Patient Education

The immune system makes an abundance of proteins called antibodies. Antibodies are made by white blood cells (B cells). The antibodies recognize and combat infectious organisms (germs) in the body. Antibodies develop in our immune system to help the body fight infectious organisms. When an antibody recognizes the foreign proteins of an infectious organism, it recruits other proteins and cells to fight off the infection. This cascade of attack is called inflammation.

Sometimes these antibodies make a mistake, identifying normal, naturally-occurring proteins in our bodies as being “foreign” and dangerous. When these antibodies make incorrect calls, identifying a naturally-occurring protein (or self protein) as foreign, they are called autoantibodies. Autoantibodies start the cascade of inflammation, causing the body to attack itself. The antibodies that target “normal” proteins within the nucleus of a cell are called antinuclear antibodies (ANA). Most of us have autoantibodies, but typically in small amounts. The presence of large amount of autoantibodies or ANAs can indicate an autoimmune disease. ANAs could signal the body to begin attacking itself which can lead to autoimmune diseases, including lupus, scleroderma, Sjögren’s syndrome, polymyositis/dermatomyositis, mixed connective tissue disease, drug-induced lupus, and autoimmune hepatitis. A positive ANA can also be seen in juvenile arthritis.

Source: American College of Rheumatology

Antiphospholipid antibody syndrome (commonly called antiphospholipid syndrome or APS) is an autoimmune disease present mostly in young women. Those with APS make abnormal proteins called antiphospholipid autoantibodies in the blood. This causes blood to flow improperly and can lead to dangerous clotting in arteries and veins, problems for a developing fetus and pregnancy miscarriage. People with this disorder may otherwise be healthy, or they also may suffer from an underlying disease, most frequently systemic lupus erythematosus (commonly called lupus or SLE).

APS affects women five times more commonly than men. It is typically diagnosed between the ages of 30 and 40. While up to 40 percent of patients with SLE will test positive for the anti-phospholipid autoantibodies, only half will develop thrombosis and/or experience miscarriages. Like most autoimmune disorders, APS has a genetic component, although there is not a direct transmission from parent to offspring.

Source: American College of Rheumatology

Joint problems caused by crystals of a calcium salt called pyrophosphate may be one of the most misunderstood forms of arthritis. Joint problems seen with these crystals often are mistaken for gout and other conditions. Proper diagnosis (detection) is important. Untreated calcium pyrophosphate deposition (CPPD) may lead to severe, painful attacks or chronic (long-term) pain and inflammation. Over time, joints may degenerate, or break down, resulting in long-term disability. Some treatment options for the arthritis pain do exist, but these do not treat the underlying crystal deposits. Some of the underlying causes are treatable and should be evaluated in people with CPPD (see causes below).

Source: American College of Rheumatology

See more at: http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Calcium-Pyrophosphate-Deposition-CPPD#sthash.ZlJAAxEV.dpuf

Carpal tunnel syndrome is possibly the most common nerve disorder experienced today. It affects 4 – 10 million Americans and is usually very treatable. Middle-aged to older individuals are more likely to develop the syndrome than younger persons, and females three times more frequently than males.

Carpal tunnel syndrome disables a key nerve, resulting in symptoms ranging from mild occasional numbness to hand weakness, loss of feeling and loss of hand function. The main symptom is numbness of the fingers. Given this widespread familiarity, people often attribute any discomfort or pain in the hand or wrist to carpal tunnel syndrome. However, there are many other conditions which can cause similar complaints. It is important to know the difference.

Source: American College of Rheumatology

Cryopyrin-Associated Autoinflammatory Syndromes (CAPS) consist of three very rare diseases related to a defect in the same protein: cryopyrin. These diseases differ in the systems involved and in the severity of the disease. All the CAPS are very rare, found in about one in 360,000 to 1,000,000 people. Familial cold autoinflammatory syndrome is more common in the Unites States, and Muckle-Wells syndrome is more common in Europe. NOMID, the least common disease, is present around the world, and usually starts shortly after birth. Familial cold autoinflammatory syndrome usually starts in the first year of life. Muckle-Wells syndrome may start later. Males and females are both affected, and all ethnic groups can be affected.

