Rheumatoid Arthritis: Symptoms, Causes, Treatment

 

Rheumatoid Arthritis is an autoimmunity condition(autoimmunity is a condition in which cells known as antibodies designated to protect our bodies' systems from harm/infection accidentally attacks our normal tissues).

Rheumatoid arthritis causes swelling and damage to the tissues at the joints and may later progress and start damaging organs. It normally affects joints symmetrically(both joints or joints parallel to each other).

Symptoms of Rheumatoid Arthritis

Some of the symptoms that one may have includes; joints pain, joints swelling, joint deformities, loss of joints function.

Risk factors of Rheumatoid Arthritis

Gender(females are more predisposed than males), middle age, obesity, smoking and family history of rheumatoid arthritis.

Diagnosis of Rheumatoid Arthritis

This can be determined by taking the patient's ailment history and examination.

Some of the tests that may be done in diagnosis making includes: Rheumatoid factor, Erythrocyte sedimentation rate, Antinuclear antibodies and C- reactive protein.

Treatment of Rheumatoid Arthritis

It does not resolve completely. Treatment therefore focuses on controlling its progression/organs damage and improve quality of life of the patient.

Treatment modalities can be classified into three categories; medical(use of disease modifying anti-rheumatic drugs- DMARDs), surgical repair for extreme joints damage, healthy lifestyle/diet(exercise/controlled alcohol intake/stop smoking,controlled fat content intake, taking more vegetables/fruits and whole grains).

Complications of Rheumatoid Arthritis

Some of the complications that may be encountered include: osteoporosis (softening of the bones hence making one to be susceptible to fractures), respiratory failure due to the scarring of the lungs' tissues, lowered immunity hence making one to be prone to infections, cardiac failure due to heart damage, lymphoma which is a type of blood cancer.

 

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Health Mondays: A Sharp Focus on Juvenile Idiopathic Arthritis

 

Juvenile Idiopathic Arthritis was initially known as juvenile rheumatoid arthritis. It is a type of arthritis that affects children below the age of 16 years.

It is an autoimmunity condition(a condition in which cells meant to protect the body's systems from harm/infection, accidentally turns to fight it's normal cells).

It's duration varies, it may resolve after a few months however in some cases it may prolong for several years.

Symptoms of Juvenile Idiopathic Arthritis

Some of the symptoms that one may present with are joints stiffness especially in the morning, joints pain, swollen warm joints, reddening of the joints, recurrent fevers.

Types of Juvenile Idiopathic Arthritis

1. Oligo articular: affects less than five joints. 
2. Polyarticular: affects five or more joints
3. Enthesitis related: involves bones at their connection to tendons and ligaments.
4. Systemic: affects the entire body.

Diagnosis of Juvenile Idiopathic Arthritis

This is first made by taking the patient's history and examining them. 

Based on the patient's state, some of the the following diagnostic tests may be done: Rheumatoid factor, Antinuclear antibodies, C- reactive protein, X-ray/MRI may be done to rule out other possible inflammatory conditions.

Treatment of Juvenile Idiopathic Arthritis

The modality of treatment will be determined by the grade of the patient's condition.

The treatment strategy focuses on- resolving pain and inflammation, preventing further disease progression/joints or organs damage and improving quality of life.

The treatment modalities are in three categories: 

1. Medical(e.g Disease modifying anti-rheumatic drugs/non-steroidal anti-inflammatory drugs). 
2. Surgical repair in case of a marked joint damage.
3. Healthy lifestyle(non-aggressive exercises, balanced diet).

Complications of Juvenile Idiopathic Arthritis

Some of the complications that may develop includes- stunted growth, uneven limbs, anemia, visual limitations, heart failure.

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Osteoarthritis in Africa: Symptoms, Treatments, and Causes

 

Osteoarthritis is the most common form of arthritis. It is a degenerative chronic condition that wears out joints' cartilages(slippery protective tissues covering bones' endings at the Joints).

Cartilages serves to cushion bones' endings at the joints from friction. It can affect any joint however it commonly affects joints at the hands, knees,hips and the spine.

The difference between osteoarthritis and rheumatoid arthritis

Osteoarthritis is a wear and tear condition whereas rheumatoid arthritis is an autoimmunity condition, there is no morning stiffness in osteoarthritis but in case it is experienced it doesn't last more than thirty minutes.

However morning stiffness is a common feature in rheumatoid arthritis, pain gets worse with increased usage of the affected joint in osteoarthritis; however there is no marked relationship of pain with activity in rheumatoid arthritis, osteoarthritis affects joints randomly whereas rheumatoid arthritis affects joints symmetrically(parallel to each other).

