Systemic Lupus Erythematosus Symptoms

Wide spread Lupus Erythematosus Manifestations – Systemic lupus symptoms


SLE influences multiple organ devices. The Systemic Lupus Erythematosus Manifestationsadvancement is visible by remissions and regressions and could vary from moderate to intense.

Mucocutaneous – A lot of people have skin lesions at some time during the advancement of the condition. Butterfly breakout, erythema or redness over the cheeks and nose, saving the nasolabial layers, which shows up after sunlight exposure is the most usual lesion. It usually persists however lasts a few days. Some people will certainly get discoid sores, that are more inflammatory and have a scarring propensity. Alopecia or baldness is common, yet thinning hair is unheard of.

Arthritis – Joint Systemic Lupus Erythematosus Manifestationswhich are often the earliest indication take place in over 90 % of people at time throughout the health problem. Just a few joints are typically had an effect on, specifically those of the hands. The SLE arthritis has the tendency to be strolling and in proportion. The arthritis is relatively uncomfortable, and hardly ever warping.
12 to 45 percent of clients have dental and/or nasal ulcers, usually pain-free, unlike herpetic chancre scorchings.

Raynaud sensation – Happened in 16 to 40 % of clients, Chilly or emotion-induced color changes of the figures of the hands and/or feet, the Raynaud phenomenon, is a frequent trouble and might antedate various other attributes of the ailment.

Gastrointestinal tract – Systemic Lupus Erythematosus Symptom is usually included GI tract, but more often from medicine negative effects than from energetic SLE. Instances of the previous consist of gastritis and even peptic ulcers secondary to using NSAIDs alone or in combo with glucocorticoids. SLE vasculitis can bring about pancreatitis, peritonitis, and colitis. Signs of esophageal irritation or reflux could develop. Nonspecific stomach discomfort is regular.

Renal – Systemic Lupus Erythematosus Symptoms of Kidney ended up being clinically obvious in roughly 50 percent of clients; however, most of the continuing to be clients have subclinical ailment that could be demonstrated if renal biopsy were executed. Renal participation normally develops in the first few years of health problem, and should be identified early by routine urinalyses, quantitation of proteinuria, and estimation of the glomerular filtering price (normally by overseeing the plasma creatinine concentration). A number of kinds of glomerulonephritis can take place and renal biopsy serves to determine the type and level of renal involvement.

Cardiovascular – There are a selection of cardio signs of SLE. Pericarditis is rather usual, while verrucous (Libman-Sacks) endocarditis is normally medically quiet however can generate valvular lack and function as a resource of emboli (image 5). Patients with SLE have an enhanced threat of coronary artery condition.

Lung – Pleurisy, pleural effusion, pneumonitis, interstitial lung condition, pulmonary hypertension, and alveolar hemorrhage can all happen in SLE. The threat of thromboembolic involvement is boosted in those with antiphospholipid antibodies. Dyspnea, episodic pleuritic breast pain, dynamic decrease in lung amount in the absence of interstitial fibrosis or substantial pleural ailment recommends the shrinking lung disorder. Pulmonary feature tests are often substantially unusual, with limiting irregularities, before complaints of dyspnea.

Neurologic – Neurologic complications include cognitive defects, organic brain syndromes, delirium, psychosis, seizures, headache, and/or peripheral neuropathies. Other less common problems are movement disorders, cranial neuropathies, myelitis, and meningitis.

Psychosis, which may be due to SLE or to glucocorticoid treatment, is one of several psychiatric manifestations of SLE. Others include: depression, anxiety, and mania.

Neonatal lupus can cause heart block of varying degrees that may be noted in utero and or present as congenital heart block.

Thromboembolic events, often in association with antiphospholipid antibodies, may occur in a substantial minority (20 percent) of patients with SLE. Arterial thromboemboli may cause focal neurologic problems, such as stroke or seizures, and/or more diffuse cognitive defects

Ophthalmologic – The eye is frequently involved in SLE with the most common manifestation being keratoconjunctivitis sicca. rare ophthalmologic manifestations of SLE include: Cotton wool exudates due to retinal vasculitis, Anterior uveitis, Episcleritis or scleritis.

Hematologic– Cytopenias and thrombophilia, an increased the propensity to develop thromboembolic disease, might be features of SLE. Leukopenia which is diagnostically useful is common. While, it is usually not symptomatic unless severe  (less than 2000/mm3). 43 to 66 % of patients have leukocyte count of less than 4500/mm3. Many patients have a mild anemia, which is most often due to the anemia of chronic disease.

Lymphadenopathy and splenomegaly – Many patients have peripheral lymphadenopathy and/or splenomegaly.
Anticardiolipin antibodies can produce a false positive test for syphilis (eg, VDRL).

Immunologic – Autoantibody production is a hallmark of Systemic Lupus Erythematosus Symptoms.