Source:  American College of Rheumatology

Juvenile dermatomyositis is an inflammatory disease of the muscle (myositis), skin and blood vessels that affects about 3 in 1 million children each year. The cause is unknown. The primary symptoms of JDM include muscle weakness and skin rash. All age and ethnic groups are affected. Most cases start  in children ages 5 -10 and adults ages 40-50. Women are affected about twice as often as men.

Patients with juvenile dermatomyositis (JMD) develop weakness in the large muscles around the neck, shoulders and hips. This causes difficulty in climbing stairs, getting into cars, getting up from a chair or off the floor, or brushing hair. Most patients have little, if any, pain in their muscles, which distinguishes them from patients with other forms of muscle disease. Many patients with other conditions complain of weakness; however, when questioned closely, they really mean that they are tired, short of breath or depressed rather than suffering from true muscle weakness.

Source: American College of Rheumatology

Familial Mediterranean Fever (FMF) is a genetic disorder that causes recurrent episodes of fever that are typically accompanied by pain in the abdomen, chest or joints. It most often occurs in individuals of Mediterranean and Middle Eastern descent, and the first episodes typically begin in childhood.

The disease generally affects people of Mediterranean and Middle Eastern descent, typically Sephardic Jews, Turks, Arabs and Armenians. Since the discovery of the gene defect, it is being diagnosed more frequently, even among populations where it was thought to be very rare, such as Italians, Greeks Ashkenazi Jews and even among Asian populations. FMF episodes start before the age of 20 years in approximately 90 percent of the patients. In about 75 percent of patients, fever appears before the age of 10 years. FMF can appear or be active in adults, but often the disease is milder and less obvious (and harder to diagnose) than in children.

Source: American College of Rheumatology

In an older adult, a new, persisting headache — especially if together with flu-like symptoms, unexplained fatigue (tiredness) or fevers — can be due to an illness called giant cell arteritis, also known as GCA. It is a disease of the blood vessels that can occur together with polymyalgia rheumatica polymyalgia rheumatica (also called PMR).

Source: American College of Rheumatology

Taking a glucocorticoid medication (sometimes called corticosteroids) for treatment of inflammatory arthritis or other health problem may weaken your bones. This, in turn, can lead to osteoporosis. The good news is there are ways you can protect your bones while taking glucocorticoid medicine.

Source: American College of Rheumatology

Gout is a painful and potentially disabling form of arthritis that has been around since ancient times. It is sometimes referred to as the “disease of kings,” because people long have incorrectly linked it to the kind of overindulgence in food and wine only the rich and powerful could afford. In fact, gout can affect anyone, and its risk factors vary.

The first symptoms usually are intense episodes of painful swelling in single joints, most often in the feet, especially the big toe. The swollen site may be red and warm. Fifty percent of first episodes occur in the big toe, but any joint can be involved. Fortunately, it is possible to treat gout and reduce its very painful attacks by avoiding food and medication triggers and by taking medicines that can help. However, diagnosing gout can be hard, and treatment plans often must be tailored for each person.

Source: American College of Rheumatology

Granulomatosis with polyangiitis (Wegener's), also known as GPA, is a rare blood vessel disease. It can cause symptoms in the sinuses, lungs and kidneys as well as other organs. This is a complex and potentially serious disease. However, with prompt diagnosis, granulomatosis with polyangiitis can be treated effectively.

Source: American College of Rheumatology

The hepatitis C virus—often referred to as HCV—is the leading cause of liver failure and the top reason for needing a liver transplant. Besides hepatitis (liver inflammation), this virus can also cause arthritis (joint inflammation), muscle pain and weakness, and vascular (blood vessel) problems. The HCV infection often has no symptoms (what you feel).

