT

17. TEMPOROMANDIBULAR JOINT DISORDER

(TMD)

• occur as a result of problems with the jaw,

jaw joint and surrounding facial muscles

that control

chewing and

jaw movement

TMJ – the

hinge that

connects the

lower jaw

(mandible) to the

temporal bone

of the skull

CAUSE: unclear

POSSIBLE CAUSES:

• injury to the jaw, TMJ, muscles

of the head and neck

• grinding / clenching of the

teeth

• dislocation of the soft cushion

or disc between the ball and

socket

• osteoarthritis or RA in TMJ

• stress

S/S: • pain or tenderness in the face, jaw

joint area, neck & shoulders, in or

around the ear

• lock-jaw in the open or closed mouth

position

• clicking, popping or grating sounds

when opening or closing the mouth

• tired feeling in the face

• difficulty in chewing or sudden

uncomfortable bite

• swelling

• toothache, headache, neckaches,

earache

DIAGNOSIS:

History

P.E.: TMJ Examination

Panoramic X-Ray

MRI / CT scans

CONSERVATIVE TREATMENT

• apply moist heat or cold packs

ice pack x 10 min. Do simple jaw

stretching exercises Apply a warm

towel x 5 min.

• eat soft foods

• medications

NSAID – naproxen, ibuprofen

• anti-anxiety

• muscle relaxant

TREATMENT

• low level laser therapy – reduce

the pain and inflammation as well

as increase range of motion

• splint or night guard – plastic

mouthpiece

• undergo corrective dental

treatments

e.g. replacing missing teeth and

using crowns, bridges or braces

• avoid extreme jaw movements