Commonly Associated Medical Syndromes

2019 ◽  
Author(s):  
Elaine I. Yang ◽  
Genewoo Hong
Keyword(s):  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Osteogenesis Imperfecta ◽  
Lupus Erythematosus ◽  
Joint Destruction ◽  
The Body ◽  
Rheumatologic Diseases ◽  
Organ Systems ◽  
Increased Risk ◽  
Anesthetic Considerations

Rheumatologic diseases such as RA, ankylosing spondylitis, psoriatic arthritis, SLR, and osteogenesis imperfecta make up a large percentage of pathologies in patients undergoing orthopedic surgery. These arthropathies are progressive, difficult to treat, and often lead to lifelong debilitating pain and disability. In addition to their effects on bones and joints, they are all characterized as medical syndromes, which affect many other organs and tissues throughout the body. Subsequently, these patients often have many comorbidities that make rendering a safe anesthetic challenging. Disease-modifying therapy combines aggressive immunomodulatory agents and immunosuppression. Severe joint destruction is treated surgically, but these surgeries are often at increased risk due to the effects of these syndromes on other organ systems. In this review, we address the approach to and evaluation of these five commonly associated medical syndromes and their medical and/or surgical treatment as well as any anesthetic considerations. This review 5 figures, 4 tables, and 50 references.  Key Words: anesthetic considerations, ankylosing spondylitis, inflammatory arthropathies, psoriatic arthritis, orthopedics, osteogenesis imperfecta, rheumatoid arthritis, rheumatologic syndromes, systemic lupus erythematosus

scholarly journals Pancreas as an Occult Source of Recurrent Salmonella enteritidis Bacteremia in an Immunocompromised Patient

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Don Bambino Geno Tai ◽  
Laxmi Upadhyay ◽  
Ruchika Jain ◽  
Robert Goldstein
Keyword(s):  
Lupus Erythematosus ◽  
Rare Case ◽  
Salmonella Enteritidis ◽  
Immunocompromised Patient ◽  
The Body ◽  
Oral Antibiotics ◽  
Risk Of Infection ◽  
Organ Systems ◽  
Increased Risk ◽  
Almost All

Salmonella infection usually presents as gastroenteritis and enteric fever. Some cases of bacteremia can lead to invasion of different organ systems and become occult sources for recurrence. Almost all organs of the body can be affected and have been reported in the literature. We report a rare case of repeated Salmonella enteritidis infection in a patient with systemic lupus erythematosus. She was treated with intravenous and oral antibiotics but still had recurrence of fevers and bacteremia. After a thorough workup, pancreatic abscesses were identified and drained with abscess culture revealing Salmonella enteritidis. She was then treated with a prolonged course of antibiotics and finally cleared the infection. This case demonstrates that nontyphoid Salmonella can be invasive and cause persistent infection. This is particularly pertinent in immunocompromised patients who are at an increased risk of infection. An aggressive workup and prolonged antibiotic course might be beneficial for this subset of patients.

scholarly journals Systemic Lupus Erythematosus Disease: An Overview of the Clinical Approach to Pathogenesis, Diagnosis, and Treatment

2021 ◽  
Vol 4 (2) ◽  
pp. 91-98
Author(s):  
Saurabh Nimesh ◽  
Md. Iftekhar Ahmad ◽  
Shikhka Dhama ◽  
Pradeep Kumar ◽  
Muhammad Akram ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Immune System ◽  
Chronic Disease ◽  
Lupus Erythematosus ◽  
The Body ◽  
Clinical Approach ◽  
Systemic Lupus Erythematosus Disease ◽  
Systemic Lupus ◽  
Organ Systems ◽  
Novel Approaches

The systemic lupus erythematosus (SLE), commonly known as Lupus, is a rare and complex multisystem autoimmune disease where one’s immune system is overactive, and the body attacks its organ systems. SLE is a historically old disease described already in antiquity; it is an example of a chronic disease with physical, psychological, financial, and social implications for individuals diagnosed. It has inspired medical and basic biological scientists that focus on molecular biology, basic immunology, immunopathology, clinical science, genetics, and epidemiology. The syndrome is real in its existence-although hidden behind obstacles, cumbersome for patients and clinicians, and rebellious for scientists. There is currently no cure for SLE. The goal of treatment is to ease symptoms. This article will review information on the general approach to SLE therapy, focusing on currently approved therapies and novel approaches that might be used in the future.