It is common for HCV-positive patients to have related rheumatic diseases. In fact, these problems can appear before you even know you have HCV.

Rheumatic diseases are problems, including pain, in the joints, muscles and connective tissue (the tissue that supports and binds many other parts of the body). HCV-related rheumatic diseases result from infection with HCV. Painful joints and muscles combined with fatigue are usually the first and most common complaints. Less often, joint swelling and inflammation of blood vessels (vasculitis) can occur.

Source: American College of Rheumatology

HIV infection and its most serious complication, acquired immunodeficiency syndrome — more often referred to as AIDS — were first recognized over 30 years ago. Since then, there has been great progress in understanding, treating and preventing AIDS and infection with HIV, the virus that causes AIDS. Despite these advances, more than 1.1 million people in the United States are living with HIV infection, and almost 1 in 5 is unaware of their underlying infection.

Many people with HIV have problems of the musculoskeletal system (joints, muscles and bones). HIV infection can lead to rheumatic (joint and muscle) illness, including joint pain, arthritis, muscle pain, weakness and fatigue (feeling very tired). Extra-articular manifestations such as uveitis (eye inflammation) may also occur in HIV patients exhibiting arthritis. Sometimes these symptoms (what someone feels) happen before the person knows he or she has HIV.

Source: American College of Rheumatology

Mevalonate Kinase Deficiency (MKD) was formerly known as Hyperimmunoglobulin D Syndrome and is a very rare disease. The disease is mostly found in Western Europe, especially in the Netherlands and France, but has been described in all ethnic groups. Boys and girls are affected equally. Symptoms usually start in early childhood, most commonly in the first year of life.

Source: American College of Rheumatology

Joints that are more flexible than normal or that move in excess of a normal range of motion are considered hypermobile. When generalized, hypermobility occurs with symptoms such as muscle or joint pain without systemic disease, it is called - hypermobility syndrome or joint hypermobility syndrome. Rarely, children may have a more widespread connective tissue disorder associated with their hypermobility such as Marfan or Ehlers-Danlos syndrome.

The presence of hypermobility varies widely across different ages, ethnicities and populations. Typically girls tend to be more hypermobile compared to boys.

Source: American College of Rheumatology

The prospect of a muscle disease worries some people because they are afraid of not being able to walk. Yet in many cases, treatment exists for myopathy (muscle disease). Proper diagnosis and treatment raise the chance of living life fully despite this illness.

Source: American College of Rheumatology

About 1 child in every 1,000 develops some type of juvenile arthritis. These disorders can affect children at any age, although rarely in the first six months of life. It is estimated that around 300,000 children in the United States have been diagnosed with the condition.

Growing up with arthritis can be challenging. However, with care from a team of rheumatology professionals, most children with arthritis live full and active lives. There are various types of childhood arthritis, which can last from several months to many years. In every instance, early diagnosis and treatment can help avoid joint damage.

There are many terms used to describe a child with chronic arthritis. These include juvenile rheumatoid arthritis, juvenile chronic arthritis and juvenile idiopathic arthritis. While JIA is used most by specialists in pediatric rheumatology, JRA is commonly used in the United States.  Juvenile arthritis may involve one or many joints, and cause other symptoms such as fevers, rash and/or eye inflammation.

Source: American College of Rheumatology

Scleroderma means “hard skin.” Children with localized scleroderma often have involvement of the tissues below the skin, including muscle and bone. Besides the skin hardening, there can be changes in skin color and texture, and the underlying tissues may fail to grow normally. Localized scleroderma can occur in several different forms, including linear scleroderma (where the lesion appears as a line or streak) and circumscribed morphea (where the lesion appears as a roundish lesion). Most patients have the disease on just one part or side of their body. Early on, some lesions may have a red or purplish color that may be limited to the lesion border. Others may have a white or waxy appearance and feel hard.

Ssource: American College of Rheumatology

Systemic lupus erythematosus, referred to as SLE or lupus, is a chronic (long-term) disease that causes inflammation — pain and swelling. It is sometimes called the “great imitator,” because of people often confuse lupus with other health problems due to its wide range of symptoms.