Lupus Procedure Rules

Lupus Treatment Guidelines

What is Systemic Lupus Erythemathosus? You could read that on my previous article What is Lupus. We could divide the Lupus Procedure into Non-Pharmacological and Pharmacological in shorts Non-Drugs and Drugs. We will certainly review Lupus treatment into 2 parts. In this section we will certainly go over on the Non-Pharmacological Treatment.

Non-Pharmacological Lupus Procedure comprises of

1. Academic training

Person education and learning plays an essential part since Systemic Lupus Erythemathosus is a persistent disease. Patients should be geared up with adequate info about an assortment of medical manifestations that can take place, the extent of the illness is differ, so people could recognize and decrease too much anxiety. It is essential to females of reproductive age to provide the understanding that if they want to obtain expectant, after that the pregnancy must be prepared when the illness is in remission, so it could decrease the incidence of flare and the threat of abnormalities in the unborn child in addition to patients during pregnancy.

2. Social and Psychological Assistance

This can come from physicians, family, buddies and includes peer group or support group among lupus patients. The team could conduct clients and public education and also can give advocacy and support for Lupus clients. There are a great deal of lupus team or organization, you can locate it on the internet.

3. Relax

Patients with Systemic Lupus Erythemathosus frequently experience tiredness that it needs sufficient rest, along with take into consideration other reasons such as fibromyalgia, hypothyroidism and/or misery. You could review my prevoius blog post on Lupus Symptoms for even more info on fatigue reasons.

4. Sun screen lotion

In clients with Systemic Lupus Erythemathosus ailment activity could be raised after exposure to sunshine, so it is strongly advised to stay clear of excessive sun direct exposure and use sun screen lotion with SPF> )30 in 30-60 minutes before exposure, every 4-6 hrs.

5. Screen closely

Clients with Systemic Lupus Erythemathosus vulnerable to infection and should look out if there is unexplained fever source. The danger of infection likewise enhanced in addition to the administration of drugs and corticosteroids immunosupression. Danger of incident heart disease events, weakening of bones and malignancy additionally increased in clients with SLE, so the need to regulate threat aspects resemble cigarette smoking, excessive weight, dyslipidemia and hypertension is a must.

Pharmacological Procedure of SLE

Immunomodulatory treatment

1. Cyclophosphamide.

2. Mycophenolate mofetil (MMF).

3. Azathioprine.

4. Leflunomide (Arava).

5. Methotrexate.

Treatment Plan

There is no recognized remedy for lupus. However, your team of health care suppliers can develop a treatment plan to prevent flare-ups, to address them when they do occur, and to minimize problems.


While you could’ t protect against lupus, you can assist protect against flare-ups:

Avoid sunlight exposure, high-dose birth control pills, penicillin, and sulfonamides (anti-bacterial representatives).
Exer.cise regularly
Get flu and pneumonia vaccines


Lupus Symptoms in Pregnant Women

Lupus Symptoms in women is surely an autoimmune disease which commonly affects women, although men can also have the lupus symptoms,  and often many experts have said that women who have lupus symptoms cannot become pregnant due to their condition. However, this myth has been denied by specialists, approximately 50% of  pregnant women who has lupus symptoms can have a ordinary pregnancy and give birth healthy babies. Conversely, some women might possibly face complications and even lose their fetuses during the pregnancy.

Whilst many pregnancies with lupus are totally natural, women risk to facing problems over their pregnancy. The expectant mother with lupus need to be supervised by an expert doctor (obstetrician) till the end of pregnancy,  in other words, the health risk of the mother’s is definitely diminished and normal babies are usually born. In addition, women with lupus symptoms must obey the doctor’s instruction manuals.

Pregnant women with symptoms of lupus may perhaps face particular symptoms which includes rashes and lupus flare which can appear because of an increased blood flow in the skin, growth of new hair during pregnancy plus severe hair loss after the baby born.

One of the important things we need to notice is that 20% of lupus patients who are pregnant tend to have an abrupt rise in BP (blood pressure), protein in the urine, a condition which you’ll find known as Preeclampsia or toxaemia and degree of serious treatment as well as immediate delivery. The presence of antibody called anti-phospholipid antibody could occur to lupus pregnancies which is another serious complications.  Anti-phospholipid antibody can minimize the function of the placenta by bring about blood clots, as well as blood clots within the placenta, making the placenta to higher risks. Neonatal Lupus Syndrome can occur in lupus pregnancy when the unborn children are exposed to an antibody known as anti-ro or anti-SSA. In many events, women who has severe form of lupus symptoms in pregnancy  have to get through a caesarian section to conserve the premature baby.

