Hallmarks and clinical presentation of the main rheumatological immune-mediated diseases
Disease Hallmarks / clinical presentation Prevalence
Rheumatoid arthritis
Ankylosing spondylitis
Psoriatic arthritis
Juvenile idiopathic arthritis
Systemic lupus erythematosus
Sjögren ’ s syndrome
Symmetrical bilateral arthritis often involving the small joints of the hands and feet Inflammatory changes in synovial tissue of joints , cartilage and bone leading to joint pain , swelling . Progressive deterioration of joints +/ - extra-articular involvement Pathogenesis involves a genetic predisposition and environmental risk factors with production of autoantibodies ( i . e ., anti-CCP and rheumatoid factor ) in the majority of patients
Chronic back pain with inflammatory characteristics ( e . g ., worse after rest , better with movement ) X-rays show structural damage in sacroiliac joints and vertebral bodies ( i . e ., syndesmophytes ) MRI is useful for the detection of ‘ active ’ inflammation in sacroiliac joints and spine , especially in the early phases of the disease ( prior to radiological change ie non-radiographic SpA ) HLA-B27 is an important genetic risk factor
Seronegative arthritis that occurs in approximately 20 % of people with psoriasis . Family history for skin psoriasis ( i . e ., first-degree relative ) is also a predisposing factor Joints , tendons and entheses can be affected . In about 15 % of patients , joint manifestations precede the skin involvement
Arthritis that begins before 16 years and persists for > 6 weeks , of unknown origin . Eye involvement ( i . e ., uveitis ) is a common extra-articular manifestation .
Heterogeneous immune mediated clinical manifestations including arthritis , neurological , renal , cutaneous and gastrointestinal The presence of autoantibodies , especially ANA and dsDNA plus decreased levels of complement are characteristic of this condition
Dry mouth and eyes (“ sicca symptoms ”), pain and fatigue ANA , anti-SSa and anti-SSb are commonly associated with this condition
1 %
0.05 – 0.23 %
0.25 % ( 5 – 30 % in people with psoriasis )
0.1 % ( of children in UK )
28-97 / 100,000 in Europe ; 2-7.6 / 100,000 in the US
0.04 %
Systemic sclerosis Characterised by vascular changes and fibrosis . Puffy hands , thickening of the skin of hands and feet with Raynaud ’ s phenomenon are common manifestations in the early phases of the disease . Inflammation and scarring of other organs , including lungs ( i . e ., interstitial lung fibrosis and pulmonary hypertension ), heart and vessels Autoantibodies , such as anti-Scl70 and anti-centromere antibodies , are common
Giant cell arteritis Headache ; muscle pain , weakness ; sudden / severe loss of vision ; jaw claudication ; polymyalgia rheumatica Rare in people < 50 years old
0.03 %
0.1 %; highest incidence in Scandanavia
ANCA + ve vasculitis
Diffuse cluster of conditions characterised by inflammation of small and medium sized vessels , which are associated with anti-neutrophil cytoplasmic antibody ( ANCA )
0.0046 – 0.0184 %
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