In addition to affecting the skin and joints, it can affect other organs in the body such as the kidneys, the tissue lining the lungs (pleura) and heart (pericardium), and the brain. Most patients feel fatigue and have rashes, arthritis (painful and swollen joints) and fever.

Lupus flares vary from mild to serious. Most patients have times when the disease is active, followed by times when the disease is mostly quiet — referred to as a remission. Yet, there is much reason for hope. Improvements in treatment have greatly improved these patients’ quality of life and increased their lifespan.

Source: American College of Rheumatology

Metabolic myopathies are genetic diseases, usually inherited, that affect the body’s muscles. Metabolic refers to chemical reactions that provide energy, nutrients and substances necessary for health and growth. Some people with a metabolic myopathy (muscle disease) develop weakness; others tire easily with exercise or physical activity, suffer muscle pain after physical effort, and/or experience severely swollen and tender muscles. These symptoms occur when muscle cells don’t get enough energy. Without enough energy, the muscle lacks enough fuel to work properly.

Most metabolic myopathies are genetic and tend to occur within families. They can appear at any age in those who inherit the disease. Either a parent or another relative may have been symptomatic. However, metabolic myopathies can develop in a person with no family history of the condition.

Source: American College of Rheumatology

Osteoarthritis (also known as OA) is a common joint disease that most often affects middle-age to elderly people. It is commonly referred to as "wear and tear" of the joints, but we now know that OA is a disease of the entire joint, involving the cartilage, joint lining, ligaments, and bone.  Although it is more common in older people, it is not really accurate to say that the joints are just “wearing out.” It is characterized by breakdown of the cartilage (the tissue that cushions the ends of the bones between joints), bony changes of the joints, deterioration of tendons and ligaments, and various degrees of inflammation of the joint lining (called the synovium).

This arthritis tends to occur in the hand joints, spine, hips, knees, and great toes. The lifetime risk of developing OA of the knee is about 46 percent, and the lifetime risk of developing OA of the hip is 25 percent, according to the Johnston County Osteoarthritis Project, a long-term study from the University of North Carolina and sponsored by the Centers for Disease Control and Prevention (often called the CDC) and the National Institutes of Health.

OA is a top cause of disability in older people. The goal of osteoarthritis treatment is to reduce pain and improve function. There is no cure for the disease, but some treatments attempt to slow disease progression.

Source: American College of Rheumatology

The bones and bone marrow of the human body are made up of living cells that need a steady blood supply to stay healthy. If blood flow to these cells greatly decreases, the cells may die, causing the bone to collapse. This process is called osteonecrosis. Osteonecrosis can lead to pain, arthritis and limited use of affected joints. Some people may even need joint replacement surgery.

Source: American College of Rheumatology

Osteonecrosis of the jaw, commonly called ONJ, occurs when the jaw bone is exposed and begins to starve from a lack of blood. Most cases of osteocronosis of the jaw happen after a dental extraction. Osteo means bone and necrosis means death. As the name indicates, the bone begins to weaken and die with OJN, which usually (but not always), causes pain.

ONJ is associated with cancer treatments (including radiation), infection, steroid use, or potent antiresorptive medications. Antiresorptive medications help slow down bone loss in patients suffering from conditions such as osteoporosis. Examples of potent antiresorptive medications include bisphosphonates such as alendronate (Fosamax); risedronate (Actonel and Atelvia); ibandronate (Boniva); and denosumab (Prolia).

While ONJ is associated with these conditions, it also can occur without any identifiable risk factors.

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Osteoporosis is a common condition where bones become weak that affects both men and women, mainly as they grow older. Bone is living tissue that is in a constant state of regeneration. That is, the body removes old bone (called bone resorption) and replaces it with new bone (bone formation). By their mid-30s, most people begin to slowly lose more bone than can be replaced. As a result, bones become thinner and weaker in structure.