Even though, lupus patient in remission generally have less problem when compared with women with activate lupus, a balanced healthy diet could actually help a lot throughout the pregnancy. There are some golden rules to be followed by pregnant woman living with lupus, they are: regularly visits on the doctor, proper prescription of  medication, stay away from pills that can put the baby’s life in danger, a sensible food diet, as well as no bad habits like smoking or drinking.

In conclusion, a normal pregnancy can be carried on by pregnant women who put up with lupus symptoms if  they follow the suitable management and have an equalize standard of living. Moreover, it has been taken into account that most medications for Systemic Lupus Erythematosus (SLE) are safe to be used during the pregnancy given that that they don’t pass through the placenta.


Cutaneous Sarcoidosis – All You Need to Know and Exciting New Information

Cutaneous Sarcoidosis

Cutaneous sarcoidosis as other individual forms of sarcoidosis isn’t really simple to recognize the means it can mirror bunches of various other ailments. Due to this, skin sarcoidosis is also called the ‘wonderful imitator’ in dermatology.

Cutaneous sarcoidosis happens in as much as one 3rd regarding people with systemic sarcoidosis. It is extremely important recognize skin sarcoidosis thinking about that it could supply crucial insight in the improvement of the problem with the skin sores being so available for histologic checking.

Cutaneous sarcoidosis Medical diagnosis

You do not have single test which could certainly identify the particular visibility of sarcoidosis. Consequently the intention is generally to finish a clinical picture to see histological proof with noncaseating granulomas.

Additionally, the wellness professional might be looking to dismiss various other possible trigger of the exact same symptoms, for example infections.

Cutaneous sarcoidosis – particular and nonspecific indications on the ailment

All indications of skin sarcoidosis are typically split into number of teams, certain along with non-specific:.

  • Non-specific (no granuloma is situated in the tissue biopsy)
  • Specific (granuloma is situated in the cells biopsy)

Erythema Nodosum

Erythema Nodosum is the best nonspecific cutaneous lesion about sarcoidosis. It occurs in the form of soreness of your skin created by congestion from the blood vessels, which might result from a selection of reasons. In cutaneous sarcoidosis, this typically indicates that that spots appear associating with the legs – the shins much more reguarily then other individual parts.


The most familiar sorts of accurate lesions are papules. They commonly develop associating with the face however could possibly develop anywhere to the physical body and can be different in color consisting of red, reddish-brown as well as violaceous.


Cavity enducing plaques are really bigger, sores that perform the face and they typically have a fat-free top torso, or perhaps extremities. The sores might maybe be solitary or numerous and will also be different in tone.

Lupus pernio

Lupus pernio is amongst the few cutaneous symptoms which could be particular of sarcoidosis. A lot more consistently after that not, it has an effect on the edge belonging to the nose. It can be acknowledged by all the characteristic purplish color selection.

Cutaneous sarcoidosis – Treatment

Very much like various other kinds connected with sarcoidosis, dental steroids are typically utilized in cutaneous sarcoidosis. Procedure which may be certain just for cutaneous sarcoidosis are typically topical corticosteroids emulsions.


Polymyositis and Dermatomyositis Symptoms

Polymyositis is an unheard of wide spread disorder whose main feature is balanced muscular tissue weakness
and throwing away involving the proximal muscles of the shoulder and pelvic girdles.
Polymyositis + associated breakout = dermatomyositis

dermatomyositis heliotrope rash

Clinical components

  • any age
  • peak occurrence 40-60 years
  • female to male proportion 2:1
  • muscular tissue disadvantage and losing proximal limb muscular tissues
  • major problem is weakness
  • muscular tissue discomfort and inflammation in concerning FIFTY %
  • arthralgia or arthritis in regarding FIFTY % (resembles circulation of rheumatoid arthritis)
  • dysphagia in concerning 50 % as a result of oesophageal involvement
  • Raynaud’s phenomenon
  • think about linked malignancy: lung and ovary

The breakout

The unique rash shows attributes of photosensitivity. There is violet staining of the eyelids,.
forehead and cheeks, and possible erythema appearing like sunburn and periorbital oedema. There is a.
particular rash on the hands particularly the fingers and nail folds. The knees and elbows are.
generally included.

muscle enzyme studies (serum creatine kinase and aldolase)
biopsies—skin and muscle
EMG studies—show characteristic pattern


includes corticosteroids and cytotoxic drugs. Early referral is appropriate.


