Understanding Rheumatic Diseases: Causes and Manifestations

Criteria for Rheumatoid Arthritis Diagnosis

Diagnosis requires meeting 4 out of 7 criteria:

• Morning stiffness lasting at least 1 hour.
• Arthritis in 3 or more joints.
• Symmetric arthritis.
• Arthritis of the hands.
• Rheumatoid nodules.
• Positive rheumatoid factor.
• Typical radiological alterations.

Inflammatory Spondyloarthropathies

Characterized by axial skeleton and/or sacroiliac joint involvement, often with peripheral arthritis and enthesitis. HLA-B27 positivity is common.

Common Spondyloarthropathies

These inflammatory, chronic, and progressive conditions affect the sacroiliac joints and spine, leading to loss of mobility. Etiology is often multifactorial, and enthesitis is a fundamental alteration.

Subchondral Sclerosis and Osteophytes

Subchondral sclerosis involves increased bone density hardening the cartilage. An osteophyte, or bone spur, is a bony outgrowth, typically seen in the spine, representing a degenerative process. It attempts to increase the surface area for weight distribution.

Syndesmophytes

Syndesmophytes are a variation of osteophytes originating from ligamentous tissue.

Connective Tissue Diseases

These involve antigen-antibody reactions and include conditions like systemic lupus erythematosus. They are characterized by immunological and inflammatory reactions in connective tissues, with periods of remission and exacerbation, often influenced by hormonal and genetic factors.

Gout

Untreated or inadequately treated gout can lead to joint structure destruction, severe pain, edema, redness, and limited movement. Recurrent hyperuricemia can evolve into chronic gout, which may present with subcutaneous tophi and joint damage.

Sclerosing or Systemic Sclerosis

This condition involves excessive collagen synthesis by fibroblasts, typically affecting individuals aged 35-55. Symptoms include skin tightening, Raynaud's phenomenon, calcinosis, and potential organ involvement such as esophageal hypomobility, intestinal dysfunction, and lung or kidney lesions. The CREST syndrome (Calcinosis, Raynaud's phenomenon, Esophageal dysfunction, Sclerodactyly, Telangiectasias) is a common manifestation.

Osteoporosis

Osteoporosis is a decrease in bone mass per unit volume, leading to altered bone microarchitecture and increased fragility. It is diagnosed when BMD is less than 2.5 standard deviations below the mean (T-score). Peak bone mass is achieved in the third decade, with a decline starting in the fourth decade. Menopause accelerates bone loss due to reduced estrogen production.