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Rheumatoid Arthritis
Definition:
Rheumatoid arthritis is a chronic and systemic disease. The disease lasts indefinitely, with unpredictable flares and remissions, often getting worse as the patient ages. Other organs or in fact the whole body may be affected by the inflammatory process. It can affect the eyes, the mouth, the skin, the liver, the heart and the lungs. Patients generally feel tired and some may develop anaemia.
Scientists are still debating what actually causes rheumatoid arthritis. We know that genetics plays a role. Patients with certain genotypes are particularly vulnerable, and the disease tends to run in families. Whatever triggers the disease, it is the profound inflammation, mostly happening in the lining of the joints, that does the damage.
Normally, inflammation is part of our body's immune process to get rid of foreign invasions. With inflammation, blood supply to that part of the body is increased. The part is swollen with body fluid rich in white blood cells and antibodies. The pain associated with inflammation ensures adequate rest to allow for recovery.
The control of the immune process is very complicated, and is mediated and coordinated through chemicals secreted into the blood and body fluids. It is believed that patients with rheumatoid arthritis have a genetically determined abnormal immune response to some unidentified environmental factors. Whatever the trigger is, the patient's immune system mistakes the body's healthy tissue as a foreign invader and attacks it, incessantly. The body is harmed not by the enemies, but by "friendly fire". The same disease mechanism is involved in a class of diseases called autoimmune disorders.
Who is at risk?
Rheumatoid arthritis affects up to 1 % of the normal population, and can affect any age group, though most frequently it starts in the fourth and fifth decades of life. 80% develop the disease between the ages 35 to 50. People with family members suffering from rheumatoid arthritis are more likely affected.
Symptoms:
In rheumatoid arthritis, the main battle field is in the lining of joints, called the synovium. With repeated inflammation, this lining becomes thickened into a pannus (Meaning: vascularised granulation tissue overgrows the bearing surface of the joint), which can erode into bones and tendons. That's how deformity can happen in patients suffering from rheumatoid arthritis. The joints can be so much deformed that render the limbs useless.
The most common symptom is joint pain. Arthritis can start with any joint, but commonly involves joints in the hands and fingers in a symmetrical pattern. The patient may complain of stiffness of the hands and fingers, especially in the morning. The systemic nature of the disease is revealed by the presence of fatigue, tiredness, low grade fever and sometimes flu-like symptoms. Some patients may have lumps under the skin and over tendons - so called rheumatoid nodules. Some may even suffer problems unrelated to their joints, such as dry mouth or red eye.
Blood tests can help doctors to establish the diagnosis but there is no single test to tell if you have the disease or not. Rheumatoid Factor is one of the antibodies that regulates the immune process. Around 75% of patients with rheumatoid arthritis have an abnormally high Rheumatoid Factor. Some normal people that they can have an elevated Rheumatoid Factor, but without the disease.
Since rheumatoid arthritis is a chronic disease with serious implications, doctors need time to collect enough information to make a diagnosis and recommend the best treatment. The diagnosis depends on a careful history, body examination, a review of all the laboratory tests and relevant X-rays. If you suspect that you might have the disease, make sure you make an unhurried appointment with your doctor and collect any of the laboratory results and X-ray reports for a review.
Treatment:
Medical management of rheumatoid arthritis can include the following approaches:
- Nonsteroidal Anti-Inflammatory Drugs
Examples are aspirin, ibuprofen and many others that can have analgesic as well as anti-inflammatory properties. Some may irritate the stomach but newer drugs with less chance of upsetting the gastrointestinal tract are available. - Disease-Modifying Antirheumatic Drugs
These drugs do not have analgesic or anti-inflammatory effect by themselves, but can alter the course of the disease so that patients go into remission earlier and longer. Examples are gold compounds, D-penicillamine and methotrexate. - Corticosteroids
- Immunosuppressive therapy
Some patients with severely damaged joints may need reconstructive surgery or joint replacement operations. Physiotherapy can also relieve symptoms and increase mobility of patients.
