A Simple Guide to Systemic Lupus Erythematosis

A Simple Guide to Systemic Lupus Erythematosis
----------------------------------------------------

What is Systemic Lupus Erythematosis?
---------------------------------------

Systemic Lupus Erythematosis is a chronic multisystem autoimmune inflammatory disease which attacks the whole body.

It typically has a butterfly erythematous rash on the face.

It is not contagious.

Who is affected by Systemic Lupus Erythematosis?
---------------------------------------------------

Systemic Lupus Erythematosis is more common in women than in men(9:1 ratio)

Most cases begin at the age range of 15-45 years and occurs less frequently between the age of 45-70 years.

It occurs more frequently in blacks than in white people.


What is the Cause of Systemic Lupus Erythematosis?
-----------------------------------------------------

The exact cause of Systemic Lupus Erythematosis is not known.

1.It has been suggested that an autoimmune disease is the main cause of Systemic Lupus Erythematosis disease.

The antibodies produced by the body to fight germs starts to attack the body's own healthy tissue.

2.Psychological problems like stress and anxiety is not a cause of Systemic Lupus Erythematosis but has been known to trigger off the disease.

3.Some cases are induced by medications such as :
hydralazine
procainamide
penicillamine
isoniazid

What are the Symptoms and signs of Systemic Lupus Erythematosis?
-----------------------------------------------------------

The disease may be mild to severe.

There are also periods of remissions and activity.

During the active stage:
Systemic involvement:
-----------------------------

1.fever

2.anorexia

3.weakness

4.weight loss

5.Lymphadenopathy

Skin Mucosa Involvement:
-------------------------------

1.Typical butterfly erythrematous rash on the face

2.pleomorphic erythrematous and maculopapular lesions on the face, neck and extremeties.

3.Vasculitic nail bed and digital pulp lesions

4.Alopecia, petechiae, bullae, and mucous membrane lesions.

Musculoskeletal System:
---------------------------

1.Polyarthritis especially small joints of fingers

2.Arthritis milder and non erosive compared to rheumatoid arthritis

3.morning stiffness

4.muscle atrophy and weakness may occur

Eyes:
-----------

1.Retinal hemorrhages and exudates

2.Cytoid bodies

Lungs and Pleura:
-----------------------

1.Recurrent pleurisy

2.Pleural effusions - small

3.Pulmonary infiltrates

Cardiovascular
-----------------

1.Pericarditis

2.Endocarditis with vegetation on the mitral valve especially

Gastrointestinal
--------------------

1.Non specific nausea

2.Gastrointestinal ulcers, hemorrhage, necrosis

Renal
-------------

1.Focal membranous nephritis

2.Proliferative nephritis - deposit of autoimmune complexes on capillary walls give rise to typical wireloop changes and epithelial crescents in kidneys resulting in proteinuria, hematuria,and renal failure.

Central nervous system:
------------------------------

1.Lesions in the brain can cause mental disorders( dementia, psychosis,epilepsy), chores, cerebrovascular accidents,cranial nerve lesions.

2.Peripheral neuropathy of various types

Others:
-----------------

1.Thrombotic thrombocytopenic purpura

2.Sjogren's syndrome


How do you make the Diagnosis of Systemic Lupus Erythematosis?
------------------------------------------------------------

1.A history of facial butterfly rash, systemic symptoms

2.Blood for ESR, positive ANA(antnuclear Antibodies), LE cells

3.Full blood count for anemia, hemolytic anemia, neutopenia, thrombocytopenia, Coombs' test(usually positive)

4.Renal or skin biopsy

5.X- rays of the chest, abdomen and brain

6.MRI of brain, kidney,

What are the complications of Systemic Lupus Erythematosis?
-----------------------------------------------------------------

1.Severe Dermatitis with discoid lesions (maculopapular in nature)

2.Polyathritis with swelling of joints

3.Anemia

4.Pleural effusions

5.hemorrhage

6.Dementia

7.Renal failure

What is the treatment of Systemic Lupus Erythematosis?
--------------------------------------------------------------

There is no cure for SLE at the present moment.

