The term rheumatoid arthritis (RA) was coined by Sir Alfred Baring Garrod in 1858. Rheumatoid arthritis is the most frequent occurring chronic, inflammatory joint disease and can affect any joint, even larger ones like shoulders, elbows, or knees. The inflammation causes swelling resulting in slowed and limited mobility and pain. If untreated, joint erosions can occur, which lead to functional impairment up to disability. Therefore, an early and appropriate treatment is important to prevent joint damage.
About 1% of the worldwide population suffers from rheumatoid arthritis with approximately three times more women than men. Patients are mostly aged 30 to 50 years when first disease symptoms occur.
In most patients, rheumatoid arthritis starts with tender and swollen joints. Often the joints of hands and feet are affected. The symptoms are mainly symmetrical which means that they occur in the same joints on both sides of the body, e.g. both wrists. In addition, joint stiffness after long rest periods like in the morning and a general fatigue are common symptoms. Your doctor will make several examinations including blood tests and ultrasound scanning, MRI, or X-rays to confirm the diagnosis. You will probably be asked about your family history. As soon as the diagnosis is certain, your doctor will start with an appropriate therapy for you to ease your current symptoms and to prevent future joint erosions.
JUVENILE IDIOPATHIC ARTHRITIS
Joint inflammations not only occur in elderly people but can also affect children. Juvenile idiopathic arthritis (JIA) is the technical term for the most common rheumatic disease in children up to 16 years. The word juvenile refers to the early age at onset, idiopathic states the unknown cause of the disease, and arthritis can be translated as joint inflammation. Other terms used for juvenile idiopathic arthritis are juvenile chronic arthritis (JCA) or juvenile rheumatoid arthritic (JRA). The disease is classified into several subtypes depending on characteristic symptoms. There is the oligoarticular or pauciarticular (few joints) form, the polyarticular (many joints) and the systemic (affecting the whole body) onset. Juvenile idiopathic arthritis can also be associated with psoriasis or be enthesitis-related (an inflammation of the entheses).
About one child in 1000 suffers from this disorder. Children of any age can develop juvenile idiopathic arthritis with major peak onsets at the age of one to two years and later between nine and 15 years. The disease shows many faces and next to joint pain and swelling quite unspecific symptoms such as reduced physical activity, fatigue, morning stiffness, persistent and intermittent fever, and rashes may be present. Therefore, the correct diagnosis might be difficult. Parents should also consider seeing a pediatric rheumatologist who is specialized in the diagnosis and treatment of children with arthritis. For diagnosis the doctor will perform physical examination including blood samples to do several laboratory tests and will ask some questions to your family history.
Juvenile idiopathic arthritis can have a good outcome with full recovery, called remission. However, this can take months or even years. In some children, however, joint and tissue damage occur which can cause severe discomforts and limitations with consequences for the personal quality of life up to the adult age. Therefore, a timely and appropriate treatment will be necessary to reduce current symptoms and to prevent further joint erosions.
The term psoriasis vulgaris is derived from the Greek words psora (itch) and -iasis (disease) and the Latin word vulgaris (common). Psoriasis typically results in thick and red patches on the skin which are covered with a silvery accumulation of dead skin cells. These scaly patches are called psoriasis plaques or lesions and can occur on all parts of the body. In these lesions the production of cells, the so-called cell proliferation, proceeds more rapidly than in normal skin areas. Psoriasis vulgaris is also called plaque psoriasis and affects up to 85% of psoriasis patients. Other types of psoriasis affect skin folds (inverse psoriasis) or show numerous spots or pustules (guttate and pustular psoriasis, respectively).
Psoriasis is a chronic skin disease affecting approximately 2-3% of the population worldwide. Both sexes are affected equally. The onset of psoriasis can happen at any age but commonly occurs at the age of 15 to 25 years or after the age of 40.
Psoriasis is not contagious, thus can not be passed from one person to another. In fact, psoriasis is an autoimmune disease and involves a special type of white blood cells, called T-lymphocytes or just T-cells. These T-cells are essential for protection against infections and for healing, but in psoriasis they become over-stimulated resulting in inflammation and an extraordinary production of new skin cells. Usually the skin cells replace themselves every 21 to 28 days. However, in psoriasis plaques this happens every four to seven days. Hence, the skin thickens and starts to scale.
