A Simple Guide to Uveitis

A Simple Guide to Uveitis
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What is Uveitis?
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Uveitis is inflammation of the eye's uvea. The uvea is the eye's middle layer that consists of the iris, ciliary body and choroid.

What are different types of Uveitis?
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Uveitis is classified by the part of the uvea it affects.

1. Anterior uveitis refers to inflammation of the iris alone (called iritis) or the iris and ciliary body. Anterior uveitis is the most common form.

2.Intermediate uveitis refers to inflammation of the ciliary body.

3. Posterior uveitis is inflammation of the choroid.

Diffuse uveitis is inflammation in all areas of the uvea.

What are the dangers of Uveitis?
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Many cases of uveitis are chronic.
They can produce numerous possible complications, including clouding of the lens (cataract) or cornea, elevated intraocular pressure (IOP), glaucoma, and retinal problems (such as swelling of the retina or retinal detachment).
These complications can lead to loss of vision.

Who are affected by Uveitis?
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Uveitis occurs most frequently in people ages 20 to 50.
It is more common in women and more likely to develop with age.

What are the Complications of Uveitis?
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Uveitis complications:
secondary cataracts,
secondary glaucoma,
high intraocular pressure,
retinal detachment

What are the Symptoms and Signs of Uveitis?
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With anterior uveitis, the symptoms usually affect only one eye.
There may be
mild to strong pain
redness and
light sensitivity.
Your vision may also be blurred.
Eye is tender to palpation

Both intermediate and posterior uveitis are usually painless.
Symptoms are blurred vision and floaters, typically in both eyes.

Diffuse uveitis has a combination of symptoms of all types of uveitis.

What Causes Uveitis?
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Uveitis has dozens of causes, including viral, fungal, and bacterial infections.
But, in many cases, the cause is unknown (idiopathic).
Eye doctors can sometimes identify the cause if there has been trauma to the eye, such as from surgery or a blow, or if there is a history of an infectious or immunological systemic disorder.
Some of the many different systemic disorders that can cause uveitis include:
acute posterior multifocal placoid pigment epitheliopathy
ankylosing spondylitis
Behçet's disease
birdshot retinochoroidopathy
brucellosis
herpes simplex
herpes zoster
inflammatory bowel disease
juvenile rheumatoid arthritis
Kawasaki's disease
leptospirosis
Lyme disease
multiple sclerosis
presumed ocular histoplasmosis syndrome
psoriatic arthritis
Reiter's syndrome
sarcoidosis
syphilis
systemic lupus erythematosus
toxocariasis
toxoplasmosis
tuberculosis
Vogt-Koyanagi-Harada syndrome

What is the Treatment of Uveitis?
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Non-drug:
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warm water
pads to cover eyes for rest and avoid sun

Drugs:
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Your doctor will likely prescribe a steroid to reduce the inflammation in your eye.
Whether the steroid is in eye drop, pill, or injection form depends on the type of uveitis you have.
Because anterior uveitis affects the front of the eye, it's easy to treat with eye drops.
Intermediate uveitis can go either way, and
posterior uveitis usually requires tablets or injections.

Steroids and other immunosuppressants can produce many serious side effects:
such as
kidney damage,
high blood sugar,
high blood pressure,
osteoporosis, and
glaucoma.

In April 2005 the drug Retisert was approved by FDA for chronic non-infectious posterior uveitis. Retisert is a drug implant and is the first of its kind for treatment of uveitis. It consists of a drug reservoir that delivers sustained amounts of fluocinolone acetonide, an anti-inflammatory corticosteroid, for about two and a half years. It is implanted into the back of the eye. During clinical trials the incidence of reccurent uveitis fell from 40%-54% to 7%-14%. The most common side effects noted during those studies were cataract progression, increased intraocular pressure, procedural complications, and eye pain.

If you have anterior uveitis, your doctor will likely prescribe, in addition to the steroids, pupil-dilating eye drops to reduce pain.
You may also need eye drops to lower your intraocular pressure if it's elevated.

A Simple Guide to Rheumatoid Arthritis

A Simple Guide to Rheumatoid Arthritis
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What is Rheumatoid Arthritis?
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Rheumatoid arthritis is a systemic autoimmune disease that can cause chronic inflammation of the joints and other areas of the body.

Who gets Rheumatoid Arthritis?
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Rheumatoid Arthritis is one of the most common form of inflammatory arthritis.
It most commonly occurs between the 25 and 50 years.
However it can occur at any age.
Females are 3 times more likely to get Rheumatoid Arthritis than males.