Sarcoidosis Treatment Natural Remedies

natural remedies for sarcoidosis

Sarcoidosis is a multisystemic disorder of unknown aetiology which is characterised by non-caseating
granulomatous inflammation that involves the lung in about 90% of affected patients. A characteristic
feature is bilateral hilar lymphadenopathy, which is often symptomless and detected on routine CXR.
Radiological lung involvement can be associated with or occur independently of hilar lymphadenopathy.
Clinical features:

  • may be asymptomatic (one-third)
  • onset usually 3rd or 4th decade (but any age)
  • bilateral hilar lymphadenopathy (on CXR)
  • cough
  • fever, malaise, arthralgia
  • erythema nodosum
  • ocular lesions, e.g. anterior uveitis
  • other multiple organ lesions (uncommon)
  • overall mortality 2-5%

Erythema nodosum with acute fever, malaise and arthralgia in a young adult female is diagnostic of

Histological evidence from biopsy specimen, usually transbronchial biopsy (essential if an alternative
diagnosis, e.g. lymphoma, cannot be excluded) or skin biopsy in cases of erythema nodosum.

Supporting evidence:

  • elevated serum ACE (non-specific)
  • PFTs: restrictive pattern; impaired gas transfusion in advanced cases.
  • ±ve Kveim test (not recommended these days)

Sarcoidosis may resolve spontaneously (hilar lymphadenopathy without lung involvement does not require treatment). About half of all people with sarcoidosis get better without needing treatment. For others, medications such as corticosteroids may help reduce swelling, rashes, pain, fever, and lung problems. Some lifestyle changes may help control complications, such as kidney stones or other damage. While complementary therapies for sarcoidosis have not been well studied, they may help you feel better as part of an overall treatment plan.
Indications for treatment with corticosteroids:

  • no spontaneous improvement after 6 months
  • symptomatic pulmonary lesions
  • eye, CNS and other systems involvement
  • hypercalcaemia, hypercalcuria
  • erythema nodosum with arthralgia
  • persistent cough


If you smoke, quit. Quitting smoking can ease lung symptoms.

Sarcoidosis can be a long-lasting disease, so it’s important to eat a healthy diet filled with fruits, vegetables, and whole grains.

Exercise regularly. Be sure to ask your doctor before starting a new exercise program, especially if sarcoidosis leaves you short of breath.


Corticosteroid treatment
Prednisolone 30 mg daily for 4-6 weeks, then reduce to lowest dose that maintains
improvement. 6 If there is no response, taper the dose to zero. If there is a response, taper the
dose to 10-15 mg (o) daily as a maintenance dose for 6-12 months. 14
Prednisolone 20-30 mg for 2 weeks for erythema nodosum of sarcoidosis.

Corticosteroids such as prednisone are considered the first-line treatment for lowering inflammation associated with sarcoidosis. Oral corticosteroids can have some serious side effects if taken in high doses for long periods. Side effects may include high blood pressure, diabetes, peptic ulcers, tuberculosis, or osteoporosis. Your doctor will likely suggest regular check-ups and tests.

Other medications sometimes used for sarcoidosis include those that suppress the immune system, such as methotrexate, azathioprine (Imuran), and infliximab (Remicade). However, there are no long-term studies on whether these medication are effective for treating sarcoidosis.

Other medications that may be used include:

Antimalarial drugs such as hydroxychloroquine — used when the skin is affected. It may be toxic to the eyes.

Thalidomide — being studied for sarcoidosis; used to improve lung function and treat skin problems.

Surgery and Other Procedures

Surgery, such as a lung or heart transplant, is only necessary in very severe cases.

Nutrition and Dietary Supplements

Although there is no evidence that any particular herb or supplement helps treat sarcoidosis, a comprehensive treatment plan may include complementary and alternative therapies. Ask your team of doctors about the best ways to bring these therapies into your overall treatment plan. Always tell your doctor about the herbs and supplements you are using or considering using, as some supplements may interfere with conventional treatments.

These nutritional tips will help your overall health:

  • Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
  • Include foods rich in magnesium and low in calcium, such as barley, bran, corn, rye, oats, soy, brown rice, avocado, banana, and potato.
  • Avoid refined foods, such as white breads, pastas, and sugar.
  • Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
  • Use healthy oils, such as olive oil or vegetable oil.
  • Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
  • Avoid caffeine, alcohol, and tobacco.
  • Drink 6 – 8 glasses of filtered water daily.
  • Exercise at least 30 minutes daily, five days a week. Ask your doctor before starting a new exercise routine.

The following supplements may also help overall health:

  • A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
  • Omega-3 fatty acids, such as fish oil, 1 – 2 capsules or 1 – 3 tablespoonfuls oil, one to three times daily. Fish oil seems to help reduce inflammation throughout the body. Cold-water fish, such as salmon or halibut, are good sources to add to your diet. If you take supplements, check with your doctor because they may increase the risk of bleeding, especially if you take blood thinners such as warfarin (Coumadin) or aspirin. Eating fish doesn’ t cause the same risk.
  • Bromelain, a mixture of enzymes derived from pineapple, 500 mg per day. Bromelain may also help reduce inflammation in the body. Ask your doctor before taking it, because it can increase the risk of bleeding and may interact with other medications.
  • Probiotic supplement (containing Lactobacillus acidophilus), 5 – 10 billion CFUs (colony forming units) a day. These “friendly” bacteria help maintain gastrointestinal health. You should refrigerate your probiotic supplements for best results.