There is no specific factor known which causes psoriasis, although certain genes are supposed to be linked to psoriasis. After all, about 30% of psoriasis patients have a first-degree relative with psoriasis. Furthermore, the onset is associated with several risk factors such as emotional stress situations, some medications (lithium against depressions, beta blockers for blood pressure regulation, antimalarial drugs, nonsteroidal anti-inflammatory drugs, and withdrawal of oral steroids), infections, skin injuries, or disorders of the metabolism such as diabetes mellitus or hormonal changes (pregnancy, adolescence).
Psoriasis is usually diagnosed by an accurate examination of the skin, sometimes in combination with a skin biopsy to confirm the findings. It mostly occurs at elbows, knees, scalp, lower back, and palms or soles of the feet. In addition, fingernails and toenails sometimes change their appearance (psoriatic nail dystrophy). This might be an additional evidence for your dermatologist. Probably you will be interviewed about relatives with psoriasis. In the end, your dermatologist will try to find an appropriate treatment for you to minimise skin lesions and itching. Medical therapy could include creams and ointments, balneotherapy, UV light, and drugs.
Patients with psoriasis are at an increased risk to develop joint inflammation as well (psoriatic arthritis). If you feel stiffness, pain, or a swelling in your joints, please do not hesitate to contact your doctor, so that he or she can react as soon as possible.
Psoriatic arthritis (PsA) is an inflammatory disease of the skin and of joints. The disease can develop at any time with a major peak at the age of 35 to 45. Two to three percent of the worldwide population have psoriasis, and up to 30% of these patients are estimated to develop psoriatic arthritis. Usually the arthritis develops after skin lesions within five to ten years after onset of psoriasis, but also the similar or reverse course occurs. Similar to psoriasis, psoriatic arthritis affects both sexes equally.
Psoriatic arthritis can not be diagnosed by one specific test. Instead, a variety of medical screenings (physical examination, blood tests, X-rays, MRI, questions about the family history of psoriasis etc.) will be done by your doctor. Symptoms like painful and swollen tendons and joints, redden painful eyes, fatigue, morning stiffness, and nail changes can indicate psoriatic arthritis. The arthritis can appear in any joint such as the hips, knees, or spine. Also the distal joints (closest to the nails) of fingers and toes can be affected by arthritis, a symptom which is called dactylitis. In general, joints are mainly affected in an asymmetrical manner which means that they do not occur in the same joints on both sides of the body (e.g. only one wrist is affected, not both at the same time).
If psoriasis existed before, patients usually consult their general practitioner or dermatologist. However, patients with psoriatic arthritis should also consider visiting a rheumatologist who is a specialist for arthritis. A timely treatment can reduce troubles with daily activities caused by joint pain. As psoriatic arthritis is a chronic disease an appropriate treatment can also help to slow down and even prevent joint and tissue destruction.
Crohn's disease is an autoimmune disease that belongs in the group of the so-called inflammatory bowel diseases.1 The disease is named after Burrill Bernard Crohn who described it in 1932. Crohn's disease is characterized by recurrent inflammation in specific parts of the intestines. From mouth to rectum, the entire digestive tract can be affected. But most commonly the large intestine and end part of the small intestine are inflamed.1
The disease can cause a wide variety of symptoms which can be very different from person to person. Typical symptoms are diarrhea, stomach ache, weight loss and fever. The inflammation of the bowel due to Crohn's disease often affects all layers of the tissue and causes a thickening and narrowing of the bowel that can lead to strictures.1
Today it is still unknown exactly why a person gets Crohn's disease. But various possible triggers and risk factors could already be identified including factors like infections, lifestyle, a genetic influence or smoking.1
Crohn's disease is more common in industrialized and westernized countries. In Europe about 0.3 % of the population suffers from the disease.2 Men are more often affected than women with a ratio of 2:1 and the disease can occur at any age.1,3
Gastroenterologists are the specialists in treating Crohn's disease. Depending on the location as well as the severity and duration of the inflammation they have various treatment options to medicate the disease. These medications include drugs such as salicylates, steroids, thiopurines, biologics or methotrexate.3
When your doctor suspects your symptoms to be the cause of Crohn's disease he has various options to confirm his diagnosis including endoscopic, histological, radiological or biochemical examinations for example.1 Once the diagnosis is certain, your doctor will choose the best therapy for you to control the inflammation and reduce your symptoms.
Please note that only the pre-filled syringe 50 mg/ml is registered for the treatment of Crohn’s disease.
1Baumgart and Sandborn. Lancet 2012; 280:1590-1605
2Molodecky et al., Gastroenterology 2012; 142:46-54
3Baumgart, Deutsches Ärzteblatt 2009; 206(8):123-33