Osteoporosis is silent because there are no symptoms (what you feel). It may come to your attention only after you break a bone. When you have this condition, a fracture can occur even after a minor injury, such as a fall. The most common fractures occur at the spine, wrist and hip. Spine and hip fractures, in particular, may lead to chronic (long-term) pain and disability, and even death. The main goal of treating osteoporosis is to prevent such fractures in the first place.

Fortunately, you can take steps to reduce your risk of osteoporosis. By doing so, you can avoid the often-disabling broken bones (fractures) that can result from this condition. If you already have osteoporosis, new medications are available to slow or even stop the bones from getting weaker. These medicines also can decrease the chance of having a fracture.

Source: American College of Rheumatology

Paget's disease of bone is an uncommon, chronic bone disorder that occurs in only about one percent of people in the United States and slightly more often in men than in women (3 to 2). Individuals with Paget's disease experience rapid isolated bone repair, which causes a variety of symptoms from softer bones to enlarged bone growth, typically involving one or more bones of the pelvis, low back (spine), hips, thighs, head (skull) and arms. This can lead to problems such as bending, breaking, pinched nerves, arthritis and reduced hearing. Medical therapies have proven effective in reducing the frequency of pain, fractures and arthritis that may be caused by this condition.

Source: American College of Rheumatology

Periodic Fever, Aphthous Stomatitis, Pharyngitis, Cervical Adenitis (PFAPA) is a syndrome that consists of recurrent episodes of fever, sore throat, mouth sores and swelling of the glands in the neck. The frequency of PFAPA is not known, but the disease appears to be more common than originally thought, and may be the most common recurrent fever syndrome that does not come from an infection. Both males and females and all ethnic groups can develop PFAPA. PFAPA usually starts in early childhood, between the ages of 2 to 5 years. Occasionally PFAPA may develop at an older age, including rare cases in adults.

It is not yet known what causes this disorder. No gene defect has yet to be found in PFAPA, although sometimes more than one family member has the disease and a history of a tonsillectomy (surgical removal of the tonsils) may be reported among family members. No infection has been found in PFAPA, and it is not a contagious disease. It is clear that the inflammatory process is active during episodes, but it is not clear why this happens.

Source: American College of Rheumatology

Polymyalgia rheumatica (sometimes referred to as PMR) is a common cause of widespread aching and stiffness that affects adults over the age of 50, especially Caucasians. Because polymyalgia rheumatica does not often cause swollen joints, it may be hard to recognize. It may occur with another health problem, giant cell arteritis.

The average age when symptoms start is 70, so people who have PMR may be in their 80s or even older. The disease affects women somewhat more often than men. It is more frequent in whites than nonwhites, but all races can get PMR.

Source: American College of Rheumatology

Psoriatic arthritis is a type of inflammation that occurs in about 15 percent of patients who have a skin rash called psoriasis. This particular arthritis can affect any joint in the body, and symptoms vary from person to person. Research has shown that persistent inflammation from psoriatic arthritis can lead to joint damage. Fortunately, available treatments for are effective for most people.

Psoriatic arthritis usually appears in people between the ages of 30 to 50, but can begin as early as childhood. Men and women are equally at risk. Children with psoriatic arthritis are also at risk to develop uveitis (inflammation of the middle layer of the eye). Approximately 15 percent of people with psoriasis develop psoriatic arthritis. At times, the arthritis can appear before the skin disorder.

Source: American College of Rheumatology

Raynaud's phenomenon. This term refers to color changes (blue, white and red) that occur in fingers and, sometimes, toes. Raynaud’s often occurs after exposure to cold temperatures. It occurs when the blood flow to the hands, fingers or toes is temporarily reduced. Raynaud's can lead to finger swelling, color changes, numbness, pain, skin ulcers and gangrene on the fingers and toes. People with have Raynaud's may have other diseases, and some people with Raynaud's do not have any other disease.