Symptoms of osteoarthritis

Some of the symptoms at the affected joint/joints include pain, stiffness, swelling, tenderness, cracking sounds/grating sensation on movement.

Risk factors for osteoarthritis

Older age, sex(females are more predisposed), congenital joints/bones deformities, obesity, joints injuries, genetics(people with a positive osteoarthritis family history are more predisposed), persistent stress to a certain joint/joints due to activities.

Diagnosis of Osteoarthritis

Mostly made by taking a patient's history and examining him/her.Lab diagnostic tests are normally not essential however they may be conducted to rule out other inflammatory conditions.

Imaging e.g X-ray or MRI may also be done to rule out other possible related conditions or to determine the extent of the damage.

Treatment of Osteoarthritis 

There are several modalities of treatment. The choice of treatment will be determined by the patient's state/the disease level.

They include- medical(e.g corticosteroids and nonsteroidal agents), surgical repair in extreme joint damage and lifestyle/conservative management(e.g non aggressive exercises, balanced diet, physiotherapy & assistive devices such as crutches).

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Health Mondays: What is Systemic Lupus Erythematosus(SLE)?

 

According to Centers for Disease Control and Prevention, Systemic lupus erythematosus (SLE), is the most common type of lupus.

SLE is an autoimmune condition(a condition in which the body's immune system accidentally fights it's normal tissues). 

It may later progress from tissues to organs.

Symptoms of Systemic Lupus Erythematosus(SLE)

This condition shares alot of symptoms with various inflammatory diseases however majority of people with it presents with unique clustered rashes at the cheeks and the nasal bridge forming a butterfly shape.

The symptoms' onset may be rapid or slow/marked or mild/short-lived or permanent.

Symptoms presentation will be determined by the systems affected; they are as follows: butterfly-shaped group of rashes at the cheeks and the nasal bridge,fever, fatigue, joints pain/stiffness, shortness of breath/chest pain, headache/confusion,sun sensitivity rashes, hair loss, fingers turning white or blue and tingling on cold exposure(Raynaud's phenomenon).

Risk factors of Systemic Lupus Erythematosus(SLE)

Gender(females are more predisposed), Age(15 - 45 years aged are more susceptible), genetics(people with a positive family history of SLE are more predisposed), Race(it's more common among Africa-Americans/Hispanics/Asian-Americans), overwhelming physical/emotional stress, extreme Ultra violet light exposure, certain viral infections and certain anti-hypertensive/anti-seizure drugs.

Diagnosis of Systemic Lupus Erythematosus(SLE)

There is no definite diagnostic screening modality.Diagnosis is normally made by taking the patient's history with an evaluation of his/her signs and symptoms.

Some antibody tests and imaging however may be done for the purposes of ruling out other possible inflammatory conditions/supporting the diagnosis made.

Treatment of Systemic Lupus Erythematosus(SLE)

This will be determined by the state of the patient and the disease level of progression. 

The treatment may include anti-inflammatory/analgesic agents, steroid based creams for the skin and corticosteroids agents to reduce immune response.

Complications of Systemic Lupus Erythematosus(SLE)

This may include- heart failure, respiratory failure, stroke and kidney failure.

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Leukemia in Kenya: Symptoms, Causes, Types, Diagnosis, Treatment

 

Leukemia is a type of cancer that affects the primary(early) blood building cells and the bone marrow(a soft spongy tissue found in the canal of bones that produces blood cells). It majorly affects the white blood cells.

Leukemia causes abnormal multiplication of the affected cells.These abnormal cells that don't function or doesn't function properly later outnumbers the normal function blood cells leading to deficiency in their services to the body.

Symptoms of Leukemia

It doesn't have well defined/specific symptoms hence can easily be missed at it's initial stages. 

Some of the symptoms that may present are as follows- headache, excessive night sweats, fever alternating with chills, weight loss, fatigue, recurrent episodes of infection, easy bleeding/bruising and bone pain/tenderness.

Risk factors for Leukemia

There is no known cause for this condition scientifically however there are certain factors that have shown positive increased risk for it's development such as follows:

A positive family history of leukemia, certain genetic disorders e.g Down Syndrome, previous cancer treatments, exposure to certain industrial chemicals e.g benzene and smoking.

Classification of Leukemia

It is classified based on it's rate of progression and based on the cells type involved as follows:

Based on the rate of progression

• Acute leukemia which consists of immature cells which divide at a high rate.
• Chronic leukemia: it's cells are slightly matured and the rate of progression is low.