What causes Rheumatoid Arthritis?
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Rheumatoid Arthritis is an autoimmune disease..
Autoimmune diseases are illnesses that occur when the body tissues are mistakenly attacked by its own immune system which consists of cells and antibodies designed normally to "seek and destroy" invaders of the body, particularly infections.
Patients with autoimmune diseases have antibodies in their blood that target their own body tissues .

What are the symptoms of Rheumatoid Arthritis?
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Most common symptoms are pain, swelling, stiffness, warmth and sometimes redness of the joints.

Rheumatoid Arthritis is suspected when there are:
1. Swelling in the joints especially those of the hands,elbows,knees,ankles and feet.

2. Stiffness in the joints in the mornings which can last more than an hour or after prolonged rest

3.redness and warmth in one's joints

4.Persistent pain or tenderness in a joint for more than a month

5.Inability to move or use a joint normally

6. Unexplained weight loss and appetite, fatigue, or weakness together with joint pains

What tests are done to confirm Rheumatoid Arthritis?
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Abnormal blood antibodies can be found in patients with rheumatoid arthritis.

1.A blood antibody called "rheumatoid factor" can be found in 80% of patients.

2.Another antibody called "the antinuclear antibody" (ANA) is also frequently found in patients with rheumatoid arthritis.

3.Another blood test that is used to measure the degree of inflammation present in the body is the C-reactive protein.

4.A blood test called the sedimentation rate (ESR) is a measure of how fast red blood cells fall to the bottom of a test tube. The sed rate is used as a crude measure of the inflammation of the joints.

The rheumatoid factor, ANA, sed rate, and C-reactive protein tests can also be abnormal in other systemic autoimmune and inflammatory conditions. Therefore, abnormalities in these blood tests alone are not sufficient for a firm diagnosis of rheumatoid arthritis

How does the Rheumatoid Arthritis starts?
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Rheumatoid Arthritis may start gradually or with a sudden and severe attack.
It usually attacks many joints at one time.
Rheumatoid arthritis is a chronic disease, characterized by periods of disease flares and remissions.

Where does Rheumatoid Arthritis occur?
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In rheumatoid arthritis, multiple joints are usually affected in a symmetrical pattern.
It most commonly affects the hands and feet,often in a systemic pattern(both right and left joints are affected).
Other joints affected are the elbow,knees,and ankles.
Less common are shoulder,hip and spine.

What are the Complications of Rheumatoid Arthritis?
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Rheumatoid Arthritis can result in joint deformities and disability especially in untreated severe cases.
Daily activities such as bathing,dressing, walking and even writing may be difficult.
Besides the joints, Rheumatoid Arthritis may sometimes affect other organs such as the eyes,lungs,skin,intestines,nerves and bone marrow.
Mild fever, fatigue, loss of appetite and loss of weight may be present.
Severe Rheumatoid Arthritis is associated with an incresed risk of mortality.

How is Rheumatoid Arthritis treated?
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There is no known cure for rheumatoid arthritis.
Therefore the purpose of treatment is to:
1. improve functions and
2. reduce pain and discomfort.

Treatment of Rheumatoid Arthritis can be broadly classified into:
1. Non-drug therapy:
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.
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 flexibilty are useful to minimise the disability of Rheumatoid Arthritis. 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 Rheumatoid Arthritis. The warm water especially is a good medium for joint mobility and together with the buoyancy of water it helps to minimse the body weight impact on the joints.
2. Drug therapy

There are 2 main types of drugs:
1. symptom modifying helps to alleviate the symptoms but do not change the natural history of the conditions. Examples are Non-steroidal Anti-inflamatory Drugs(NSAIDS) like diclofenac.

2. disease modifying drugs such as steroids, methothrexate, sulphasalazine, redaura, hydroxychloroquine have been shown to slow down the damage caused by Rheumatoid Arthritis. However they cause a lot of side effects such as anemia, abnormal white cells, kidney damage,liver damage, vision loss so the medications must be monitored all the time.
It is important that the disease should be controlled before irreversible joint damage occurs.

Newer "second-line" drugs for the treatment of rheumatoid arthritis include leflunomide (Arava), and the "biologic" medications etanercept (Enbrel), infliximab (Remicade), anakinra (Kineret), and adalimumab (Humira).

3. Surgery

Surgery is used as a last result to correct deformities and reduce disability.

The treatment of rheumatoid arthritis optimally involves a combination of patient education, rest and exercise, joint protection, medications, and occasionally surgery.

Early treatment of rheumatoid arthritis results in better outcomes.