Rheumatology

2020 ◽  
pp. 263-306
Author(s):  
Charlotte Frise ◽  
Sally Collins
Keyword(s):  
Rheumatoid Arthritis ◽  
Systemic Lupus Erythematosus ◽  
Systemic Sclerosis ◽  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Lupus Erythematosus ◽  
Pregnant Patient ◽  
Systemic Lupus ◽  
Musculoskeletal Problems ◽  
In Pregnancy

This chapter covers rheumatic diseases in the pregnant patient. It gives background, clinical features, and management in the pregnant patient for rheumatoid arthritis, Sjögren’s syndrome, psoriatic arthritis, systemic lupus erythematosus, antiphospholipid syndrome, and ankylosing spondylitis among others. It also covers systemic sclerosis, osteoporosis, and other musculoskeletal problems. Medications and the use of biologics in pregnancy are also discussed, with reference to breastfeeding.

scholarly journals Proton Pump Inhibitor Use, Hypergastrinemia, and Gastric Carcinoids—What Is the Relationship?

2020 ◽  
Vol 21 (2) ◽  
pp. 662 ◽  
Author(s):  
Denis M. McCarthy
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Chronic Atrophic Gastritis ◽  
The Body ◽  
True Incidence ◽  
Ecl Cells ◽  
Gastric Carcinoids ◽  
Organ Systems ◽  
Increased Risk ◽  
Young Subjects

Neuroendocrine tumors (NETs) throughout the body are the focus of much current interest. Most occur in the gastrointestinal tract and have shown a major increase in incidence over the past 30 years, roughly paralleling the world-wide increase in the use of proton pump inhibitor (PPI) drugs. The greatest rise has occurred in gastric carcinoids (g-NETs) arising from enterochromaffin-like (ECL) cells. These tumors are long known to occur in auto-immune chronic atrophic gastritis (CAG) and Zollinger-Ellison syndrome (ZES), with or without multiple endocrine neoplasia type-1 (MEN-1), but the incidences of these conditions do not appear to have increased over the same time period. Common to these disease states is persistent hypergastrinemia, generally accepted as causing g-NETs in CAG and ZES, and postulated as having similar tumorigenic effects in PPI users. In efforts to study the increase in their occurrence, g-NETs have been classified in a number of discussed ways into different grades that differ in their incidence and apparent pathogenesis. Based on a large amount of experimental data, tumorigenesis is mediated by gastrin’s effects on the CCK2R-receptor on ECL-cells that in turn leads to hyperplasia, dysplasia, and finally neoplasia. However, in all three conditions, the extent of response of ECL-cells to gastrin is modified by a number of genetic influences and other underlying risk factors, and by the duration of exposure to the hormonal influence. Data relating to trophic effects of hypergastrinemia due to PPI use in humans are reviewed and, in an attached Appendix A, all 11 reports of g-NETs that occurred in long-term PPI users in the absence of CAG or ZES are summarized. Mention of additional suspected cases reported elsewhere are also listed. Furthermore, the risk in humans may be affected by the presence of underlying conditions or genetic factors, including their PPI-metabolizer phenotype, with slow metabolizers likely at increased risk. Other problems in estimating the true incidence of g-NETs are discussed, relating to non-reporting of small tumors and failure of the Surveillance, Epidemiology, and End Results Program (SEER) and other databases, to capture small tumors or those not accorded a T1 rating. Overall, it appears likely that the true incidence of g-NETs may be seriously underestimated: the possibility that hypergastrinemia also affects tumorigenesis in additional gastrointestinal sites or in tumors in other organ systems is briefly examined. Overall, the risk of developing a g-NET appears greatest in patients who are more than 10 years on drug and on higher doses: those affected by chronic H. pylori gastritis and/or consequent gastric atrophy may also be at increased risk. While the overall risk of g-NETs induced by PPI therapy is undoubtedly low, it is real: this necessitates caution in using PPI therapy for long periods of time, particularly when initiated in young subjects.