Treatment is to relieve symptoms and prevent organs from deteriorating.

Patients with mild symptoms may not need any treatment.

Mild Cases:
---------------
1.short course of antiinflammatory medications such as NSAID or corticosteroids.

2.Rest and freedom from stress

Severe cases:
--------------------
Patients with serious illness which has affected their organ may require stronger medications:
1.high doses of corticosteroids intially intravenously, followed by oral medication whose dosage is reduced slowly to the minimum possible.

Corticosteroids are particularly helpful if internal organs are involved.

Side effects of corticosteroids include gastric problems, thinning of the bones, infection, facial puffiness, cataracts.

2.NSAIDs can reduce inflammation and pain especially in the musculoskeletal system.

Examples of NSAIDs include aspirin, ibuprofen, naproxen.

The side effects are stomach upset, abdominal pain, ulcers or GIT bleeding.

To reduce the side effects, NSAIDs are usually taken with food or H2 antagonist like cimetidine, ranitidine.

3.Antimalarial medication such as Hydroxychloroquine has been particularly effective for SLE patients with fatigue, skin, and joint disease.

Side effects include diarrhea, upset stomach, and eye pigment changes.

Eye pigment changes are rare, but require monitoring by an ophthalmologist

Other antimalarial drugs, such as chloroquine or quinacrine, are considered

4.Treatment for severe skin disease skin disease include dapsone and retinoic acid (Retin-A).

5.immunosuppressive medications are used for treating patients with more severe manifestations of SLE with damage to internal organ(s).

Examples of immunosuppressive medications include methotrexate, azathioprine (Imuran), cyclophosphamide, and cyclosporine .

Side effects are depression of blood cell counts and increased risks of infection and bleeding.

6. mycophenolate mofetil (Cellcept) is very effective in lupus with kidney disease.

It has been able to reverse active lupus kidney disease and maintain remission.

It's lower side effects made it more useful than immunosuppresive drugs.

7.plasmapheresis is used to remove antibodies and other immune substances from the blood to suppress immunity.
It has also help to to remove proteins (cryoglobulins) that can lead to vasculitis.
SLE patients with low platelet levels can have severe bleeding.

7.rituximab is an intravenously infused antibody that suppresses a particular white blood cell, the B cell, by reducing the number in the blood stream.
B cells play a central role in lupus activity, and when suppressed, the disease tends toward remission.

8.omega-3 fish oils could help patients with lupus by decreasing disease activity and possibly decreasing heart disease risk.

9.rest during periods of active disease
Poor sleep quality can cause fatigue in patients with SLE.
Sleep quality and the effect of underlying depression, lack of exercise can have an adverse effect on the health of SLE patients.
It is important to maintain muscle tone and range of motion in the joints.

10.Endstage kidney damage from SLE requires dialysis and/or a kidney transplant.


What is the prognosis of Systemic Lupus Erythematosis?
-------------------------------------------------------------

The prognosis depends on the severity of the disease

Severe cases with renal disease has poorer prognosis.


How is SLE prevented?
----------------------------

1.Adequate rest

2. Avoid stress

3. Avoid the sun and use sunscreen.

4.Healthy lifestyle with exercise prevents arthritis

A Simple Guide to Gonorrhea

A Simple Guide to Gonorrhea
-----------------------------------

What is Gonorrhea?
------------------------

Gonorrhea is a sexually transmitted disease caused by the gram negative bacteria Neisseria gonorrhoeae.

How is gonorrhea spread?
-----------------------------

Gonorrhea is a very common infectious disease, a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract, including the cervix, uterus and fallopian tubes in women, and in the urethra in women and men.
The bacterium can also grow in the mouth, throat, eyes, and anus.

Gonorrhea is spread by infected people through contact with the penis, vagina, mouth, or anus.
There is no life long immunity after tratment with Gonorrhea.
A person who has been treated for gonorrhea may get infected again if there is sexual contact with a person infected with gonorrhea.
Gonorrhea can also be spread from mother to baby during delivery.

