Autoimmunity is a general term that refers to the condition when the body's immune system becomes overactive. The immune system is the part of the body that fights infection and is an important part of keeping the body healthy. In autoimmune diseases, the immune system mistakenly attacks the body and depending on which organ is affected results in unique set of symptoms. Autoimmune diseases include a wide range of different conditions and are generally treated by rheumatologists.
Psoriatic Arthritis is a condition where generally there is the occurrence of both psoriasis, a skin condition, and joint inflammation and pain. Psoriasis is a red, scaly skin rash. There are some patients with Psoriatic Arthritis who only have joint involvement without skin disease. The therapy for this disease has dramatically improved over the last 10-20 years and there are multiple treatment options.
Rheumatoid Arthritis is one of the most common inflammatory types of arthritis. Although it generally tends to affect the hands and feet in a symmetrical pattern, it can affect any joint. Research into this condition has resulted in the development of very specific medications, known as “biological agents and targeted synthetics” that can successfully manage this illness.
Ankylosing Spondylitis / Axial Spondyloarthritis
Ankylosing Spondylitis and the new term “Axial Spondyloarthritis” are a group of inflammatory diseases that predominately affect the spine, neck, back and hips. They can also uncommonly affect the gastrointestinal tract, the eyes and the skin. Generally, these diseases cause pain that is worse in the morning and improves throughout the day. The therapy for this group of diseases has dramatically improved over the last 10-20 years and there are multiple treatment options.
Autoimmune Eye Disease
There are a number of autoimmune, or inflammatory diseases that can affect the eye. These include uveitis, scleritis, orbital inflammatory disease and keratitis. Although these conditions can exist as independent illnesses, they frequently are manifestations of other underlying conditions. Symptoms can include red eyes, painful eyes or, when severe, loss of vision. There are multiple medications that are used to treat autoimmune eye disease, and management of these conditions involves close coordination between the ophthalmologist and the rheumatologist.
Dryness of the eyes, mouth and other mucous membranes characterize this autoimmune disease. It can exist as an independent entity, or it can be associated with other autoimmune diseases such as Rheumatoid Arthritis, Lupus or Scleroderma. If an underlying disease is identified, treatment is directed at the underlying disease. If not, there are a number of medications that can address the dryness experienced by patients who have this illness.
Polymyalgia Rheumatica (PMR,) Giant Cell Arteritis (Temporal Arteritis) and Vasculitis
Polymyalgia Rheumatica (PMR) is an inflammatory illness that tends to affect people over the age of 50. It generally causes severe pain and stiffness of the muscles in the shoulders and hips. It is often very symptomatic, particularly in the morning. Uncommonly, patients with PMR have a condition called Temporal Arteritis, also known as Giant Cell Arteritis (GCA), that is caused by inflammation of the arteries in the head. Symptoms can include headache, scalp tenderness, pain with chewing and/or vision loss. New medications have been approved for the management of this condition.
GCA belongs to a group of conditions known as “vasculitis.” Vasculitis occurs when there is inflammation of the blood vessels. In this group of diseases, there are a variety of different symptoms that occur depending on which blood vessels are involved. Other forms of vasculitis include Granulomatous Polyangiitis (GPA), Microscopic Polyangiitis (MPA), Takayasu’s Arteritis, Henoch Schoenlein Purpura (HSP) and Eosinophilic Granulomatosis with Polyangiitis (Churg Strauss syndrome). Although these diseases differ in terms of what organs are affected, many of the treatments overlap.
Gout and Pseudogout
Gout and Pseudogout (calcium pyrophosphate dihydrate disease or CPPD) are well understood joint diseases in which different crystals (uric acid for gout and CPPD for pseudogout) cause episodic inflammation in joints. In addition to having different causes, there are different associations with diet and other medical conditions. Although some therapies treat both diseases, there are certain medications that are unique for the management of each condition.
Osteoarthritis / Arthritis
The term “arthritis” includes any disease that can affect the joints. When this term is used, most people refer to osteoarthritis which is a condition that affects over 40 million Americans. This condition can affect any joint, but tends to focus on the hands, feet, spine, knees and hips. New medications are being investigated and currently, there are many modalities that can be used to improve the pain associated with this illness and quality of life.
Infectious Arthritis and Lyme Disease
Many different types of infections can cause arthritis. When bacteria invade a joint, the joint can quickly become red, hot and swollen. Patients generally develop fevers and medical care is required. Viral and post- viral arthritis can result in a slower more indolent and at times chronic forms of arthritis. Lyme disease can have many medical presentations and frequently it can affect the joints. Although previously more difficult to diagnose, testing has improved.
In Raynaud’s Phenomenon, the arteries are predisposed to spasm. This generally occurs with exposure to cold, but stress and some medications may trigger episodes of Raynaud’s. The spasms can lead to decreased circulation predominantly in the hands and feet where there is a classic color change: pale, purple followed by bright red. Although the direct cause is unknown, at times Raynaud’s is seen in other autoimmune conditions such as Scleroderma/CREST, Rheumatoid Arthritis and Lupus, however it can be present without any other underlying disease. Treatment involves careful protection from the cold, medications that relax blood vessel spasm and, if needed, immunosuppression.
Systemic Lupus Erythematosus
Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease in which cells and immunoglobulins of the immune system mistakenly attack different parts of the body. We do not know exactly what causes this disease, and almost any organ can be involved, although there is a predisposition for the skin, joints, lungs, and kidneys. This disease has a very strong tendency to affect women. The management of this illness has been revolutionized over the last 20 years with much better outcomes and therapies are continuously being studied.
Scleroderma and CREST Disease
Scleroderma and CREST disease are autoimmune conditions that predominantly affect the skin. However, other organs including the gastrointestinal system, joints, kidney and the lung can be involved. Raynaud’s phenomenon, a condition of the blood vessels, can also be associated with Scleroderma and CREST. Although in the past the treatment for this group of illnesses was predominantly based on the symptoms and dependent on the specific organs involved, currently, for the first time, therapies that are specifically approved for scleroderma that have become available.
Myositis is a group of conditions that are characterized by inflammation of the muscle and subsequent muscle weakness. Some forms can also present with a rash. There are a variety of different causes of these illnesses and it is important, when possible, to identify the underlying precipitant. However, sometimes the cause remains unknown. Generally, muscle weakness can present slowly but at times it can be very rapid. Typically, management of this group of diseases involves treating the underlying condition, if one is found and/or treating the inflammation driving the disease.
Inflammatory Bowel Disease (Crohn’s Disease and Ulcerative Colitis) Associated Arthritis
Inflammatory Bowel Disease (IBD) typically includes Crohn’s Disease and Ulcerative Colitis. These are diseases that target the gastrointestinal system. However, this group of diseases can affect many other organ systems as well. Overwhelmingly, the most common involvement outside of the gastrointestinal system is the musculoskeletal system. A large number of patients with inflammatory bowel disease have inflammation both in their joints and in their spines.
Interestingly other organ systems including the eyes and skin can also be a part of this group of illnesses. Although many of the therapies used to treat inflammatory musculoskeletal diseases overlap and treat IBD, there are some medications that are used to treat inflammatory joint diseases that actually worsen Crohn’s and Ulcerative Colitis. It is important to coordinate co-management of these conditions by the rheumatologist and the gastroenterologist.