Connective tissue diseases rheumatoid arthritis

The definition of an overlap syndrome dictates that the criteria for diagnosis of both disorders (in the present context, of PM/DM and of some other connective tissue disorder), are fulfilled. It is not unexpected that those syndromes which overlap with PM/DM are also either known autoimmune conditions or ones in which an autoimmune basis is strongly suspected. The association of these disorders with PM/DM syndromes may not materially alter the basic histopathological featmes expected in PM/DM but some differences may be identifiable. The disorders most frequently associated with an overlap syndrome are rheumatoid arthritis, systemic lupus erythematosis, scleroderma, and mixed connective tissue disease. 

Besides drugs, other conditions that can lead to mouth dryness are radiation against the neck, fever, concomitant diseases such as rheumatoid arthritis and other connective tissue diseases (scleroderma, sicca syndrome), Parkinson s disease, numeral psychiatric conditions and stroke with paralysis, dysphagia, neglect or oral apraxia. Damage to the mouth can arise due to drug treatment through different mechanisms and here are some examples. 

The autoimmune rheumatic diseases consists of Rheumatoid Arthritis (RA), Spondylarthritis (SpA), Systemic Lupus Erythematosus (SLE), Polymyositis, Dermatomyositis, Polymyalgia Rheumatica, Acute Temporal Arteritis, Giant Cell Arteritis, Behcet s Disease, Sjorgren s Syndrome, Felty s Syndrome and Mixed Connective Tissue Disease (MCTD). Spondylarthritis (SpA) can be subdivided in Reactive Arthritis (ReA), Ankylosing Spondylitis (AS), Psoriatic Arthritis (PsA), Arthritis associated with the inflammatory bowel diseases are Crohn s disease and Ulcerative Colitis (IBD), Undifferentiated SpA (UspA) and Sacro-ilitis, Juvenile SpA and Acute Anterior Uveitis (AAU). 

The main clinical uses of immunosuppressive drugs are suppression of organ and tissue rejection after transplant surgery and the treatment of diseases with an autoimmune component. Thses include renal diseases, e.g. glomerulonephritis, some nephrotic syndromes, connective tissue diseases, such as systemic lupus erythematosus rheumatoid arthritis, and systemic vasculitis. 

Although there are reports of associations between exposure to organic solvents and various connective tissue diseases, such as systemic sclerosis, scleroderma, undifferentiated connective tissue disease, systemic lupus erythematosus, and rheumatoid arthritis, the evidence of a causal association is weak (44). 

In addition to the evaluation protocols discussed previously to diagnose dry eye, it is important to probe fiar symptoms related to connective tissue disease. Simply inspecting the patient s hands may yield a presumptive diagnosis of rheumatoid arthritis. A useful technique to screen for xerostomia is to listen for a clicking soimd as the patient speaks, caused by inadequate saliva and poor oral lubrication. Alternatively, a tongue depressor may be placed on the patient s tongue the depressor often adheres to the surface of the tongue in patients with xerostomia. 

The most common types of arthritis in the UK are osteoarthritis (UK prevalence 23%) and rheumatoid arthritis (1%). The less common t3 es of inflammatory arthritis include juvenile idiopathic arthritis spondylarthritis (ankylosing spondylitis, Reiter s syndrome, psoriatic arthritis, arthritis associated with inflammatory bowel disecise) and reactive arthritis associated with infection. Joint pains (arthralgia) are common in many other diseases, for example the connective tissue diseases (systemic lupus erythematosus, scleroderma), endocrine conditions (hypo-and h5 erthyroidism) and malignancies, but in these, joint inflammation and damage do not usually occur. 

Aseptic meningitis is a rare adverse effect of non-selective NSAIDs in patients with or without connective tissue disease or rheumatological disease. Rofecoxib has been implicated in five patients (four women and one man), in each case occurring within 12 days of the start of rofecoxib therapy (1). The clinical presentations and cerebrospinal fluid findings were typical of aseptic meningitis. One patient had rheumatoid arthritis. After drug withdrawal and recovery, two consecutive rechallenges in one patient led to relapses. 

There have been case-reports of a confirmed diagnosis of systemic sclerosis, rheumatoid arthritis, or systemic lupus erythematosus in patients with silicone breast implants (Silverstein et al., 1992 Sanchez-Guerrero et al., 1994 Cuellar et al., 1995 Field Bridges, 1996). However, no association between silicone breast implants and connective tissue disease has been seen in more than... 

Altered copper metabolism in rheumatoid arthritis (RA), osteoarthritis, and other chronic degenerative diseases, which are also historically known as connective tissue diseases because of associated pathological changes involving these tissues, has been an area of active research interest [30] since Heilmeyer and Stuwe [31] originally reported elevated plasma copper levels in RA patients. 

Connective tissue diseases, such as systemic lupus erythematosus, systemic sclerosis, or rheumatoid arthritis, may also be related to mesenteric lymphadenopathy (Calguneri et al. 2003). In these patients, mesenteric lymphadenopathy is more frequently an occasional US finding and seldom the only manifestation of lymph node involvement... 

In June of 1994, a population-based retrospective cohort study was published which examined the risk of a variety of connective tissue diseases and other disorders after breast implantation [65]. In this study, all women in Olmsted County, Minnesota who received a breast implant between 1 January 1964 and 31 December 1991 (the case subjects) were studied. For each case subject, two women of the same age (within three years) from the same population who had not received a breast implant and who underwent a medical evaluation within two years of the date of the implantation in the case subject were selected as control subjects. Each woman s complete inpatient and outpatient medical records were interviewed for the occurrence of various connective tissue diseases (i.e., rheumatoid arthritis, systemic lupus erythematosus, Sjogren s syndrome, dermatomyositis, polymyositis, systemic sclerosis, ankylosing spondylitis. 