Herbs : Natural Remedies

Herbs are generally a safe way to strengthen and tone the body’s systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 – 10 minutes for leaf or flowers, and 10 – 20 minutes for roots. Drink 2 – 4 cups per day. You may use tinctures alone or in combination as noted.

Studies haven’ t found any herbs that specifically treat sarcoidosis. However, the following herbs may help overall health. Talk to your doctor before taking any herb or supplement if you have sarcoidosis.

  • Turmeric (Curcuma longa) standardized extract, 300 mg three times a day, may help reduce inflammation. Turmeric may increase the risk of bleeding and interact with other medications, so ask your doctor before taking it.
  • Cat’s claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, may help reduce inflammation. People with leukemia should not take cat’ s claw. Cat’ s claw interacts with some medications, so ask your doctor before taking it.


A few case reports suggest that homeopathic remedies may improve the general well-being of individuals with sarcoidosis. An experienced homeopath can prescribe a regimen for treating sarcoidosis that is designed specifically for each individual. The primary remedies used by individuals who reported improvements in their symptoms include:

  • Tuberculinum bovinum
  • Beryllium

Other homeopathic remedies that have been used clinically for the condition are as follows:

  • Carcinosin
  • Euphrasia
  • Graphites
  • Leuticum (Syphilinum)
  • Bacillinum
  • Sepia
  • Phosphorus
  • Arsenicum album

Signs and Symptoms of Multiple Sclerosis-How is MS Diagnosed

Multiple sclerosis (MS) is the most common cause of progressive neurological disability in the 20-50 year age group. The Signs and Symptoms of Multiple Sclerosis is vast, early diagnosis is difficult because MS is characterised by widespread neurologic lesions that cannot be explained by a single anatomical lesion, and the various signs and symptoms are subject to irregular exacerbations and remissions. The most important issue in diagnosis is the need for a high index of suspicion.

Signs and symptoms of multiple Sclerosis MS

What Causes MS? MS is a primary demyelinating disorder with demyelination occurring in plaques throughout the white matter of the brain, brainstem, spinal cord and optic nerves. The clinical features depend on their

Clinical features – Signs and Symptoms of Multiple Sclerosis

> more common in females
> peak age of onset is in the fourth decade
> symptoms develop over several days but can be sudden
> transient motor and sensory disturbances
> upper motor neurone signs
> monosymptomatic initially in about 80%
> multiple symptoms initially in about 20%
> common initial symptoms include:
> visual disturbances of optic neuritis
– blurred vision or loss of vision in one eye (sometimes both)
– central scotoma with pain on eye movement (looks like unilateral papilloedema)
> diplopia (brainstem lesion)
> weakness in one or both legs, paraparesis or hemiparesis
> sensory impairment in the lower limbs and trunk
– band-like sensations
– numbness, paraesthesia
– clumsiness of limb (loss of position sense)
– feeling as though walking on cotton wool
> vertigo (brainstem lesion)
> subsequent remissions and exacerbations that vary from one individual to another
> there is a progressive form especially in women around 50 years

Neurological examination
The findings depend on the site of the lesion or lesions and include optic atrophy, weakness, hyperreflexia,
extensor plantar responses, nystagmus (two types: cerebellar or ataxic), ataxia, incoordination and regional impairment of sensation.

Signs and Symptoms of MS causing diagnostic confusion
> bladder disturbances, including retention of urine and urgency
> ‘useless hand’ due to loss of position sense
> facial palsy
> trigeminal neuralgia
> psychiatric symptoms

In established disease common sign and symptoms of ms are fatigue, impotence and bladder disturbances.

How is MS Diagnosed?

The diagnosis of MS is clinical and depends on the following determinants:

  • Lesions affect the CNS white matter.
  • Lesions are invariably UMN.
  • >1 part of CNS is involved, although not necessarily at time of presentation.
  • Episodes are separated in time (it is possible to make a diagnosis with the first episode).

Other neurological diseases such as infections (e.g. encephalitis), malignancies, spinal cord compression, spinocerebellar degeneration and others must be excluded.

For Diagnosing MS, some Lab and Imaging are needed

  • Lumbar puncture: oligoclonal IgG detected in CSF in 90% of cases 8 (only if necessary)
  • Visual evoked potentials: abnormal in about 90% of cases
  • CT scan: rarely demonstrates MS lesions but useful in excluding other pathology
  • MRI scan: usually abnormal, demonstrating MS lesions in about 90% of cases 8

Relapsing Remitting MS Symptoms – What You Need To Know

Having multiple sclerosis (MS), a disease which damages the nerves, can be quite a ride. A patient is in pain at a time then it becomes better at another.

