Arthritis etiology

Ascorbic acid also forms soluble chelate complexes with iron (142—145). It seems ascorbic acid has no effect on high iron levels found in people with iron overload (146). It is well known, in fact, that ascorbic acid in the presence of iron can exhibit either prooxidant or antioxidant effects, depending on the concentration used (147). The combination of citric acid and ascorbic acid may enhance the iron load in aging populations. Iron overload may be the most important common etiologic factor in the development of heart disease, cancer, diabetes, osteoporosis, arthritis, and possibly other disorders. The synergistic combination of citric acid and ascorbic acid needs further study, particularly because the iron overload produced may be correctable (147). 

In the past number of years a number of studies have shown that in a variety of diseases there is a significant oxidation of Met residues to Met(O) in specific proteins that results in a loss of biological activity. These diseases include cataracts, rheumatoid arthritis, adult respiratory distress syndrome and emphysema. The most convincing evidence that Met(O) in proteins may be involved in the etiology of a pathological condition comes from studies with a-l-PI. It is well accepted that a-l-PI is inactivated upon oxidation of its Met residues. A decreased activity of a-l-PI in lung tissue that would result in an increased elastase activity has been associated with pulmonary emphysema. In patients who have a... 

The musculoskeletal system consists of the muscles, bones, joints, tendons, and ligaments. Disorders related to the musculoskeletal system often are classified by etiology. Acute soft-tissue injuries include strains and sprains of muscles and ligaments. Repeated movements in sports, exercise, work, or activities of daily living may lead to repetitive strain injury, where cumulative damage occurs to the muscles, ligaments, or tendons.1-3 While tendonitis and bursitis can arise from acute injury, more commonly these conditions occur as a result of chronic stress.3,4 Other forms of chronic musculoskeletal pain, such as pain from rheumatoid arthritis (see Chap. 54) or osteoarthritis (see Chap. 55), are discussed elsewhere in this text. 

Brahn E. Animal models of rheumatoid arthritis. Clues to etiology and treatment. Clin Orthop 1991(265) 42-53. 

Rheumatoid arthritis (RA) is a chronic and usually progressive inflammatory disorder of unknown etiology characterized by polyarticular symmetric joint involvement and systemic manifestations. 

The idea of reduced adrenal capacity as a possible model for PTSD has also been recently raised by Heim et ah, who concluded that low cortisol may not be a unique feature of PTSD, but may represent a more universal phenomenon related to bodily disorders, having an etiology related to chronic stress (Heim et al. 2000). There are numerous stress-related disorders such as chronic fatigue syndrome, fibromyalgia, rheumatoid arthritis, chronic pain syndromes, and other disorders that are characterized by hypocortisolism. In one study, Heim et al. showed decreased cortisol responses to low-dose DEX, but failed to observe blunted ACTH responses to CRF in women with chronic pelvic pain, some of whom had PTSD, compared to women with infertility (Heim et al. 1998). Since the data were not analyzed on the basis of the subgroup with and without trauma and/or PTSD, it is not possible to directly compare results of that study to other reports examining PTSD directly. 

Since the recognition of the biological role of lycopene in the prevention of chronic diseases, the emphasis of the scientific community has been in the area of cancer, with special focus on prostate cancer. However, based on the hypothesis that oxidative stress may be an important etiological factor in the causation of most of the degenerative diseases and that lycopene is a potent antioxidant, the scientific community has started to study its role in diseases other than the ones reviewed in this chapter. These health disorders include skin and ocular diseases, rheumatoid arthritis, periodontal diseases, and inflammatory disorders. The scientific information pertaining to the role of lycopene in these diseases is still in its infancy. However, the rationale for undertaking these studies is scientifically valid and it is hoped that in the next 3-5 years several studies will be reported in the literature. 

Arthritis and arthralgia are well-known adverse effects of intravesical BCG instillation as part of therapy of bladder cancer (SED-13, 925). The etiology and the different clinical pictures of BCG immunotherapy have been discussed (51). Considering that mycobacteria are potent stimulators of the immune system and especially of T cells, it is not surprising to observe T cell-mediated aseptic arthritis after BCG therapy. The authors suggested that the site of immune stimulation is critical, since intradermal injection produces a clinical presentation similar to reactive arthritis, and intravesical therapy causes a clinical picture identical to Reiter s syndrome. 

Rheumatoid arthritis is a chronic, inflammatory, autoimmune disease of unknown etiology that if left untreated results in progressive joint destruction, deformity, disability, and premature death. Theories of possible etiologies include genetic, hormonal, viral, autoimmune, and environmental factors. The disease peaks between the fourth through sixth decades of life and is two to three times more common in women than in men. Differences in prevalence rates between ethnic groups are small. 

There is also a significantly increased incidence of IgA deficiency in patients with autoimmune or potentially autoimmune disorders, and usually it is not clear which came first. It can be argued that autoimmunity is a complication of immune imbalance subsequent to inborn IgA deficiency (H24). With inborn absence of IgA, exposure to normal human colostrum, plasma, and saliva can result in the production of antibodies to IgA. By the time such patients are discovered the etiological mechanisms are often obscured and IgA treatment is out of the question. The incidence of IgA deficiency is known to be 1-4% in the following conditions Still s disease, systemic lupus erythematosus, rheumatoid arthritis, Sjogren s disease, warm hemolytic anemia, megaloblastic anemia, idiopathic pulmonary hemosiderosis, thyrotoxicosis, and cirrhosis. 

The immunologic basis of IBD is supported by a number of observations. First is the pathology of the lesions. With Crohn s disease, the bowel waU is infiltrated with lymphocytes, plasma cells, mast cells, macrophages, and neutrophils. Similar infiltration has been observed in the mucosal layer of the colon in patients with ulcerative cohtis. Inflammation in IBDs is maintained by an influx of leukocytes from the vascular system into sites of active disease. This influx is promoted by expression of adhesion molecules (such as alpha-4 in-tegrins) on the surface of endothefial cells in the microvasculature in the area of inflammation. Second, many of the systemic manifestations of IBD have an immunologic etiology (e.g., arthritis or uveitis). Finally, IBD is responsive to immunosuppressive drugs (e.g., corticosteroids and azathioprine). 

Luhmann JD, Luhmann SJ. Etiology of septic arthritis in children An update for the 1990s. Pediatt Emerg Care 1999 15 40-42. 

Sjogren syndrome. Chronic inflammatory autoimmune disease of the exocrine glands of unknown etiology. Its primary symptoms are keratoconjunctivitis sicca and xerostomia. Two types of Sjogren syndrome are distinguished a primary (isolated) type and a secondary type associated with another underlying autoimmune disease (e.g. rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, primary biliary cirrhosis, autoimmune hepatitis, multiple sclerosis, thyroiditis, autoimmune, etc.). Ro/SS-A and La/SS-B autoantibodies are used as classification criteria. 

The implication of microbial infection as an etiological agent in arthritis has been the main stimulus for the investigation of the antimicrobial properties of gold complexes. The... 

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