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Rheumatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Some symptoms are common in rheumatic diseases so pain, stiffness and joint swelling should be explored in depth. The important questions to ask a patient are listed in HISTORY & EXAMINATION 4.1.
Radiation Hormesis in Cancer
Published in T. D. Luckey, Radiation Hormesis, 2020
Radium vials were used extensively to cure cancer and a variety of minor ailments from the beginning of the 19th century until about 1933. Enthusiastic medical reports focus on rheumatism and arthritis.218,481,483,808 When 226Ra was administered to >1000 patients in Germany from 1944 to 1951, one developed bone sarcoma following a dose of <10 Gy.791 Thousands of patients were injected with about 370 kBq of radium. These provide information about the metabolism and biologic effects of radium. Several forms of radium are still available for a variety of medical uses. Widespread use for minor illness decreased after the cause of cancer in radium dial painters was accepted, about 1930. Nonprescription use of radium ceased about 1933 following the death of a man who for several years drank four bottles daily of “Radiothor”, a combination of 37 kBq of Ra and 37 kBq mesothorium salts.481–483
Autoimmunity and Rheumatic Fever
Published in Irun R. Cohen, Perspectives on Autoimmunity, 2020
Many investigators have sought genetic markers for rheumatic hosts. Blood group antigens have been extensively studied. It appears that RF occurs more frequently in persons who do not secrete ABH antigens in their saliva than in those who do.27,28 Concentrations of serum IgA are lower in nonsecreters than secreters.29 Because secretory IgA may prevent colonization of mucous membranes, the pharyngeal mucosa of nonsecreters may be more vulnerable to, or react differently with, group A streptococci. There is no convincing evidence, however, to support such a suggestion. Repetitive pharyngeal infection by group A streptococci may be a requirement for the development of RF, but no difference in rheumatic hosts and normal controls has yet been shown in the frequency of steptococcal pharyngitis. The statistically greater magnitude of streptococcal antibody responses in the former may reflect such frequency as well as severity of the antecedent pharyngitis, but need not relate to a unique host factor. Studies of salivary IgA against specific streptococcal antigens have not been adequately made in rheumatic and control populations.
JAK inhibitors in rheumatology
Published in Immunological Medicine, 2023
Rheumatology is a field in medicine that covers diseases presenting with painful musculoskeletal problems encompassed as rheumatic diseases. Therefore, rheumatic diseases overlap with other fields such as dermatology or gastroenterology which are also covered in a different section of this special issue. The pathophysiology involves autoimmunity and/or autoinflammation of unknown causes. Due to unknown etiology, specific treatment for a specific disease does not exist and glucocorticoid (GC) is still the primary treatment tool for most of the diseases. Unfortunately, aiming cure for rheumatic diseases is still not a realistic treatment goal. However, targeting specific molecules involved in the inflammatory process with biologics has revolutionized the treatment of rheumatic diseases which also lead to revolutionary change in other medical fields. The most recent advance in rheumatology is the efficacy of JAKis for rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) which demonstrated superiority over biologics. The convenience of an orally available JAKis as opposed to biologics that require parenteral injection is innovative from the patient’s perspective. Another aspect of JAKis that makes it unique is that the mechanism of action is conceptually selective to JAKs as an orally available small molecule compound however, very complex.
Risk of Staphylococcus aureus bacteraemia in patients with rheumatoid arthritis and the effect of orthopaedic implants on the risk: a nationwide observational cohort study
Published in Scandinavian Journal of Rheumatology, 2023
SS Dieperink, B Glintborg, LB Oestergaard, M Nørgaard, T Benfield, F Mehnert, A Petersen, C Torp-Pedersen, ML Hetland
For patients with RA, both the disease itself (disease activity and disability) and the anti-rheumatic treatments increase the infection risk (2, 42, 43). RA disease severity and treatment could potentially mediate some of the excess risk of SAB associated with having both RA and orthopaedic implants; however, it was beyond the scope of this study to explore the impact of RA-specific factors such as disease activity and immunosuppressive treatments on the risk. Information on injectable glucocorticoids, other anti-rheumatic treatments, and disease activity was not available in this study. The effect of oral glucocorticoids without corresponding information about disease activity would have been heavily subjected to confounding by indication and thus the true effect would still be unclear. In addition to the risk from orthopaedic implants, future studies should investigate whether subgroups of RA patients are more susceptible to this serious infection.
Triptolide and l -ascorbate palmitate co-loaded micelles for combination therapy of rheumatoid arthritis and side effect attenuation
Published in Drug Delivery, 2022
Man Li, Guoqiang Wang, Yinyin Yan, Mengyuan Jiang, Zhirong Wang, Zhenqiang Zhang, Xiangxiang Wu, Huahui Zeng
Rheumatoid arthritis (RA) is a systemic autoimmune disease of joints, characterized by hyperplasia of synovial joints, joint inflammation, cartilage erosion and bone destruction (Liu et al., 2021). The destruction of cartilage, bone and other adjacent tissues are often irreversible in the later stages of the disease, which will eventually lead to severe joint deformities and even disabilities (Zhao et al., 2021). The global incidence rate of rheumatoid arthritis is about 0.4% to 1.3% (Littlejohn & Monrad, 2018). Currently available anti-rheumatic drugs, including non-steroidal drugs, glucocorticoids, and biological agents, cannot cure RA radically but only relieve its symptoms and progression (Goldbach-Mansky et al., 2009; Weber et al., 2019). In China, herbal medicines have been extensively utilized as alternative anti-rheumatic drugs for decades (Zhao et al., 2019; Li & Zhang, 2020). However, the traditional herbs contain a lot of ingredients which may result in serious side-effects (Wang et al., 2019). Therefore, the functions of every ingredient must be further defined to improve the therapeutic performance of the herbs.