There are different forms of MS, one of which is relapsing-remitting MS (RRMS), the most common form, in which a patient can have sudden attacks followed by a period of stability. In this kind of MS, patients are most likely to experience flare-ups a month after the last attack happened. During a relapse a patient may have severe urinary problems, troubled sexual functions, and depression, among others. These symptoms may simultaneously appear during a relapse or may even be worse than the previous occurrence.  It is also possible for a new symptom to arise.

Another type of MS which is progressive-relapsing ultimately gets worse over time. Although uncommon, this disease gives no assurance for remission. In contrast to other forms of MS, RRMS gives the patient some time to feel better. Symptom occurrences might be mild or severe but it will wear off eventually since after the experience of a relapse, there will be a remission. When MS remits, it means that the condition of someone with the said illness shows improvement. For people who have Relapsing remitting MS symptoms thus, chances for recovery are higher. At least during remission, a patient with RRMS feels stronger, with fewer or no attacks that can last longer than expected.

A remission does not guarantee though that a patient’s condition will no longer deteriorate. In due course, RRMS will develop into a secondary progressive MS wherein a relapse seldom happens while the disease becomes even worse.

Most RRMS patients are women and Caucasians and they start to experience a relapse at age 20, based on estimates. Doctors could not give a definite list of causes for having this disease but they associate the relapse with pollutants or lack of vitamin D which primarily aids in the absorption of calcium in the body. Specialists are open to the possibility that RRMS have something to do with genes although they do not deem it necessarily hereditary.

Due to the unpredictability of relapsing-remitting MS, a patient might feel dejected because any moment the pain will again strike. In the same manner, RRMS sheds light on the possibility of living like nothing had gone wrong during relapses. Upon remission, patients will experience how it feels again to be pain-free.

What could be the worse reaction of a patient with RRMS symptoms? Perhaps, sulking under the covers and failing to acknowledge that non-remitting sickness does not even give people the chance to live like how most normal people do.


Autoimmune disease – Diagnosis, Symptoms, Investigation, Definition

Autoimmune disease is a pathological condition which is caused by an adaptive autoimmune response directed against an antigen within the body of the host. In other words, the body mistakenly attacks its own cells. The disease can affect every part of the human body. It may be systemic, affect single organs or organ systems or attacking several organ systems simultaneously. Thus, the symptoms are vary correspondingly depend on which parts of the body are attacked by the immune system and on the development of the disease. However, these definitions can be unclear since it is often difficult to differentiate the causality when dealing with a human disease. It is very beneficial to consider the evidence of an autoimmune etiology of a human disease with three degrees of stringency.

Direct evidence
Indirect evidence
Circumstantial evidence


How to determine if autoimmunity is the cause of the disease rather than an accompanying feature or an outcome? The demonstration of auto-antibodies is the first step in the diagnosis of these diseases, however the antibodies might not be the actual pathogens of the disease. Autoantibodies can occur naturally and are common in all immunologically competent person and might even increase nonspecifically while in the course of disease or injury. Hence, the miniscule presence of autoantibodies does not automatically determine a cause-and-effect relationship, because the autoantibodies might be the result, not the cause, of the disease process. However it is important to emphasize, that the presence of autoantibody responses has great value in diagnosing and prognosing numerous human diseases.

Autoantibodies may be present many years before the diagnosis of diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Type 1 diabetes mellitus (DM) and antiphospholipid syndrome. Combined with genetic information or family history, the presence of autoantibodies may be highly predictive of the later onset of an autoimmune disorder.

Direct evidence – The disease can be produced by showing autoimmune response. Direct evidence usually involves transfer of autoantibody from a patient to a healthy recipient, either an animal or a human. A few instances of such transfers have been successfully performed.

Reproduction of pemphigus by injection of patient serum into a neonatal mouse.
Maternal-fetal transmission (transplacental transmission) of myastenia gravis, Graves’ disease, and the complete heart block associated with lupus and Sjögren’s disease. The clinical manifestations in the offspring are temporary, because the autoantibody in these cases is provided through passive transfer of serum from the mother.

Indirect evidence – The second level of proof of causality is indirect evidence which requires the availability of an appropriate animal model where the necessary transfer studies can be carried out. Different animal models are implemented :

Reproduction of disease in animals via immunization with the appropriate antigen.
Autoimmune thyroiditis in the mouse after immunization with thyroglobulin – Hashimoto’s thyroiditis (chronic autoimmune thyroiditis).
Myocarditis after immunization of susceptible mice with murine myosin.
Naturally occurring disease in animals that resembles its human counterpart.
Many aspects that resemble human SLE (Systemic Lupus Erythematosus) have been found in particular genetic strains of mice.
A disease closely resembling Type 1 (autoimmune) diabetes.
Disease resulting from manipulation of the immune system.
Models of inflammatory bowel disease have been described in animals in which particular cytokines such as interleukin (IL)-2 and IL-10 have been eliminated.
Autoimmune dilated cardiomyopathy develop in mice which are deficient in programmed cell death-1 (PD-) immuno-inhibitory coreceptor.

