1. Bernadette C. Siaton, MD Assistant Professor of Medicine Division of Rheumatology and Clinical Immunology University of Maryland School of Medicine

2.  NONE

3.  By the end of this talk, you should be able to:  Describe the differences between arthralgia and arthritis  Recognize the symptoms of autoimmune disease symptoms  Recognize the symptoms of two common autoimmune connective tissue diseases Lupus and rheumatoid arthritis  Recognize the symptoms of fibromyalgia

4.  Describe the differences between inflammatory joint pain and non- inflammatory joint pain  Overview of autoimmune disease and its symptoms and treatment  Briefly discuss some common autoimmune connective tissue diseases  –Lupus and rheumatoid arthritis  Provide an overview of fibromyalgia

5. ARTHRITISARTHRALGIA  DIAGNOSIS  Joint pain  Inflammatory  Swelling  Redness  Tenderness  Limitations in range of motion  Stiffness  SYMPTOM  Joint pain  Non-inflammatory  Pain without swelling  “achiness”

6.  Varied group of illnesses that can involve any human organ system  Nervous, gastrointestinal, endocrine, skin, and connective tissues  The body’s immune system becomes misdirected and attacks its own organs and tissues  Diseases may affect several systems so many different types of doctors may be involved in treatment

7.  More than 80 types of autoimmune disease  Autoimmune diseases range from very common to very rare  Some of the more commonly recognized autoimmune diseases include Hashimoto’s thyroiditis, lupus, and Grave’s disease

8.  23.5-50 million Americans have autoimmune disease  75% are women!!!  NIH estimates the impact of auto-immune disease is more than $100 billion dollars in direct healthcare costs  Cancer $57 billion  Heart and strokes $200 billion www.aarda.org

9.  Top 10 cause of death in US women >65 years old  4 th leading cause of disability in US women  In the US the overall risk of developing autoimmune rheumatic disease is:  8.4% (1 in 12) for women  5.1% (1 in 20) for men

10. DiseaseFemale:Male Ratio Hashimoto’s thyroiditis10:1 Systemic lupus erythematosus (Lupus) 9:1 Sjogren’s syndrome9:1 Primary biliary cirrhosis9:1 Autoimmune hepatitis8:1 Graves’ disease7:1 Rheumatoid arthritis2.5:1 Anti-phospholipid syndrome (primary) 2:1 Multiple Sclerosis2:1 Myasthenia gravis2:1

11.  Women of childbearing age  Family history of autoimmune disease (genetics)  People of certain race or ethnic background (genetics)  Environmental exposures

12.  45% are labeled chronic complainers early in the disease  Most patients wait 4.6 years for a formal diagnosis and see 5 different doctors/ medical professionals  Many of the symptoms are not specific and may be seen in many other diseases  Fatigue, pain, hair loss

13. DiseaseSymptoms Alopecia areataPatchy hair loss on the scalp, face, or other areas of the body VitiligoWhite patches on areas of skin, loss of skin color Graves’ diseaseDifficulty sleeping, weight loss, temperature sensitivity, weakness, tremors Hashimoto’s disease Fatigue, weakness, weight gain, muscle aching, stiff joints, constipation Celiac DiseaseAbdominal bloating, diarrhea or constipation, fatigue, rashes, difficulty getting or staying pregnant PsoriasisThick red patches of scaly skin on head, elbows, knees, itching, joint pain and swelling (psoriatic arthritis)

14. DiseaseSymptoms LupusFever, weight loss, hair loss, fatigue, rashes, joint pain, sun sensitivity SclerodermaFingers that change color in cold, pain and swelling in joints, thickening of skin, difficulty swallowing, diarrhea or constipation Sjogren’s syndrome Dry eyes, dry mouth, fatigue, joint swelling or pain, swollen glands Rheumatoid arthritis Painful, stiff, swollen joints. Deformities in joints, fatigue, fever, weight loss, eye pain Anti-phospholipid syndrome Blood clots in your veins and arteries, multiple miscarriages, lacy skin changes

15.  Chronic autoimmune disease that affects more than 1.5 million Americans  90% of persons affected are women  African Americans and Hispanics are more often affected than whites  Most women diagnosed in child-bearing years  age 15-44  16,000 new cases in the US each year  5 new cases per 100,000 people

16.  3 different types  Systemic lupus –affects various parts of the body  Cutaneous lupus –affects skin only  Drug-induced lupus –triggered by certain medications  Diagnosis based on a combination of clinical findings AND lab tests