Who is at risk for gonorrhea?
-----------------------------------

Any sexually active person can be infected with gonorrhea if their partner has the disease.

What are the symptoms of gonorrhea?
---------------------------------------------

A high percentage of men with gonorrhea do not have any symptoms at all.
Some men have some symptoms that appear two to five days after infection.
Symptoms include
1.a burning sensation when urinating, or a white, yellow, or green discharge from the penis.

2. painful or swollen testicles.

In women the symptoms of gonorrhea are often mild.
Most women who are infected have no symptoms.
The initial symptoms in women include
1.a painful or burning sensation when urinating,

2.increased vaginal discharge,

3.vaginal bleeding between periods.

4.lower abdominal pain due to salpingitis(infected fallopian tubes)

Women with gonorrhea are at risk of developing serious complications from the infection.

Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements.
Most of the time rectal infection do not cause symptoms.

Infections in the throat may cause a sore throat.
Usually there are no symptoms.

How does gonorrhea affect a pregnant woman and her baby?
-----------------------------------------------------------------------

A pregnant woman with gonorrhea may give the infection to her baby as the baby passes through the birth canal during delivery.
This can cause blindness, joint infection, or a life-threatening blood infection in the baby.
Treatment of gonorrhea should be started as soon as it is detected in pregnant women.

How is gonorrhea diagnosed?
-----------------------------------

There are several laboratory tests available to diagnose gonorrhea:

1. a swab may be taken from cervix, urethra, rectum, or throat for testing

2. A direct Gram smear test of a sample from a urethra or a cervix allows the doctor in the clinic to see the gonorrhea bacterium under a microscope.

3. blood test can also detect the presence of gonorrhea in the blood stream

What is the treatment for gonorrhea?
--------------------------------------------

There are several antibiotics(penicillin, tetracyclines, spectinomycin) which can successfully cure gonorrhea in adolescents and adults.

Drug-resistant strains of gonorrhea are increasing in many areas of the world and successful treatment of gonorrhea is becoming more difficult.

Sometimes people with gonorrhea also have chlamydia.
Antibiotics for both infections are usually given together.

Persons with gonorrhea should be tested for other STDs.

It is advisable to take all of the medication prescribed to cure gonorrhea.
People who have had gonorrhea and have been treated can get the disease a second time if they have sexual contact with persons infected with gonorrhea.

What are the complications of gonorrhea?
--------------------------------------------------

Untreated gonorrhea can cause serious and permanent complications in both women and men.
In women, gonorrhea is a common cause of pelvic inflammatory disease (PID).
Women with PID may not have symptoms.
Symptoms when present can be very severe and can include abdominal pain and fever.
PID can cause internal abscesses in the pelvis which can give rise to long-lasting, chronic pelvic pain.
PID can damage the fallopian tubes enough to cause infertility and the risk of ectopic pregnancy.
Ectopic pregnancy is a life-threatening condition in which a fertilized egg grows outside the uterus, usually in a fallopian tube, sometimes in the abdomen.

In men gonorrhea can cause epididymitis, a painful infection of the testicles that can lead to infertility if left untreated.
Prostatits(infection of prostate), seminal vesiculitis and chronic urethral infection may be associated with fever and lead to urethral strictures causing difficulty in passing urine.

People with gonorrhea are more likely to contract HIV the virus that causes AIDS.

Gonorrhea can spread to the blood, joints or eyes(uveitis).
Blood infection or septicemia can be life threatening.

How can gonorrhea be prevented?
-----------------------------------------

The best way to avoid transmission of sexually transmitted diseases is to abstain from sexual intercourse.
He or she should be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Latex condoms, when used consistently and correctly, can reduce the risk of transmission of gonorrhea.

Any genital symptoms such as discharge or burning sensation during urination or unusual sore or rash should be a signal to stop having sex.
A person who has been diagnosed and treated for gonorrhea should notify all recent sex partners so they can also be treated.
In this way there is less risk that the sexual partners will develop serious complications from gonorrhea.
It will also reduce the person's risk of becoming re-infected.
The person and all of his or her sex partners must avoid sex until they have completed their treatment for gonorrhea.