Circumstantial evidence – This is the lowest level of proof, which is the one most commonly available to connect a mysterious human disease to autoimmunity.

The hazards of using this kind of evidence as the basis for concluding that a disease is caused by autoimmunity have been previously described. Natural autoantibodies are common and might rise nonspecifically in the course of a disease process.
Autoimmune diseases tend to cluster, maybe simply because they share a number of genetic susceptibility traits. For examples, a single person will have more than one autoimmune disease, and family members share the very same or even other autoimmune diseases.
A particular bias to certain HLA haplotypes is shown by most of the autoimmune diseases, usually the Class II category. Because genes that are important in regulating the immune response are encoded by the Class II Major Histocompability Complex (MHC), some rational association may exist between the genetic constitution and susceptibility to a specific autoimmune disease.
Most, but not all, autoimmune diseases are more common in women than men. Therefore, a sex bias provides increased circumstantial evidence of an autoimmune etiology. In addition, new information on the differing pathogenic mechanisms involved in men and women has been provided by comparing of the sex-based differences in autoimmune diseases.
A disease’s response to immunosuppressive therapy is usually an important clinical indicator of autoimmune etiology. If effective symptomatic therapy can be obtained by immunosuppression, therefore, demonstrating the etiologic agent of the disease may seem less essential.


Rheumatoid Arthritis Symptoms and Diagnosis

Rheumatoid Arthritis Symptoms
Rheumatoid Arthritis

Rheumatoid Arthritis

What is Rheumatoid arthritis – Rheumatoid arthritis (RA) is one of autoimmune diseases which is a chronic or long-term inflammatory condition. RA is the commonest chronic inflammatory polyarthritis and affects about 3% of the population. The symptoms develop gradually, and can vary from a mild to a most severe debilitating expression. It may include joint pain, stiffness, and swelling. The condition can affect many tissues throughout the body, but the joints are usually most severely affected. The cause of rheumatoid arthritis is unknown.

RHEUMATOID ARTHRITIS RISK FACTORS – The particular cause of rheumatoid arthritis is still not known yet. Susceptibility factors and Initiating factors, however, have been suspected as factors that can affect a person’s risk.

Susceptibility factors – RA most likely develops when a susceptible person is exposed to factors that start the inflammatory process. Heredity, gender, and genes mostly determine a person’s chance of developing rheumatoid arthritis. Approximately 1 per 100 individuals has rheumatoid arthritis.

Heredity – RA is not an inherited disease. Genes do not cause rheumatoid arthritis, they only affect the risk of disease’ development.
Gender – Gender seems to participate in a major role in a person’s susceptibility to rheumatoid arthritis. Females are about 3 times more likely than males.
Specific genes – Person with certain variants of human leukocyte antigen (HLA) genes are more likely to acquire rheumatoid arthritis.
Initiating factors – Many people who have HLA genes never develop the disease. In fact, when one identical twin has rheumatoid arthritis, the likelihood that the other will develop disease is only about 1 in 3. This indicates that other factors must be necessary for a person to develop RA.

Infection – Bacteria or viruses may be one of the factors that initiate rheumatoid arthritis.
Cigarette smoking – Cigarette smoking may increase the risk of developing RA and also can increase the likelihood the severity should it occurs.
Stress – Stressful events such as accidents, divorce and grief are more common in people with RA in the six months prior their diagnosis.

RHEUMATOID ARTHRITIS SYMPTOMS – In most people RA begins with the insidious onset of pain and stiffness of the small joints of the hands and feet which is on-going rather than fleeting and mainly affects the fingers where symmetrical involvement of the PIP joints produces spindling while the metacarpophalangeal joints (joints in the middle of the fingers) develop diffuse thickening as does the wrist. Early symptoms may include fatigue, muscle pain, a low-grade fever, weight loss, and numbness and tingling in the hands. In some cases, these symptoms occur before joint pain or stiffness is noticeable. In 25% of cases RA presents as arthritis of a single joint such as the knee, a situation leading to confusion with Lyme disease or a spondyloarthropathy.

rheumatoid arthritis pictures, rheumatoid arthritis symptoms,

Joints involved

Hands : MCP and PIP joints, DIP joints (30%)
Wrist and elbows
Feet : MTP joints, tarsal joints (not IP joints), ankle
Knees (common) and hip (delayed—up to 50%)
Shoulder (glenohumeral) joints
Temporomandibular joints
Cervical spine
Joint symptoms – Usually begin gradually and include pain and stiffness, redness, warmth to the touch, and joint swelling. The joint stiffness is most bothersome in the morning and after sitting still for a period of time. The stiffness can persist for more than one hour.

rheumatoid arthritis symptoms

Hands – The joints of the hands are often the very first joints affected by rheumatoid arthritis. Between 1 and 5 % of people with rheumatoid arthritis develop carpal tunnel syndrome because swelling compresses a nerve that runs through the wrist which is characterized by weakness, tingling, and numbness of certain areas of the hand.
Certain characteristic hand deformities can occur with long-standing rheumatoid arthritis. swan neck deformities and boutonniere deformities, and may drift together in the direction of the small finger. The tendons on the back of the hand may become very prominent and tight, called the bow string sign.

