RHESUS ISOIMMUNIZATION
R
rh e s u s is o im m u n iz a tio n
T h e d e v e l o p m e n t o f
a n tib o d ie s
( p r o t e i n s
t h a t a r e m a n u f a c t u r e d b y t h e i m m u n e
s y s t e m )
a g a i n s t
R h e s u s
( R h ) - p o s i t i v e
b l o o d i n a p e r s o n w h o h a s b l o o d t h a t i s
R h - n e g a t i v e ( s e e
h a e m o ly t ic d is e a s e o f th e
n e w b o r n
;
R h e s u s in c o m p a t ib ilit y ).
rh e u m a tic fe v e r
A
d i s e a s e
t h a t
c a u s e s
i n f l a m m a t i o n
t h r o u g h o u t
t h e
b o d y ,
e s p e c i a l l y
i n
t h e
jo in ts .
N o w r a r e i n d e v e l o p e d c o u n t r i e s , i t
i s a n i m p o r t a n t c a u s e o f h e a r t d i s e a s e i n
d e v e l o p i n g c o u n t r i e s a n d i s m o s t c o m
-
m o n i n c h i l d r e n a g e d f i v e t o 1 5 y e a r s .
CAUSE
R h e u m a t i c
f e v e r
i s
b e l i e v e d
t o
b e
a n
a u to im m u n e d is o rd e r
( i n w h i c h t h e b o d y ’s
i m m u n e s y s t e m a t t a c k s i t s o w n t i s s u e s )
i n d u c e d b y c e r t a i n s t r a i n s o f s t r e p t o c o c c a l
b a c t e r i a . R h e u m a t i c f e v e r a l w a y s f o l l o w s a
t h r o a t
i n f e c t i o n .
T h e
d e v e l o p m e n t
o f
r h e u m a t i c f e v e r c a n u s u a l l y b e p r e v e n t e d
b y t r e a t m e n t w i t h
a n tib io tic d ru g s.
SYMPTOMS AND SIGNS
R h e u m a t i c f e v e r c a u s e s f e v e r w i t h p a i n ,
i n f l a m m a t i o n ,
a n d s w e l l i n g
o f o n e
o r
m o r e
o f
t h e
l a r g e r
j o i n t s .
T h e
h e a rt
v a lv e s
m a y b e s c a r r e d , l e a d i n g t o
m itra l
s t e n o s is
( n a r r o w i n g o f t h e m i t r a l v a l v e )
o r
m itra l in c o m p e t e n c e
( l e a k i n g
o f t h e
m i t r a l
v a l v e ) .
I f t h e
n e rv o u s s y s t e m
i s
i n v o l v e d ,
S y d e n h a m ’s c h o re a
m a y
b e
c a u s e d ,
i n
w h i c h
t h e r e
a r e
i r r e g u l a r ,
u n c o n t r o l l a b l e ,
j e r k y
m o v e m e n t s
a n d
u s u a l l y s o m e e m o t i o n a l u p s e t .
DIAGNOSIS AND TREATMENT
R h e u m a t i c
f e v e r
m a y
b e
s u s p e c t e d
w h e n e v e r
a rth rit is
( j o i n t i n f l a m m a t i o n )
m o v e s f r o m j o i n t t o j o i n t , b u t m a y b e
d i s c o v e r e d
o n l y
a f t e r
d e v e l o p m e n t
o f
h e a r t f a i l u r e o r a h e a r t m u r m u r .
T r e a t m e n t
i s
w i t h
p e n ic illin d ru g s
t o
e r a d i c a t e
s t r e p t o c o c c i ;
w i t h
a s p irin
o r
o t h e r s a l i c y l a t e d r u g s t o c o n t r o l j o i n t p a i n
a n d i n f l a m m a t i o n a n d t o m i n i m i z e h e a r t
d a m a g e ; a n d , i n s o m e c a s e s , w i t h
c o rtic o -
s te ro id d ru g s .
I f d a m a g e t o t h e h e a r t v a l v e s
o c c u r s ,
h e a rt va lve s u rg e ry
m a y b e r e q u i r e d .
rh e u m a tis m
A p o p u l a r
t e r m
f o r
a n y
d i s o r d e r
t h a t
c a u s e s p a i n a n d s t i f f n e s s i n
m u s c le s
a n d
jo in t s .
T h e t e r m i s u s e d t o r e f e r b o t h t o
m i n o r a c h e s a n d t w i n g e s a s w e l l a s t o
d i s o r d e r s
s u c h
a s
r h e u m a t o id a rth rit is ,
o s te o a rth ritis ,
a n d
p o ly m y a lg ia rh e u m a tic a .
rh e u m a to id a rth ritis
A t y p e o f
a rth rit is
( j o i n t i n f l a m m a t i o n )
i n w h i c h t h e j o i n t s i n t h e l i m b s , a n d
s o m e t i m e s i n o t h e r p a r t s
o f t h e b o d y ,
b e c o m
e p a i n f u l , s w o l l e n , s t i f f , a n d , i n
s e v e r e c a s e s , d e f o r m e d . T i s s u e s t h a t a r e
o u t s i d e
t h e
j o i n t s ,
f o r
e x a m p l e
t h e
h e a r t , c a n a l s o b e a f f e c t e d .