Raynaud's occurs in two main types:

• Primary Raynaud's is the most common form of the disorder and is not connected to an underlying disease or related medical problem. It is also called Raynaud’s phenomenon.
• Secondary Raynaud's is also called Raynaud's phenomenon. This form is caused by an underlying, or related, problem. Secondary Raynaud's is less common than the primary form, but it tends to be a more serious disorder. Symptoms of secondary Raynaud's often first appear at later ages — around 40 — while people with the primary form often see symptoms earlier.

Source: American College of Rheumatology

Reactive arthritis is a painful form of inflammatory arthritis (joint disease due to inflammation). It occurs in reaction to an infection by certain bacteria. Most often, these bacteria are in the genitals (Chlamydia trachomatis) or the bowel (Campylobacter, Salmonella, Shigella and Yersinia). Chlamydia most often transmits by sex. It often has no symptoms, but can cause a pus-like or watery discharge from the genitals. The bowel bacteria can cause diarrhea. If you develop arthritis within one month of diarrhea or a genital infection – especially with a discharge – see a health care provider. You may have reactive arthritis.

In the past, it went by the name “Reiter’s syndrome.” Now it belongs to the family of arthritis called “spondyloarthritis.”

Source: American College of Rheumatology

People have long feared rheumatoid arthritis (commonly called RA) as one of the most disabling types of arthritis. The good news is that the outlook has greatly improved for many people with newly diagnosed (detected) RA. Of course, RA remains a serious disease, and one that can vary widely in symptoms (what you feel) and outcomes. Even so, treatment advances have made it possible to stop or at least slow the progression (worsening) of joint damage. Rheumatologists now have many new treatments that target the inflammation that RA causes. They also understand better when and how to use treatments to get the best effects.

Treatments:

Therapy for RA has improved greatly in the past 30 years. Current treatments give most patients good or excellent relief of symptoms and let them keep functioning at, or near, normal levels. With the right medications, many patients can achieve “remission” — that is, have no signs of active disease.

There is no cure for RA. The goal of treatment is to lessen your symptoms and poor function. Doctors do this by starting proper medical therapy as soon as possible, before your joints have lasting damage. No single treatment works for all patients. Many people with RA must change their treatment at least once during their lifetime.

Good control of RA requires early diagnosis and, at times, aggressive treatment. Thus, patients with a diagnosis of RA should begin their treatment with disease-modifying antirheumatic drugs — referred to as DMARDs. These drugs not only relieve symptoms but also slow progression of the disease. Often, doctors prescribe DMARDs along with nonsteroidal anti-inflammatory drugs or NSAIDs and/or low-dose corticosteroids, to lower swelling, pain and fever. DMARDs have greatly improved the symptoms, function and quality of life for nearly all patients with RA. Ask your rheumatologist about the need for DMARD therapy and the risks and benefits of these drugs.

Common DMARDs include methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine).

Gold is an older DMARD that is often given as an injection into a muscle (such as Myochrysine), but can also be given as a pill — auranofin (Ridaura). The antibiotic minocycline (Minocin) also is a DMARD, as well as the immune suppressants azathioprine (Imuran) and cyclosporine (Neoral, Sandimmune, Gengraf). These three drugs and gold are rarely prescribed for RA these days, because other drugs work better or have fewer side effects.

Patients with more serious disease may need medications called biologic response modifiers or “biologic agents.” They can target the parts of the immune system and the signals that lead to inflammation and joint and tissue damage. FDA-approved drugs of this type include abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi) infliximab (Remicade), rituximab (Rituxan, MabThera) and tocilizumab (Actemra). Most often, patients take these drugs with methotrexate, as the mix of medicines is more helpful.

Janus kinase (JAK) inhibitors are another type of DMARD. People who cannot be treated with methotrexate alone may be prescribed a JAK inhibitor such as tofacitinib (Xeljanz).