Wrist – The wrist is the most commonly affected joint of the arm in people with rheumatoid arthritis. In the early stages of rheumatoid arthritis, it may become difficult to bend the wrist backward.
Elbow – Rheumatoid arthritis may cause inflammation of the elbow. Swelling of this joint may compress nerves that travel through the arm and cause numbness or tingling in the fingers.
Shoulder – The shoulder may be inflamed in the later stages of rheumatoid arthritis, causing pain and limited motion.
Foot – The joints of the feet are often affected in the early stages of rheumatoid arthritis, especially the joints at the base of the toes.
Ankle – Rheumatoid arthritis may cause inflammation of the ankle. Inflammation of this joint may cause nerve damage, leading to numbness and tingling in the foot.

Knee – Rheumatoid arthritis may cause swelling of the knee, difficulty bending the knee, excessive looseness of the ligaments that surround and support the knee, and damage of the ends of the bones that meet at the knee. RA may cause the formation of a Baker’s cyst (a cyst filled with joint fluid and located in the hollow space at the back of the knee).
Hips – The hips may become inflamed in the later stages of rheumatoid arthritis. Pain in the hips may make it difficult to walk.
Cervical spine – Rheumatoid arthritis may cause inflammation of the cervical spine, which is the area between the shoulders and the base of the head.
Cricoarytenoid joint -In about 30 % of people with rheumatoid arthritis, there is inflammation of a joint near the windpipe called the cricoarytenoid joint. Inflammation of this joint can cause hoarseness and difficulty breathing.
Other symptoms – Although joint problems are the most commonly known issues in rheumatoid arthritis, the condition can be associated with a variety of other problems.

Rheumatoid nodule – Rheumatoid nodule is painless lumps that appear beneath the skin. The nodule may move easily when touched or they may be fixed to deeper tissues.
Felty’s Syndrome : Characterized by an abnormally enlarged spleen (splenomegaly).
Amyloidosis : Infiltration of the liver, kidneys, spleen and other tissues with amyloid (starch like substance).
Inflammatory conditions – Rheumatoid arthritis may produce a variety of other symptoms, depending on which tissues are inflamed.
Pericarditis : Inflammation of the pericardium, tissue lining the chest cavity and surrounding the heart that may cause chest pain and difficulty breathing.
Fibrosing Alveolitis : Inflammation of the lung that is not due to infection may cause shortness of breath and a dry cough.
Peripheral sensory neuropathy, mononeuritis multiplex : Abnormal nerve function may cause numbness, tingling, or weakness.
Sjögren’s syndrome : Dry eyes and dry mouth. women may develop vaginal dryness due to Sjögren’s syndrome, which can cause pain with sexual intercourse.
Inflammation of the white part of the eye may cause pain or vision problems.
Vasculitis – Inflammation of the blood vessels, may cause a wide variety of symptoms, depends on the location.
RHEUMATOID ARTHRITIS DIAGNOSIS – There is no single test used to diagnose rheumatoid arthritis. Instead, the diagnosis is based upon many factors, including the characteristic signs and symptoms, the results of laboratory tests, and the results of x-rays.

American Rheumatism Association: criteria for the diagnosis of rheumatoid arthritis

Morning stiffness
Pain on motion or tenderness in at least one joint
Swelling of one joint, representing soft tissue or fluid
Swelling of at least one other joint (soft tissue or fluid) with an interval free of symptoms no longer than three (3) months
Symmetrical joint swelling (simultaneous involvement of the same joint, right and left)
Subcutaneous nodules over bony prominences, extensor surfaces or near joints
Typical X-ray changes that must include demineralisation in periarticular bone as an index of inflammation
Positive test for rheumatoid factor in the serum
Synovial fluid – a poor mucin clot formation on adding synovial fluid to dilute acetic acid

  1. Synovial histopathology consistent with RA:

(a) marked villous hypertrophy

(b) proliferation of synovial cells

(c) lymphocyte plus plasma cell infiltration in subsynovium

(d) fibrin deposition within or upon microvilli

  1. Characteristic histopathology of rheumatoid nodules biopsied from any site