Lupus

Systemic lupus erythematosis (SLE) is an autoimmune inflammatory disease that can affect many organ systems. The cause is unknown. The process is due to trapping of antigen-antibody complexes in capillaries of various organs. This complex is made up of foreign material, in this case the body's own cells recognized as foreign (the antigen) and cells to fight infection, the antibodies made by the body. This antigen-antibody complex clogs the capillaries (tiny blood vessels) of organs or causes destruction of the body's cells.

Who is affected? About 85% of patients are women. Symptoms appear after the first menstrual cycle. One in one thousand white women have lupus whereas 1/250 black women get the disease. If a mother has the disease, her daughter has a 1:40 chance of developing the disease, a son has a 1:250 chance. Other autoimmune diseases can be found in a patient's extended family.

Symptoms and signs include fever, anorexia, malaise and weight loss. There may be a butterfly shaped rash across the cheeks and nose. Discoid (coin) lesions can appear on the trunk and extremities. Joint pain occurs in 90% of patients. Eye changes can manifest as blindness in one eye, photophobia and degeneration of nerve endings in the retina. Lungs are affected with plueral effusion (water on the lungs), bronchopnuemonia or pneumonitis. The heart sack can become inflammed leading to heart failure and irregular heart rhythms. Brain complications may include psychosis, organic brain syndrome and seizures. Glomerulonephritis, inflammation of the part of the kidney that forms urine, may occur. There may be recurrent miscarriages.

Treatment. This may be only be suppportive. A local support group can be found at your local hospital. Skin lesions may be treated with topical corticosteroids. Sun block should be worn outdoors. More serious symptoms should be treated with prednisone at the lowest dose that gives improvement.

Course and prognosis. This disease has an episodic course, with exacerbations
usually responding to increase dosages of medications. The 10 year survival is 85%. Unfortunatley there are some that have a more virulent course causing major damage to body organs which may lead to death. With improved control of lupus activity, morbidity and mortality rates are decreasing.

Fibromyalgia

Fibromyalgia is a common rheumatic syndrome affecting 3-10% of the general population. It has an increased frequency in females age 20-50. There is no lab test to diagnose this syndrome.

The cause is unknown but sleep disorders such as sleep apnea (multiple episodes of not breathing while asleep), depression and infections have been proposed.

The symptoms include chronic aching pain and stiffness with musculoskeletal pain in the neck, shoulders, low back and hips. Cold and damp weather can aggrevate the symptoms. Mild exertion can aggrevate the pain and increases fatigue.

The physical exam for fibromyalgia can be normal. Occasionally trigger points for pain can be found at the inside knee, outerside of the elbow or trapezius muscle in the neck.

Other diseases can yield some of fibromyalgia symptoms but can be diagnosed by lab tests. These include rheumatoid arthritis and lupus. If you have hypothyroid disease (slow functioning thyroid) you can have fibromyalgia symptoms. A blood test determines what your thyroid is doing.

Once fibromyalgia is diagnosed, and it may take some time, patient education is important. Presently amitriptyline (an antidepresent) is used. An exercise program is initiated. NSAIDS ( motrin, advil, nuprin,aleve) can be tried but do not offer a lot of relief.

This can be a very frustrating disease for patient and doctor. At least the disease does not progress to a more severe state. Treatment options are few and must be taylored to each patient. Perhaps in the future this will change with research.

Knee Pain

Knee pain can range from annoying to excrutiating Knee pain usually falls into several categories. They are

-traumatic
-nontraumatic or mechanical
-referred
-swelling
- chronic or recurrent

Traumatic knee pain due to an accident usually requires an orthopedist. The injury may cause a fracture, ligament tears, or bleeding into and swelling of the joint. If a fracture is not found, attention is focused on possible ligament damage as the cause of the pain.

In nontraumatic knee pain the cause could be referred pain or mechanical pain. In older patients, mechanical pain most often results from degenerative conditions such as arthritis. Xrays help with the diagnosis. In young active people, the knee pain may be due to repetitive flexing and extending of the knee with weight bearing i.e. running, climbing, jumping. Xrays yield little findings in this condition.

Referred pain is pain occuring in one area, but sending pain symptoms to another area. An example is lumobsacral radiculopathy. A long word meaning low back pain radiating to another area, usually the back of the knee. DJD (degenerative joint disease ) of the hip can refer pain to the knee. A blood clot behind the knee can present as knee pain.
These are just a few examples.

Swelling of the knee in many cases should be aspirated ( a small sample removed with a needle) for further studies if the diagnosis has not been made. Treatment depends on findings.

Recurrent or chronic knee pain may require arthroscopy. This is a minimally invasive procedure. Several small incisions are made over the joint and a fiberoptic camera with light is inserted. The joint cavity can now be seen.This procedure aids in diagnosis and treatment. Repairs can be done through "the scope". Recovery is quicker than with older procedures.

I hope this review is helpful.