Rheumatic and Granulomatous Diseases

1. RHEUMATIC
AND
GRANULOMATOUS
DISEASES

2. 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.

3. 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

4. - 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?

5. 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

6. 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

7. 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

8. 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

9. 5. SYSTEMIC LUPUS ERYTHEMATOSUS
(SLE)
• autoimmune disease
• results in inflammation of and damage of
the joints, skin, kidneys, heart, lungs, blood
vessels and brain

10. 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

11. 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

12. 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

13. 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

14. 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.

15. 13. BURSITIS
• inflammation of
the bursae (small
fluid – filled sac
that help reduce
friction between
bones and other
moving
structures in the
joint

16. 14. TENDINITIS (TENDONITIS)
• inflammation
of tendons
• caused by
overuse,
injury or
rheumatic
condition

17. 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

18. 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

19. 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

20. 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

21. • 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?

22. • eye and mouth dryness:
artificial tears and saliva
• good eye and mouth
hygiene to prevent corneal
ulcers and tooth decay
TREATMENT

23. 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

24. 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

25. 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

26. DIAGNOSIS:
History
P.E.: TMJ Examination
Panoramic X-Ray
MRI / CT scans

27. 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

28. • 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