CAUSES AND INCIDENCE
R h e u m a t o i d a r t h r i t i s i s a n
a u t o im m u n e
d is o r d e r
( i n w h i c h t h e b o d y ’s i m m u n e
s y s t e m a t t a c k s i t s o w n t i s s u e s ) t h a t u s u -
a l l y s t a r t s i n e a r l y a d u l t h o o d o r m i d d l e
a g e
b u t
c a n
a l s o
d e v e l o p
i n
c h i l d r e n
( s e e
ju v e n ile c h r o n ic a rt h rit is )
o r e l d e r l y
p e o p l e . W
o m e n a r e a f f e c t e d m o r e c o m
-
m o n l y
t h a n
m e n .
T h e r e
a r e
u s u a l l y
r e c u r r e n t a t t a c k s .
SYMPTOMS AND SIGNS
E a r l y s y m p t o m s o f r h e u m a t o i d a r t h r i t i s
i n c l u d e m i l d f e v e r a n d a c h e s f o l l o w e d
b y s w e l l i n g , r e d n e s s , p a i n , a n d s t i f f n e s s
i n t h e j o i n t s , p a r t i c u l a r l y i n t h e m
o r n -
i n g .
L ig a m e n ts ,
te n d o n s ,
a n d
m u s c le s
a r o u n d t h e a f f e c t e d j o i n t m a y
a l s o b e
i n v o l v e d .
R a y n a u d ’s p h e n o m e n o n
( a c o n -
d i t i o n i n w h i c h t h e f i n g e r s t u r n w h i t e
o n
e x p o s u r e
t o
c o l d )
m a y
o c c u r
a n d
t h e r e
m a y
a l s o
b e
rh e u m a t o id n o d u le s
( s m a l l l u m p s u n d e r t h e s k i n ) o v e r p r e s -
s u r e p o i n t s , s u c h a s t h e e l b o w s o r f i n g e r
j o i n t s . S w e l l i n g o f t h e w r i s t m a y c a u s e
c a rp a l t u n n e l s y n d ro m e
( t i n g l i n g a n d p a i n
i n t h e
f i n g e r s d u e t o p r e s s u r e
o n t h e
m e d i a n n e r v e ) a n d a l s o
te n o s y n o v itis
( i n -
f l a m e d , p a i n f u l t e n d o n s h e a t h s ) .
C o m p l i c a t i o n s
o f s e v e r e
r h e u m a t o i d
a r t h r i t i s m a y i n c l u d e
a n a e m ia
( a r e d u c e d
l e v e l
o f
t h e
o x y g e n - c a r r y i n g
p i g m e n t
h a e m o g l o b i n
i n
t h e
b l o o d ) ,
p e ric a rd itis
( i n f l a m m a t i o n o f t h e m e m b r a n o u s h e a r t
c o v e r i n g ) ,
u lc e rs
o n t h e h a n d s a n d f e e t ,
p le u ra l e ffu sio n
( a c c u m u l a t i o n
o f
f l u i d
a r o u n d
t h e
l u n g s ) ,
p u lm o n a ry f ib ro s is
( s c a r r i n g a n d t h i c k e n i n g o f l u n g t i s s u e ) ,
a n d
S jo g re n ’s s y n d ro m e
( i n w h i c h t h e e y e s
a n d m o u t h b e c o m e e x c e s s i v e l y d r y ) .
DIAGNOSIS AND TREATMENT
A d i a g n o s i s c a n b e c o n f i r m e d t h r o u g h
X -ra y s
o f t h e
a f f e c t e d
j o i n t s
a n d
b lo o d
te sts
( i n c l u d i n g
a
c h e c k
f o r
s p e c i f i c
a n t i b o d i e s k n o w n a s
rh e u m a t o id f a c t o r).
I n i t i a l l y , r h e u m a t o i d a r t h r i t i s m a y b e
t r e a t e d w i t h
n o n s t e ro id a l a n ti-in fla m m a t-
o ry d ru g s
( N S A I D s ) t o r e l i e v e j o i n t p a i n
a n d s t i f f n e s s ;
c o rtic o s t e ro id d ru g s
m a y b e
RHEUMATOID ARTHRITIS
One of the most serious forms of joint disease, rheumatoid arthritis may occur as
a single episode or a succession of progressively severe attacks. It results from a
disturbance in the body’s immune system, causing the body to attackits own
tissues. The joints are usually the worst affected, but other tissues such as the
heart and lungs may also be involved.
Affected joints
Rheumatoid arthritis
can affect virtually
anyjoint, but
especially the
fingers, wrists,
shoulders, knees,
hips, and spinal
joints in the neck.
The hands in rheumatoid arthritis
This condition commonly affects the fingers. In this
photograph, there is pronounced swelling around
the knuckles, particularly of the right hand.
Disease progression
The synovium (membrane
lining the capsule of an
affected joint) becomes
inflamed and thickened
(right). Later, inflammation
may spread to the cartilage
and bone.
Inflamed
synovium
Cartilage
Capsule
Bone
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