Prediction of Cardiovascular Events in Patients with Ankylosing Spondylitis and Psoriatic Arthritis: Role of Lipoproteins in a High-risk Population

2012 ◽  
Vol 39 (7) ◽  
pp. 1433-1440 ◽  
Author(s):  
ANNE GRETE SEMB ◽  
TORE K. KVIEN ◽  
DAVID A. DeMICCO ◽  
RANA FAYYAD ◽  
CHUAN-CHUAN WUN ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Density Lipoprotein ◽  
High Risk Population ◽  
Proportional Hazard ◽  
Mortality And Morbidity ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Increased Risk

Objective.To evaluate lipids and apolipoproteins as predictors of cardiovascular mortality and morbidity (CVD) in patients with spondyloarthritis (SpA).Methods.In the pooled cohort of participants in the IDEAL, TNT, and CARDS trials, 50 had ankylosing spondylitis (AS), 36 had psoriatic arthritis (PsA), and 21,641 did not have AS or PsA (non-SpA). We compared lipid levels at baseline between AS or PsA and non-SpA, and hazard ratios (HR) for CVD were calculated in a Cox proportional hazard model.Results.Atherogenic lipids were lower in samples from AS, but not in PsA, compared to non-SpA. The HR for 1 SD increase in baseline lipids for future CVD was for total cholesterol 1.39 (95% CI 0.82, 2.36) in AS, 1.01 (95% CI 0.44, 2.31) in PsA, and 1.10 (95% CI 1.07, 1.14) in non-SpA. Both high-density lipoprotein (HDL) and apolipoprotein (ApoA-1) were significantly associated with CVD in AS (HR 3.67, 95% CI 1.47, 9.06, and HR 1.89, 95% CI 1.02, 3.54, respectively), in contrast to PsA (HDL: HR 1.03, 95% CI 0.49, 2.15; ApoA-1: HR 0.79, 95% CI 0.34, 1.89) and non-SpA (HDL: HR 0.86, 95% CI 0.84, 0.89; ApoA-1: HR 0.88, 95% CI 0.85, 0.91).Conclusion.HDL and ApoA-1 were surprisingly associated with increased risk of future CVD in patients with AS, whereas these lipids were protective in non-SpA.

scholarly journals Case Report on Pregnancy with Lupus Nephritis Type IV with Hypothyroidism – A Clinical Vignette

2021 ◽  
Vol 8 (05) ◽  
pp. 272-274
Author(s):  
Abirbhab Pal
Keyword(s):  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
First Trimester ◽  
The Body ◽  
Fetal Mortality ◽  
Thyroid Disorder ◽  
Multisystem Disease ◽  
Mortality And Morbidity ◽  
Multiple Systems ◽  
Increased Risk

Lupus is a multisystem disease affecting almost all systems including the immune system of our body. Its aetiology is not known. Lupus involving kidneys causes lupus nephritis and adds more complications in the multisystem disease. Lupus or systemic lupus erythematosus (SLE) is a multifactorial chronic disease involving multiple systems of the body. It is autoimmune1 in nature. There is increase in maternal and fetal risk of mortality and morbidity in lupus with pregnancy. The rate of pregnancy loss is 1.7 %2 in active SLE during initial first trimester and the most common adverse morbidity causing factor of fetomaternal side.3 There can be an increase in fetal mortality and morbidity associated with lupus nephritis.4,5 There is increased risk of intrauterine growth restriction (IUGR) / neonatal lupus / gestational diabetes mellitus / osteoporosis / HELLP syndrome / preeclampsia. Associated thyroid disorder is increased with preterm pregnancy.

Vasculitis

2016 ◽  
pp. 839-848
Author(s):  
Matthew J. Koster ◽  
Kenneth J. Warrington
Keyword(s):  
Rheumatoid Arthritis ◽  
Inflammatory Bowel Disease ◽  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Inflammatory Disease ◽  
Joint Destruction ◽  
Age Related ◽  
Systemic Inflammatory Disease ◽  
Inflammatory Bowel ◽  
Reiter Syndrome

Rheumatoid arthritis is a chronic systemic inflammatory disease characterized by joint destruction. It affects 0.03% to 1.5% of the population worldwide. Women are affected 3 times more frequently than men. Its incidence peaks between the ages of 35 and 45 years; however, the age-related prevalence of the disease increases even after age 65 years. Conditions in the spondyloarthritis spectrum include ankylosing spondylitis, reactive arthritis (Reiter syndrome), arthritis related to inflammatory bowel disease, and psoriatic arthritis.

scholarly journals Autoimmune Polyglandular Syndrome Type 3-D

2022 ◽  
Author(s):  
Fadel Fikri Suharto ◽  
RM Dewi Anggraini ◽  
Ardianto Tamin ◽  
Della Fitricana ◽  
Nova Kurniati ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Immune System ◽  
Autoimmune Disease ◽  
Lupus Erythematosus ◽  
Disease Patient ◽  
The Body ◽  
Graves Disease ◽  
Systemic Lupus ◽  
Metabolic System ◽  
Organ Systems

