Arthritis Essay Research Paper Arthritis is a — страница 2

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blood levels of uric acid, which are associated with gouty arthritis, arise through either excessive production of uric acid or decreased excretion of uric acid by the kidneys. Some cases of hyperuricemia and gout are caused by known specific enzymatic defects. Many are associated with metabolic alterations that occur in obesity. When extreme, the gouty process results in large deposits of uric acid, or tophi, around joints. Acute attacks subside when the patient receives anti-inflammatory drugs. Further attacks may be prevented by colchicine, a drug that inhibits the ingestion of crystals by white blood cells. Serum uric acid levels decline and tophi resolve when the excess uric acid production is controlled by weight reduction and by drugs such as allopurinol, a purine analog

that inhibits both formation of purines and their breakdown to uric acid. The disease usually affects men over age 40. The symptoms of pseudogout may mimic GOUT, but the inflammation is initiated by crystals of calcium pyrophosphate. They can be distinguished from uric acid crystals by polarization microscopy. The disease is treated with anti-inflammatory drugs. Rheumatoid Arthritis The symptoms of rheumatoid arthritis are attributable to inflammation of the connective tissues, but the cause is unknown. The major disability produced by rheumatoid arthritis has prompted a worldwide program of research devoted to finding its cause and cure. In rheumatoid arthritis, the synovial membranes, or inner linings of the joint capsules, are chronically inflamed. The synovial mass

proliferates and thereby destroys cartilage, bone, and adjacent structures. The widespread inflammatory process also involves other tissue such as blood vessels, skin, nerves, muscles, heart, and lungs. The result is painful joints, loss of mobility, and generalized soreness and depression. Rheumatoid arthritis is predominantly a disease of women between the ages of 20 and 60. Probably many individuals have such a mild form of the disease that they never seek medical care. The typical patient with newly diagnosed rheumatoid arthritis is a 35-year-old woman who has been complaining for months of generalized aches and stiffness, particularly in her hands and fingers, for an hour after arising; swelling and pain in fingers, hands, wrists, and elbows; distressing fatigue in the early

afternoon; and difficulty in sleeping. The affected joints are tender. The fingers have a sausage-like appearance because of swelling at the proximal interphalangeal joints. The wrists, too, are swollen by overgrowth of synovium, and there are rheumatoid nodules at the elbows. Laboratory studies of the blood may reveal the presence of rheumatoid factors, proteins produced by the immune system in response to the rheumatic process. Although rheumatoid arthritis may prove to be infectious, it is not a conventional contagious disease. The minor tendency for familial occurrence is probably attributable to genetic factors. Immunology, including autoimmunity, is clearly important. Rheumatoid factors (anti-antibodies) form immune complexes that incite inflammation, and lymphocyte

accumulations in the body cause swelling of tissues, including synovia. Systemic LUPUS ERYTHEMATOSUS is about one-tenth as common as rheumatoid arthritis. It has an even stronger predilection for women, especially those in the child-bearing ages. It is characterized by inflammation of blood vessels and potential involvement of several tissues and organs, particularly the skin, joints, kidneys, lungs, heart, nervous system, and blood cells. Some patients are acutely affected with a febrile disease that is life threatening because of renal disease, nervous system disease, or accompanying infections. Most have a more indolent disease that produces moderate disability from nondeforming arthritis, skin eruptions, and fatigue. As in rheumatoid arthritis, the body seems to react against

itself rather than against an invading microorganism. Anti-self antibodies react with intact blood cells, nuclear components, and blood-vessel walls. The complexes that form in the patient’s blood precipitate in basement membranes of skin, kidneys, and nervous system and thus cause inflammation. Juvenile rheumatoid arthritis usually begins by age 5 or in the early teens. In most cases, tests for rheumatoid factors are negative and the disease becomes inactive by age 15. Ankylosing SPONDYLITIS occurs more commonly in men than women; it affects the spine and sacroiliac joints in particular, with resultant fusion of vertebrae and immobility. Tests for rheumatoid factors are negative, and tests for the tissue antigen HLA B27 are usually positive. NONINFLAMMATORY CONNECTIVE TISSUE