The best treatment of RA needs more than medicines alone. Patient education, such as how to cope with RA, also is important. Proper care requires the expertise of a team of providers, including rheumatologists, primary care physicians, and physical and occupational therapists. You will need frequent visits through the year with your rheumatologist. These checkups let your doctor track the course of your disease and check for any side effects of your medications. You likely also will need to repeat blood tests and X-rays or ultrasounds from time to time.

Source: American College of Rheumatology

Scleroderma is an autoimmune rheumatic disease affecting the skin and other organs of the body, meaning that the body’s immune system is acting abnormally. The main finding in scleroderma is thickening and tightening of the skin and inflammation and scarring of many body parts, leading to problems in the lungs, kidneys, heart, intestinal system and other areas. There is still no cure for scleroderma but effective treatments for some forms of the disease are available.

Scleroderma is relatively rare. About 75,000 to 100,000 people in the U.S. have this disease; most are women between the ages of 30 and 50. Twins and family members of those with scleroderma or other autoimmune connective tissue diseases, such as lupus, may have a slightly higher risk of getting scleroderma. Children can also develop scleroderma, but the disease is different in children than in adults.

Although the underlying cause is unknown, promising research is shedding light on the relationship between the immune system and scleroderma. A great deal of research is also underway to find better treatments for scleroderma and, hopefully, someday a cure.

Source: American College of Rheumatology

Between 400,000 and 3.1 million adults have Sjögren's syndrome. This condition can affect people of any age, but symptoms usually appear between the ages of 45 and 55. It affects 10 times as many women as men. About half of patients also have rheumatoid arthritis or other connective tissue diseases, such as lupus.

In the early 1900s, Swedish physician Henrik Sjögren (SHOW-gren) first described a group of women whose chronic arthritis was accompanied by dry eyes and dry mouth. Today, rheumatologists know more about the syndrome that is named for Sjögren and—most significantly for patients—can offer advice about how to live with it.

Source: American College of Rheumatology

Spinal stenosis (or narrowing) is a common condition that occurs when the small spinal canal, which contains the nerve roots and spinal cord, becomes compressed. This causes a “pinching” of the spinal cord and/or nerve roots, which leads to pain, cramping, weakness or numbness. Depending on where the narrowing takes place, you may feel these symptoms in the lower back and legs, neck, shoulder or arms.

Usually, the narrowing is caused by osteoarthritis, or “wear and tear” arthritis, of the spinal column and discs between the vertebrae (the bones of the back). It may also be caused by a thickening of the ligaments in the back, as well as by a bulging of the discs that separate the vertebrae. Symptoms of spinal stenosis often start slowly and get worse over time. Pain in the legs may become so severe that walking even short distances is unbearable. Frequently, sufferers must sit or lean forward over a grocery cart, countertop or walker to temporarily ease pain.

Source: American College of Rheumatology

Spondyloarthritis (or spondyloarthropathy) is the name for a family of inflammatory rheumatic diseases that cause arthritis. It differs from other types of arthritis, because it involves the sites are where ligaments and tendons attach to bones called “entheses.” Symptoms present in two main ways. The first is inflammation causing pain and stiffness, most often of the spine. Some forms can affect the hands and feet or arms and legs. The second type is bone destruction causing deformities of the spine and poor function of the shoulders and hips.

The most common is ankylosing spondylitis, which affects mainly the spine. Others include:

• axial spondyloarthritis, which affects mainly the spine and pelvic joints;
• peripheral spondyloarthritis, affecting mostly the arms and legs;
• reactive arthritis (formerly known as Reiter's syndrome);
• psoriatic arthritis; and
• enteropathic arthritis/spondylitis associated with inflammatory bowel diseases (ulcerative colitis and Crohn's disease).

Source: American College of Rheumatology

Systemic lupus erythematosus (SLE or lupus) is a disease in which the immune system is overactive and does not function properly. The immune system attacks the body and creates inflammation in the skin, joints, kidneys, lungs, nervous system, and other organs of the body. People with lupus can have times of very active disease, called a flare, and times where the disease is mostly quiet, called remission. 