A Simple Guide To Gout

What is Gout?
----------------
Gout is a disease caused by the excessive uric acid in the blood.

Who get Gout?
-----------------
Gout is often hereditary so even young adults are affected.
It occurs more commonly in men than in women.

How does it cause problems?
----------------------------------
The uric acid in the blood is usually discharged from the body dissolved in the urine and the intestinal tract and sometimes as perspiration through the skin.

1. Gouty Arthritis
high concentration of uric acid in the blood caused the formation of needle shaped urate crystals which are deposited in and around joints thus causing pain and swelling.

2.Kidney stones
Deposits can also form in the kidney and urinary tract as urate crystals or stones.

3.Skin urate trophi
Some urate crystals are also deposited in the skin, mostly commonly at the earlobe and joints.

What are the symptoms of Gouty Arthritis?
---------------------------------------------------
The symptoms of gouty arthritis are usually of sudden onset.
They are:
1.pain
2.swelling
3.pain
4.joint feels hot

Where does gouty arthritis attack?
-----------------------------------------
These are the most common joints affected by Gout:

1. Big toe 76%
2. Ankle 50%
3. Knee 32%
4. Fingers 25%
5.Elbow 10%
6. Other Joints 2%

How do I prevent Gout?
----------------------------
1.Drinks lots of fluids(at least 8 glasses of water a day).
This will help to excrete the uric acid through the urine and dilute the uric acid
concentration in the blood.

2.Avoid food which can produce high levels of uric acid. These are high protein foods such as:

Animal organs -liver,kidneys, intestines,brain
Seafood - especially prawns, crabmeat, lobsters, cockleshells, fish roes
Bean products- beancurds, soya beans,bean sprouts, peanuts
Alcohol - cause dehydration in the blood raising the concentration of uric acid.

3.Avoid fasting and starvation - again this raises the concentration of uric acid in the blood.
Obesity should be slowly reduced. The over-weight body affects the joints.

4.Avoid certain drugs like diuretic which reduces the volume of water in the blood and
raises the concentration of uric acid.

5.Take medications like allopurinol which help to reduce the production of uric acid.

How to treat an acute attack of Gouty arthritis?
--------------------------------------------------------
1.Take medicine like probenecid or cochicine which helps to flush the uric acid out through the urinary tract.

2.Drinks lots of water (eg. 3 glasses of water) immediately during an acute attack.

3.Rest the joint. If the the big toe is affected, raise it above the heart level to help the blood flow.

What are the Complications of Gout?
--------------------------------------------
1.Kidney stones may develop in the kidneys or urinary tract causing pain and damage to the kidneys.
2.Recurrent attacks of gout may erode the surfaces of the joint resulting in permanent damage.

A Simple Guide to Osteoarthritis

A Simple Guide to Osteoarthritis

Osteoarthritis
------------------
What is Osteoarthritis ?
----------------------------
Osteoarthritis
is a degenerative condition of the joints in the human body.
It is the most common form of arthritis.
The cartilage lining of the joint are worn down such that the underlying bone come in contact with each other.
In addition bone spurs may form and joint fluid is reduced.

This causes mechanical and chemical reactions giving rise to the symptoms of Osteoarthritis.

What causes Osteoarthritis ?
----------------------------------
1. Genetics
has found to have role in the predisposition of Osteoarthritis.
Genes on chromosome 2q,4 & 16 have been linked with Osteoarthritis.

2. Aging
is a risk factor of Osteoarthritis.
More than 80% of those above 65 years suffer from Osteoarthritis.

3. Excessive physical activity is a potentially correctable cause of Osteoarthritis.
Activities like long distance running and other high endurance sports may place
the joints under high stress for prolonged periods resulting in overuse injuries and
accelerated wear and tear.

4. Gender plays a role in Osteoarthritis. Osteoarthritis is more common in men for a
cohort of under 50 years and more common in women in the cohort of 50-80 years.