Based on the cells type involved

• Lymphocytic/lymphoblastic leukemia: this affects lyphoid/lymphocytes which are cells that constitutes the immune system.
• Myelogenous/myeloid leukemia: this affects myeloid cells which serves to give rise to red and white blood cells/platelets producing cells.

Types of Leukemia

1. Acute lymphocytic leukemia(ALL)-: It's common in pediatrics but can also affect adults.
2. Acute myelogenous leukemia(AML): it's a common type of leukemia generally.It affects both pediatrics/adults but it's more common among the adults.
3. Chronic Lymphocytic(CLL): it's the common chronic leukemia in adults.Symptom take a long time before presenting.
4. Chronic Myelogenous leukemia(CML): Mainly affects adults, presents with a few symptoms or none for a prolonged period of time before they manifest.

Diagnosis of Leukemia

This will be arrived at by taking the patient's history and examining him/her then based on their state some of the following diagnostic tests/imaging may be done- complete blood count, blood smear, bone marrow biopsy, spinal tap: CT- scan and MRI.

Treatment of Leukemia

This will be determined by the patient's general well-being/disease stage.Some of the options that may be adopted includes- chemotherapy, radiation, biologic therapy,stem cell transplant and surgery.

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Gout In Kenya: The Painful Rheumatic Disease Symptoms, Causes, and Treatment

 

Gout is a condition that results from build-up of excessive uric acid in the blood which will cause swelling and pain mostly in one of the big toes however other joints may also get affected.

Other joints that may get involved includes- ankle, knee, fingers, wrist and elbow joints.

How It Happens

Uric acid is formed from the breakdown of purines which are substances found naturally within the body and other foods e.g red meat, sea food, alcoholic beverages and fructose(sugar) sweetened refined drinks.

After it's production, uric acid is supposed to be excreted via the kidneys in the urine however due to kidney problems, there may be inadequate uric acid excretion leading to it's excessive build-up in the body.

In some cases the kidneys may be functioning normally however the body may abnormally produce excess uric acid that may be beyond the kidneys' capacity to excrete.

The accumulated retained uric acid will then form crystals known as urate crystals which are need like sharp substances that will cause pain and swelling at the joints.

Symptoms of Gout

Symptoms are classified into asymptomatic, acute gout symptoms and chronic gout symptoms.

In asymptomatic stage, there is no pain/swelling/any discomfort despite the high uric acid levels in the body.

In acute stage, excruciating pain and swelling is experienced majorly affecting one of the big toes though other joints may also get affected.

The acute stage attack normally lasts between 12 hours to 24 hours though it can sometimes get prolonged between 3 days to 10 days. 

Chronic stage is normally longstanding however the symptoms are not acute.

Some of the symptoms that one may present with include acute joint pain, joint swelling and reddening/hotness of the joints, limited mobility of the affected joint.

Risk factors

A positive family history of gout, frequent high purine content diet(red meat, sea food), obesity, chronic renal disease, high alcohol consumption, obesity, diabetes melitus, hypertension, thyroid disease, prolonged use of certain medications e.g diuretics/aspirin, and antirejection medications in organ transplant.

Diagnosis

This is made by taking the patient's history and physical examination. Diagnostic tests such as the affected joint's fluid uric acid levels and X-ray may also be done.

Treatment

This will be determined by the disease stage and the general health state of the patient.

Some of the drugs that may be employed include analgesics e.g NSAIDS and corticosteroids, attack blockers e.g probenacid and xanthine oxidase inhibitors.
For severe joint damage, surgical intervention may be considered.

Complications

Delayed treatment may cause joint damage which may lead to arthritis development.

Other complications includes- kidney failure and hard nodules deposits known as tophi beneath the skin of the affected joints.

 

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Diabetes Mellitus: The Increasing Burden in Kenya, Here's What You Should Know

 

The World Health Organization (WHO) estimates that the prevalence of diabetes in Kenya is at 3.3% and predicts a rise to 4.5% by 2025.

With non-communicable diseases being the leading cause of death globally, diabetes mellitus is the 4th main contributor. But what exactly is diabetes mellitus?

These are groups of conditions that are characterized by causing high blood glucose levels. 

The excessive build-up of glucose in the blood results from lack of insulin production or inadequate insulin production or body cells insensitivity to the insulin being produced.

Body Glucose Processing

Normally food will be broken down into simple glucose forms by the digestive system. The formed glucose will then be taken into the blood. 