About 20 percent of people with lupus developed the disease before 20 years of age.  It is rare to get lupus before age 5 years. Lupus is more common in females and in certain ethnic groups, including African-American, Hispanic, South and Southeast Asian and North American First Nations populations.

Source: American College of Rheumatology

Takayasu’s arteritis, also called TAK, is a rare form of vasculitis disease involving inflammation in the walls of the largest arteries in the body: the aorta and its main branches. The disease results from an attack by the body’s own immune system, causing inflammation in the walls of arteries. The inflammation leads to narrowing of the arteries, and this can reduce blood flow to many parts of the body.

Takayasu’s arteritis can result in a weak pulse or loss of pulse in arms, legs and organs. For this reason, people used to refer to the illness as “pulseless disease.” Sometimes patients with TAK may have no symptoms, and the disease is so rare that doctors may not easily recognize it. Thus, there is often a delay in detecting it, sometimes several years.

Source: American College of Rheumatology

Tendons are cord-like structures located where a muscle narrows down to attach to a bone. The tendon is more fibrous and dense than the elastic, fleshy muscle. A tendon transmits the pull of the muscle to the bone to cause movement. Tendinitis is often very tender to the touch.

Tendinitis or bursitis often involves the shoulder, elbow, wrist, hip, knee and ankle. The pain it causes may be quite severe and often occurs suddenly. As in arthritis, the pain is worse during movement. Unlike arthritis, the pain is often in parts of the body far from a joint. Tendinitis often results from repetitive use (overuse). Though the problem can recur or be chronic (long term) in some people, it is most often short term, mainly if treated early.

Bursitis is inflammation of a bursa. This small sac acts as a cushion between moving structures (bones, muscles, tendons or skin). If a muscle or tendon is pulling around a corner of a bone, or over a bone, a healthy bursa protects it from fraying and stress. When a bursa is inflamed, it becomes very painful, even during rest.

Source: American College of Rheumatology

Formerly known as Familial Hibernian fever, Tumor Necrosis Factor Receptor Associated Periodic Syndrome (TRAPS) is a rare, genetic disease that causes recurrent episodes of fever that typically last more than 1 week and are associated with chills and severe muscle pain in the torso and the arms.

Patients develop a red and painful rash that move from the torso to the arms and legs. Abdominal pain with nausea, vomiting and diarrhea are common, as are red, swollen eyes. Other important features include chest pain due to inflammation of the membrane surrounding the lungs or heart.

TRAPS is a rare disease, but since the gene defect was discovered, more patients have been diagnosed. The disease affects both males and females, and usually starts before the age of 10 years, but symptoms may start in late childhood, or even in adulthood. The first cases were reported in patients from Irish-Scottish background; the disease has now been seen in almost all ethnic groups.

Source: American College of Rheumatology

Vasculitis is a term for a group of rare diseases that have in common inflammation of blood vessels. These vessels include arteries and veins. There are many types of vasculitis, and they may vary greatly in symptoms, severity and duration. Most types of vasculitis are rare, and the causes are generally not known. Vasculitis affects persons of both sexes and all ages. A few forms of vasculitis affect certain groups of people. For instance, Kawasaki disease occurs only in children. IgA Vasculitis (Henoch-Schönlein) is much more common in children than adults. On the other hand, giant cell arteritis occurs only in adults over 50 years old.

Vasculitis can result in poor blood flow to tissues throughout the body, such as the lungs, nerves and skin. Thus, vasculitis has a wide range of signs and symptoms (what you see and feel), such as:

• Shortness of breath and cough
• Numbness or weakness in a hand or foot
• Red spots on the skin (“purpura”), lumps (“nodules”) or sores (“ulcers”)

On the other hand, vasculitis of the kidneys may produce no symptoms at first but is still a serious problem. Vasculitis can be mild or disabling, or even lead to death. Patients can have one episode of vasculitis or have repeated episodes over several years. Most types of vasculitis are rare.

Source: American College of Rheumatology