Wednesday, February 22, 2012

Autoimmune and Inflammatory Bowel Disease

Classified in this group of diseases are rheumatoid arthritis, psoriatic arthritis, the spondylitis, systemic lupus erythematosus, scleroderma, Sjogren's syndrome, autoimmune disease in pregnancy, vasculitis and other rare diseases.

Overall, these diseases affect about 1% of the population with a predilection in women 3 times higher than in men. In all of these diseases the cause is unknown. The many studies seem to support the hypothesis of a genetic predisposition of the immune system (HLA) which, when stimulated by environmental factors (eg microorganisms), could trigger an abnormal inflammatory response, biological structures facing the same body (autoimmune).This would translate into a systemic chronic inflammatory condition and, since the cells of the immune system (white blood cells) and auto-antibodies circulating in blood.

All organ systems may be affected by the inflammatory process in autoimmune diseases.

The different names used to classify these diseases often emphasizes the characteristic involvement of an organ or apparatus.

In some of these diseases, the joint involvement is predominant, and are then referred to as arthritis. In chronic polyarthritis (rheumatoid arthritis, psoriatic arthritis and spondylitis) causes a progressive alteration destructive of the articular anatomical structure which induces, over the years, the loss of the normal capacity of movement. Leads to disability, in a high percentage of cases, after long periods of suffering, with persistent pain and swelling of multiple joints.

Rheumatoid arthritis (RA) is the most common disease and most studied of this group. After 10 years of illness, more than 25% of patients with rheumatoid arthritis live their jobs due to failure to perform the required functions. It frequently causes a progressive isolation of the patient with severe loss of its social contribution. In recent years there has been profoundly new therapeutic approaches and the new biological drugs are now available making it possible to modify, often, disabling the evolution of the disease. And now the fate of RA can be modified by early diagnosis and starting early aggressive anti-rheumatic therapy.

In the elderly may seem as an acute systemic inflammatory condition that causes severe pain and problems in movement, so that those affected are unable to carry out the basic activities. This is the Rheumatic Polymyalgia, which sometimes can be associated in elderly onset of rheumatoid arthritis. In rare cases this disease, very responsive to corticosteroids, is associated with a vasculitic inflammation of the temporal arteriesis called Temporal Arteritis. If not promptly treated can cause blindness. Cortisone is the main treatment of this disease.

Patients with spondylitis have a progressive reduction in the capacity of movement of the spine. This disease affects young patients, and once the ankylosis takes overof the damage is irreversible. Often the diagnosis is delayed because the back pain is not severe, occurs at night, but it reverses with movement and it is a frequent symptom in the general population. For the diagnosis is necessary to perform some laboratory tests to document the inflammatory status and the presence of a particular HLA genetic constitution. The cornerstones of therapy are based on the use of continuous spondylitisof nonsteroidal anti-inflammatory, anti-rheumatic and an intense and constant programchinesiterapico. The occurrence of spondylitis is common even in subjects with psoriatic arthritis, however,the typical arthritic involvement is the of peripheral joints such rheumatoid arthritis. The presence of psoriasis, or family history of this skin disease, detection of arthritis, usually asymmetrical, large and small joints, together with the finding of a systemic inflammatory condition of the laboratory tests, makes a diagnosis. The evolution of this disease that causes erosion and deformation of the joints, is disabling in many cases, as in RA. Compared to rheumatoid arthritis, therapies used to treat psoriatic arthritis and RA are similar. The anti-TNF biologics are highly effective in spondilo artritis.

In these diseases there can be detected through laboratory tests, antibodies directed against their same body (autoimmune) that are directly responsible for the disease. Typically they involve multiple organ systems, resulting in failure of their function.

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