17.  Pain and swollen joints  Color change in the fingertips  Sores in the mouth and nose  Rashes when exposed to the sun  Fever  Chest pain with breathing  Protein in the urine  Fatigue  Depression or memory problems  Hair loss

18.  Treatment is dependent on the symptoms  Sometimes drugs are used to suppress the immune system  Steroids, anti-malarials, disease modifying anti- rheumatic drugs (DMARDS)  Other treatments are aimed at controlling symptoms  Pain medications

19.  Regular medical visits  Exercise  Healthy diet  Sun avoidance  Stress Reduction

20.  Common type of inflammatory arthritis  Affects small joints of the body  Wrists, hands, ankles, feet, elbows, neck  Patients may have several hours of stiffness in the morning or after sitting for too long  RA is associated with swelling and tenderness of the joints  Commonly patients have difficulty using hands –opening jars, turning doorknobs, etc.

21.  The cause of RA is unknown, probably a combination of genetics and environmental factors  Smoking may increase risk of developing RA or may make RA disease worse  Annual incidence is 40 case per 100,000 persons  Prevalence about 1 percent of Whites, but may be increased in other populations  Risk of developing RA is 1 in 28 for women and 1 in 59 for men

22.  Goals of treatment  Stop inflammation (remission)  Relieve symptoms  Prevent long term damage  Preserve functionality and well-being  Medications  Suppress the immune system  Help with symptoms (pain)  steroids, disease modifying anti-rheumatic drugs (DMARDS), biologic drugs

23.  Surgery  Physical Therapy  Exercise

24.  Classically known as degenerative arthritis or “wear and tear” arthritis  Joint space narrowing, loss of cartilage  May affect neck, back, hips, knees, and hands  Pain usually gets worse with activity and better with rest  Morning stiffness usually less than 30 minutes  Risk factors:  Age, female sex, obesity, previous injury, occupation, muscle weakness, genetic factors

25.  Medications  Acetaminophen  NSAIDS –ibuprofen, naproxen  Steroid injections  Opioid medications  Intra-articular hyaluronic acid injections  Glucosamine and chondroitin  Non-medication treatments  Exercise programs, weight loss  Joint replacement for severe cases

26.  If you are having symptoms that bother you then get checked out!  Write down a complete family health history and share with your doctor  Start with your primary care doctor who can help with referrals to specialists  See a specialist who has experience dealing with your biggest symptom  Get a second, third, etc opinion if necessary.  Be your own health advocate

27.  Nephrologists (kidney)  Rheumatologists (arthritis and connective tissue)  Endocrinologists (gland and hormones)  Neurologists (brain and nerve)  Hematologists (blood diseases)  Gastroenterologists (digestive system)  Dermatologists (skin)  Physical therapists and occupational therapists  Speech therapists  Audiologists (hearing)

28.  Many diseases have no cure but can be controlled with medications  Periods of flare and remission  Medications  Suppress immune system  Replace substances that the body can no longer make on its own (thyroid hormones, insulin)  Symptom relief

29.  Eat healthy, well-balanced meals  Low fat  Lots of fruits and vegetables  Regular physical activity  Low impact, as tolerated  Walking, swimming, zumba  Rest

30.  Integrative medicine  Acupuncture  Nutrition  Fitness  Stress reduction  mindful meditation, yoga, tai chi  Educate yourself and others about your disease  Build a support system

31.  These are NOT auto-immune diseases  Share similar symptoms  Fatigue, weakness, muscle and joint pain, forgetfulness, difficulty sleeping  May co-exist with auto-immune disease

32.  Chronic widespread pain  Affects 2-4% of the population  More commonly affects women  5 million Americans age 18 or older  Unknown cause, but there is an association with a mentally or physically traumatic event  There may be an abnormality in how the central nervous system processes pain  Diagnosis of exclusion

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34.  Treatment of mental health disorders  Counseling, medications, psychotherapy  Low-impact exercise  Walking, aquatic and physical therapy  Good sleep hygiene  Sleep study to rule out sleep apnea  Other  Meditation, tai-chi, acupuncture

35.  Depart of Health and Human Services www.womenshealth.gov  American Autoimmune Related Disease Association, Inc. www.aarda.org  Arthritis Foundation www.arthritis.org  Lupus Foundation of America www.lupus.org