A chemical known as insulin produced by pancreas cells will then stream the formed glucose now in blood into the body cells. 

At the cells the glucose will be utilized for energy production and the remaining will be converted into a chemical form known as glycogen which can later be broken down into glucose for energy needs whenever the blood glucose level is low.

Types of Diabetes

Pre-diabetes

Here the blood glucose level is above normal however it hasn't gone overboard for it to qualify to be classified as diabetes.

Type 1 diabetes(Juvenile diabetes)

The body's pancreas cells don't produce insulin that is required in the uptake of glucose from the blood stream into the cells.

It's commonly diagnosed in children and in young adults though it can also be found in the middle aged people.

Type 2 diabetes

It is characterized by inadequate insulin production by the pancreas cells or insensitivity of the body cells to the insulin being produced. 

It's commonly diagnosed in the middle aged people however it can still be found in children and young adults. It is the most common type of diabetes.

Gestational diabetes

It's a type of diabetes that may develop during the period of ones pregnancy due to the elevation of certain hormones that may make the body cells to be insensitive to the insulin being produced.

It later resolves after delivery. It increases the risk of one developing diabetes type 2 later.

Type 1 and 2 diabetes symptoms

Increased urination frequency, increased episodes of thirst, fatigue, extreme hunger episodes, blurring vision, weight loss(in type 1), increased infections frequency e.g UTI, slow healing wounds.

Type 1 risk factors

Presence of destructive immune cells that destroys pancreatic cells which produces insulin, a positive family history of type 1 diabetes, extreme viral infections that may destroy pancreas cells.

Pre- diabetes/type 2 risk factors

Middle age, excessive weight, inactivity/sedentary lifestyle, positive family history of pre-diabetes/type 1 diabetes, polycystic ovarian syndrome, low levels of HDL(which is a type of good cholesterol)/high triglycerides levels in the body, and race.

Gestational diabetes risk factors

Excessive weight gain before the pregnancy, a positive family history of gestational diabetes, and race(Blacks, Hispanics and Asian-Americans).

Diagnostic tests for diabetes

HbA1c(glycated hemoglobin)

This test measures the average blood glucose levels in the past recent 2 to 3 months as follows; 4 percent to 5.6 percent (considered normal), 5.7 percent to 6.4 percent (classified as pre-diabetes-) and 6.5 percent and above(classified as diabetes melitus).

Random blood sugar(RBS)

This is a blood glucose measuring modality that can be used at any point of the day irregardless of the last time that one fed.

The measuring ranges are as follows; 4.0 to 7.7mmol/l(considered normal), 7.8 to 11.0mmol/l(classified as pre-diabetes) and 11.1mmol/l and above(classified as diabetes melitus).

Fasting blood sugar(FBS)

This test is done after one has starved for 8 to 10 hours. The measuring ranges are as follows; 4.0 to 5.5mmol/l(considered normal), 5.6 to 6.9mmol/l(classified as pre-diabetes) and 7.0mmol/l and above(classified as diabetes).

Oral glucose tolerance test

Here one starves first for 8 to 10 hours then a fasting blood sugar is taken first after which the person is given 75Mg of glucose if he/she is an adult and 1.75Mg/ Kg but not exceeding 75Mg cumulatively if it's for a child.

The glucose is to be taken within 5 minutes at most then blood sugar test is done after  2 hours.The measuring ranges are as follows; 4 to 7.7mmol/l(considered normal), 7.8 to 11.00mmol/l(classified as pre-diabetes) and 11.1mmol/l and above(classified as diabetes melitus).

Treatment

A part from gestational and sometimes pre-diabetes, the other types of diabetes are chronic and therefore they don't resolve.

Medications therefore are meant to prevent further disease progression and improve the quality of life.

There are several types of medications for diabetes and the choice will therefore be determined by the type of diabetes that one has/the general well-being of the patient e.g artificial insulin for type 1 diabetes and oral biguanides/sulfonylureas for diabetes type 2.

Complication of pre-diabetes is the development of diabetes type 2.

Complications of diabetes type 1 and 2

Nerves damage(neuropathy), eyes damage(retinopathy), cardiovascular diseases, Alzheimer's disease, foot damage making it susceptible to chronic wounds.

Complications of gestational diabetes

To the mother - pre-eclampsia(high blood pressure, protein in urine and swollen legs in pregnancy), subsequent gestational diabetes in future pregnancies, diabetes type 2 development.

To the baby - being overly big, low blood sugar after delivery, increased risk of type 2 diabetes development later, dying shortly after being delivered.

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