Connective tissue disorders involving occupational factors are, first of all, systemic sclerosis (SSc), probably also lupus erythematosus (LE) and very rarely dermatomyositis, mixed connective tissue disease (MCTD), rheumatoid arthritis (RA) and Sjogren s syndrome (Zschunke et al. 1990 Koeger et al. 1991). 

Also, an increased incidence of cell-mediated and humoral immunity to various collagens has been found in systemic connective tissue disease such as rheumatoid arthritis, juvenile rheumatoid arthritis, and progressive systemic sclerosis (scleroderma). Patients with these diseases may thus have an increased susceptibility to hypersensitivity responses and/or accelerated clearance of their implants w hen injected with bovine dermal collagen preparations. Therefore, caution should be used when treating tliese patients including consideration for multiple skin lesions. 

Connective tissne-associated DPLD Rheumatoid arthritis Systemic sclerosis Systemic lupus erythematosus Polymyositis/dennatomyositis Mised coimective tissue disease Undifferentiated connective tissue disease... 

Finally, prominent peribronchial lymphoid aggregates can be present in both nonspecific and usual interstitial pneumonia patterns of injury associated with connective tissue diseases such as systemic lupus erythematosus and rheumatoid arthritis. The lymphoid infiltrate is typically denser and more diffuse in LIP. 

The connective tissue diseases (CTDs) are a heterogeneous group of immuno-logically mediated inflammatory conditions of unknown etiology, accompanied by diverse autoantibodies and affecting multiple organ systems. In adults, the more frequent CTDs comprise rheumatoid arthritis (RA), systemic sclerosis (SSc), Sjogren s syndrome (SjS), systemic lupus erythematosus (SLE), polymyositis/ dermatomyositis (PM/DM), and mixed CTD (MCTD). 

Abbreviations. RA, rheumatoid arthritis SLE, systemic lupus erythematosus SSc, systemic sclerosis DM/PM, dermatomyositis/polymyositis SjS, Sjogren s syndrome MCTD, mixed connective tissue disease PH, pulmonary hypertension. 

Abbreviations-. ILA, interstitial lung disease RA, rheumatoid arthritis SLE, systemic lupus erythematosus SSc, systemic sclerosis DM, dermatomyositis PM, polymyositis SjS, Sjogren s syndrome MCTD, mixed connective tissue disease NSIP, non-specific interstitial pneumonia UIP, usual interstitial pneumonia OP, organizing pneumonia DAD, diffuse alveolar damage DIP, desquamative interstitial pneumonia LIP, lymphocytic interstitial pneumonia. 

Dieppe PA. Empyema in rheumatoid arthritis. Ann Rheum Dis 1975 34(2) 181 185. Joseph J, Sahn SA. Connective tissue diseases and the pleura. Chest 1993 104(1) ... 

Mixed connective tissue disease (MCTD) is an overlap syndrome characterised by a combination of clinical features similar to those of systemic lupus erythematosus, scleroderma, polymyositis, rheumatoid arthritis and unusually high titres of circulating antibody to RNP antigen. 

Schumacher HR, Pessler F, Chen LX (2003) Diagnosing early rheumatoid arthritis (RA). What are the problems and opportunities Clin Exp Rheumatol 21 [Suppl 31] S15-S19 Scribner GH, Barboriak JJ, Fink JN (1980) Prevalence of pre-cipitins in group at risk of developing hypersensitivity pneumonitis. Clin Allergy 10 91-95 Sharp GC (1994) Mixed connective tissue disease arthritis. In Isselbacher KJ, Braunwald E, Wilson JD, Martin JB, Fauci AS, Kasper DL (eds) Harrison principles of internal medicine, 13th edn. McGraw-Hill, New York, pp 1660-1661... 

The strength of the association between silicosis and connective tissue disease varies with the type of connective tissue disorder. The risk of developing systemic sclerosis, particularly in workers with high exposure to silica dust, is well established, although such casual associations between silicosis, rheumatoid arthritis and systemic lupus erythematosis are less widely reported (Rosenman 1999 Sluis-Cremer et al. 1985, 1986 Sanchez-Roman et al. 1993)... 

Over the last few years there have been numerous further reports of hepatotoxicity following the therapeutic use of aspirin. In almost all cases the patients were receiving the dmg for arthritis and connective tissue diseases, and hepatotoxicity has been restricted largely to children and young adults. Females are affected more often than males. Most reported cases have been in patients with juvenile rheumatoid arthritis. Hepatitis usually resolves when aspirin is discontinued and has recurred on subsequent challenge with aspirin (125 —131 ). 

The salicylates and nonsteroidal anti-inflammatory drug (NSAIDs) are important in the treatment of arthritic conditions. For example, the salicylates and NSAIDs are used in the treatment of rheumatoid arthritis (a chronic disease characterized by inflammatory changes within the body s connective tissue) and osteoarthritis (a noninflammatory joint disease resulting in degeneration of the articular cartilage and... 

Human leukocyte elastase is a protease that degrades elastin and other connective tissue components. It is implicated in the pathogenesis of pulmonary emphysema and other inflammatory diseases such as rheumatoid arthritis and cystic fibrosis. Porcine pancreatic elastase has often been used as a model for HLE. Both enzymes have a small primary binding site Si. 

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