Background: Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease characterized by the presence of autoantibodies against cell nuclei and involves many organ systems in the body. The etiopathology of SLE is thought to involve complex and multifactorial interactions between genetic variation and environmental factors. Hyperthyroidism is a disease due to increased thyroid hormone function followed by signs and symptoms that affect the body's metabolic system. Graves' disease is an autoimmune disease characterized by the presence of antibodies to TSHR (TRAb). Several coexisting autoimmune diseases have been classified under different syndromes. Case Presentation: A woman, 29 years-old, came to office with complaint of chest palpitation. Patient had history of fever, joint pain, hair loss, and malar rash. Patient had been diagnosed with hyperthyroidism for 4 years and regularly taking propylthiouracil 100 mg and propranolol 10 mg. Titer ANA Test 1/100, Anti ds-DNA 68.08, C3-Complement 93 (N: 83-193), C4-Complement 11.2 (N: 15-57), Free T3 7.79 (N: 1.71-3.71), Free -T4 2.50 (N: 0.70-1.48), TSHs 0.0001 (N: 0.350-4.94), TRAb 3.38 (N: < 1.75). Patient was diagnosed with systemic lupus erythematosus (SLE) and graves’ disease. Patient treated with methimazole 10 mg, propranolol 10 mg, myfortic 360 mg, and methylprednisolone 4 mg. Conclusion: Autoimmune Polyendocrine Syndromes (APS) was at first characterized as different endocrine organ diseases related to an immune system disease in a subject. Hence, affiliation between illnesses in APS was noted not to be irregular but in specific combinations in which a few non-endocrine immune system diseases were moreover portion of the disorders.

scholarly journals Polyglandular Autoimmune Syndrome Type 3D : A Case Report

2022 ◽  
Author(s):  
Fadel Fikri
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Immune System ◽  
Autoimmune Disease ◽  
Lupus Erythematosus ◽  
Disease Patient ◽  
The Body ◽  
Systemic Lupus ◽  
Metabolic System ◽  
Polyglandular Autoimmune Syndrome ◽  
Organ Systems

Background: Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease characterized by the presence of autoantibodies against cell nuclei and involves many organ systems in the body. The etiopathology of SLE is thought to involve complex and multifactorial interactions between genetic variation and environmental factors. Hyperthyroidism is a disease due to increased thyroid hormone function followed by signs and symptoms that affect the body's metabolic system. Graves' disease is an autoimmune disease characterized by the presence of antibodies to TSHR (TRAb). Several coexisting autoimmune diseases have been classified under different syndromes. Autoimmune Polyglandular Syndrome (PGAS),Case Presentation: A woman, 29 years-old, came to office with complaint of chest palpitation. Patient had history of fever, joint pain, hair loss, and malar rash. Patient had been diagnosed with hyperthyroidism for 4 years and regularly taking propylthiouracil 100 mg and propranolol 10 mg. Titer ANA Test 1/100, Anti ds-DNA 68.08, C3-Complement 93 (N: 83-193), C4-Complement 11.2 (N: 15-57), Free T3 7.79 (N: 1.71-3.71), Free -T4 2.50 (N: 0.70-1.48), TSHs 0.0001 (N: 0.350-4.94), TRAb 3.38 (N: &lt; 1.75). Patient was diagnosed with systemic lupus erythematosus (SLE) and grave's disease. Patient treated with methimazole 10 mg, propranolol 10 mg, myfortic 360 mg, and methylprednisolone 4 mg.Conclusion: Autoimmune Polyendocrine Syndromes (APS) was at first characterized as different endocrine organ diseases related to an immune system disease in a subject. Hence, affiliation between illnesses in APS was noted not to be irregular but in specific combinations in which a few non-endocrine immune system diseases were moreover portion of the disorders.

Locomotor

2019 ◽  
pp. 187-216
Author(s):  
Tanya M. Monaghan ◽  
James D. Thomas
Keyword(s):  
Rheumatoid Arthritis ◽  
Systemic Lupus Erythematosus ◽  
Systemic Sclerosis ◽  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Lupus Erythematosus ◽  
Trigger Finger ◽  
Dupuytren’S Contracture ◽  
Systemic Lupus ◽  
Tophaceous Gout

This chapter concerns locomotive medicine, and covers rheumatoid arthritis, osteoarthritis, psoriatic arthritis, ankylosing spondylitis, Paget’s disease, tophaceous gout, Marfan’s syndrome, systemic sclerosis, vasculitis, systemic lupus erythematosus, rickets, Dupuytren’s contracture, trigger finger, and Charcot’s joint.

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