5.Trauma is a common cause of Osteoarthritis in the younger age groups.

What are the symptoms of Osteoarthritis?
-------------------------------------------------
Most common symptom are pain and swelling:

Stiff,painful and swollen joints after a workout

Stiffness in the joints in the mornings which can last about half an hour

Loss of flexibility in one's joints

Bony lumps at the base of the thumb or on the middle of the end joints of the fingers

Pain in the joints after repeated use

Osteoarthritis is often associated with joint surgery or related injury

What are the complications of Osteoarthritis ?
-------------------------------------------------------
Osteoarthritis is the top cause of disability in older women and ranks second in older men.

Besides pain and swelling, quality of life suffers in patients with Osteoarthritis due to their loss of mobility and depression.

The loss of mobility is progressive with age.


Where does Osteoarthritis occur ?
----------------------------------------
It can affect the any joint of the body although the most commonly affected joints are the weight bearing joints:
knee
hip
ankle
spine.
Other non-weight bearing joints such as
shoulder ,
elbow,
fingers
can also be affected.

How do you treat Osteoarthritis ?
----------------------------------------
Osteoarthritis is not curable and the purpose of treatment is to:
1. improve functions and
2. reduce pain and discomfort.

Treatment of Osteoarthritis can be broadly classified into:
1. Non-interventional

a. non-pharmaceutical

Weight loss is an effective way to reduce the stress on the joints and minimise the pain
Walking sticks are useful ways to offload the stress on the affected weight bearing
joints such as hips or knee. The walking aids should be used on the opposite side.
It can be in the form of a sturdy umbrella instead of a crutch.
Hot packs are useful aids in the morning to soften a stiff arthritic joint whereas braces
and knee guards are useful supports to give some comfort to the knee.
Exercises that improve strength, agility and flexibility are useful to minimise
the disability of Osteoarthritis.
A range of motion exercises is useful to keep the joints supple and mobile .
Water based exercises are a good alternative form of aerobic workout by patients afflicted
by Osteoarthritis. The warm water especially is a good medium for joint mobility and
together with the buoyancy of water it helps to minimise the body weight impact
on the joints.

b. pharmaceutical
There are 2 main types of drugs:

1. symptom modifying drugs help to alleviate the symptoms but do not change the
natural history of the conditions.
Examples are Non-steroidal Anti-inflammatory Drugs(NSAIDs) like diclofenac.

2. disease modifying drugs such as glucosamine has been shown to slow down the
wear and tear of the cartilage but it does have the ability to grow new cartilage.
It has also being found to work better with chondroitin.

2. Interventional:

a. non-surgical

Joint aspiration is a procedure where fluid from the swollen joint is removed,
helping to decompress the tension and bring relief for a while .

Vasosupplementation is a procedure whereby a lubricant is injected into the affected
joint thus reducing the the frictional wear of the joint surfaces.
In addition the lubricant has anti inflammatory properties to reduce the inflammation in the
lining of the joints and may ease the pain for months in early osteoarthritic cases .

b.surgical

Surgical intervention is usually the last resort when all other above treatment fail and in
advanced cases:

Debridement is an arthroscopic (keyhole) procedure to clean the joint of torn cartilages,
loose pieces of bones, etc.
Its main use is to remove the worn out debris which may cause pain and can mechanically
cause friction.

High tibial Osteotomy is a procedure to correct the alignment of deformed legs which
then reduce the stress on the joint.

Prosthetic joint replacement is a procedure to replace the diseased portion of the joint
with a prosthesis or artificial joint allowing painless good range of movement.
It is more suitable for older patient because there is a shelf life to these implants.

Unicondylar joint replacement can now be performed in which part of one of
the bone of the diseased joint is removed instead of a total joint replacement which
involved removal of part of both bones of a joint.

The choice of treatment depends on the stage of the disease and whether there are associated complication.

In general non-interventional methods are more suitable at the early stage of the illness and interventional modalities are more suitable for the later stage of Osteoarthritis.