Prevention:
At this time there are no medications to take or lifestyle modifications to make that can prevent rheumatoid arthritis. Early diagnosis and treatment can prevent deformities and disabilities, however. So if you have a family history of rheumatoid arthritis, watch out for the symptoms and consult your doctor.
Rickets
Definition:
Rickets is a disease affecting infants and children where the bones do not harden because not enough calcium salts are deposited in them. As the body grows, the bones bend out of shape. The disease can be caused by a poor diet lacking adequate vitamin D, calcium or phosphate. Genetic abnormalities in the metabolism of vitamin D can also result in rickets, and is hereditary in such cases.
Who is at risk?
- Children fed with a poor diet deficient in vitamin D;
- Children not taking enough milk or milk products;
- People with dark skin colour who are not exposed to the sun;
- Patients with diseases of the digestive system (such as Coeliac's disease), which is caused by sensitivity to gluten (protein of wheat and rye) and leads to impaired absorption of nutrients, resulting in poor absorption of vitamin D;
- Children suffering from kidney diseases;
- Family history of a hereditary form of rickets.
Symptoms:
- The baby is floppy and weak, with delay in walking
- Poor growth
- Delay in teething, frequent tooth decay
- Soft skull, with large fontanel (the "soft spot")
- Bow legs (the legs are curving outwards)
- Bumps and swellings at the ends of long bones and ribs
- Walking with an unusual gait, as if waddling in water
- Deformed chest, often in the form of pigeon chest
- Abnormal curves in the spine
- Frequent fractures
Older children may complain of bone pain, which often manifests as frequent crying and head sweating in infancy. When the disease is caused by a poor diet, the child may have other signs as well, such as looking pale and weak from anaemia.
Treatment:
Treatment of rickets depends on the cause. Those caused by a poor diet can be treated with vitamin D supplements. Rickets caused by genetic abnormalities in vitamin D metabolism would require more potent forms of vitamin D available by prescription.
Putting the deformed limbs in braces in special positions may help to correct deformities. When severe, these deformities may require surgical correction.
Prevention:
- Provide your child with a diet rich in vitamin D, calcium and phosphate. Dietary sources of vitamin D include fish, liver, and processed milk. Calcium and phosphorous are present in milk and green vegetables.
- When exposed to sunlight, our skin can produce vitamin D for our own use. Take your child outdoors and take off some clothing when weather permits.
- Couples with family a history of a hereditary form of rickets should seek advice from geneticist experts.
Rubella
Definition:
Rubella is a highly infectious viral illness characterized by fever, rash and painful lymphatic glands in the back of the head. The disease is mild in children and young adults, but can cause congenital abnormalities in the fetus if women in the first four months of pregnancy are infected.
Who is at risk?
The disease is most common in children from 5 to 9 years old in an unvaccinated population. Hong Kong children are receiving two doses of MMR vaccine which contains rubella as one of the components. However, sporadic cases can still occur in immigrants and in young adults whose immunity has waned.
Symptoms:
The disease may start with mild respiratory symptoms, such as a sore throat, running nose, headache and mild fever. The rash is itchy. It begins on face and spreads downwards, fading at previous site as it progresses. Within 24 hours it is already covering the whole body and would fade in 2 to 3 days. The eyes may look red. The lymph glands in the back of the head may be swollen and painful. Some patients have multiple joint pains.
Treatment:
Most patients would recover by themselves. Symptomatic treatment for fever or itchiness can help.
Prevention:
Fetuses affected by congenital rubella are born with multiple congenital abnormalities, including blindness and deafness. To prevent congenital rubella, the entire population should be vaccinated. Recent immigrants not vaccinated during early childhood should receive two doses of the vaccine.
All women of child bearing age particularly those planning to conceive should get their antibodies against rubella checked and those without protective antibodies should receive rubella vaccine (preconception prevention).
