Rheumatoid Arthritis

Immune-mediated inflammatory disorders include a clinically diverse group of conditions sharing similar pathogenic mechanisms. Conditions such as rheumatoid arthritis, psoriasis, spondyloarthropathy, inflammatory bowel disease and connective tissue diseases are characterised by immune dysregulation and chronic inflammation. This review will focus immuno-pathogenic mechanisms, aspects of early disease, co-morbidity and therapy in rheumatoid arthritis

Rheumatoid arthritis

Immune-mediated inflammatory disorders include a clinically diverse group of conditions sharing similar pathogenic mechanisms. Conditions such as rheumatoid arthritis, psoriasis, spondyloarthropathy, inflammatory bowel disease and connective tissue diseases are characterised by immune dysregulation and chronic inflammation. This review will focus immuno-pathogenic mechanisms, aspects of early disease, co-morbidity and therapy in rheumatoid arthritis

Upper limb pain syndromes

This review addresses common questions about upper limb pain that are encountered in practice.http://www.cmej.org.z

Diagnostic utility of, and influence of tobacco usage and genetic predisposition on, immunoglobulin A, rheumatoid factor and anti-citrullinated peptide auto-antibodies in South African rheumatoid arthritis patients

Background: The immunoglobulin A isotypes of anti-cyclic citrullinated peptide antibodies (ACPA) and rheumatoid factor (RF) are associated with disease severity and progression in Caucasian rheumatoid arthritis (RA) patients, as well as with genetic predisposition and tobacco use. Objectives: To compare levels of ACPA-IgA and RF-IgA with those of ACPA-IgG and cRF in a cohort of black South African RA patients and healthy controls.To investigate the relationship between IGA autoantibodies and disease severity, genetic predisposition and tobacco useMethods: RF-IgA and ACPA-IgA were determined in a cohort of predominantly black South African RA patients (n=75) in relation to serodiagnostic and prognostic potential, as well as tobacco use and genetic predisposition. Healthy control subjects were included to determine sensitivity, specificity and predictive values.ACPA-IgG/IgA and RF-IgA were determined by enzyme immunoassay and hs-CRP and cRF by nephelometry. Cotinine levels were determined by ELISA.Results: The frequencies of ACPA-IgA and RF-IgA were 31% and 88% respectively compared to 88% for both types of traditional autoantibody procedures. ACPA-IgA was significantly higher (p=0.007) in patients with short disease duration, while linear regression analysis revealed a positive relationship with baseline disease activity scores. Levels of ACPA-IgG and ACPA–IgA were significantly higher in tobacco users who carried the HLA shared epitope. Conclusion: Although lacking in serodiagnostic superiority over cRF and ACPA-IgG, inclusion of RF-IgA and ACPA-IgA in autoantibody panels may provide insights into disease pathogenesis, interactions between tobacco usage and HLA genotype in the production of potentially disease-triggering ACPA-IgA antibodies.Keywords: Tobacco usage, genetic predisposition, immunoglobulin A, anti-citrullinated peptide, South Africa, rheumatoid arthritis patients

Rheumatoid arthritis

Immune-mediated inflammatory disorders include a clinically diverse group of conditions that share similar pathogenic mechanisms. Conditions such as rheumatoid arthritis (RA), psoriasis, spondyloarthropathy, inflammatory bowel disease and connective-tissue disease are characterised by immune dysregulation and chronic inflammation. This review will focus on immunopathogenic mechanisms, aspects of early disease, co-morbidity and therapy in RA.http://www.safpj.co.zaam201

Rheumatoid Arthritis

Immune-mediated inflammatory disorders include a clinically diverse group of conditions sharing similar pathogenic mechanisms. Conditions such as rheumatoid arthritis, psoriasis, spondyloarthropathy, inflammatory bowel disease and connective tissue diseases are characterised by immune dysregulation and chronic inflammation. This review will focus immuno-pathogenic mechanisms, aspects of early disease, co-morbidity and therapy in rheumatoid arthritis.http://www.safpj.co.za/index.php/safpjhttp://www.tandfonline.com/oemdam2016Internal Medicin

Rekeningkunde 2B

Exam paper for second semeste

Lower limb pain syndromes

Lower limb pain is a common presenting complaint in primary care with aetiological factors such as trauma, repetitive strain injury and systemic inflammatory disorders. This review focuses on some commonly encountered problems when dealing with patients who present with lower limb pathology.http://www.cmej.org.za/index.php/cme

Human immunodeficiency virus infection and inflammatory arthritis : a review of clinical and imaging features

The reported prevalence of articular manifestations of human immunodeficiency virus (HIV) varies, but with sub-Saharan Africa accounting for almost 70% of the people living with HIV, this results in a considerable burden of disease in the region. The spectrum of clinical presentation described, includes articular pain syndrome, HIV-associated arthropathy and seronegative spondyloarthropathies, among others. This brief review serves to create awareness of the clinical and imaging presentation of this spectrum of disease as there is significant morbidity associated with these conditions if treatment is delayed.http://www.sajr.org.zaam2018Internal MedicineRadiolog

Systemic lupus erythematosus : a possible cause of non-alcoholic Wernicke’s encephalopathy

We report a young woman with systemic lupus erythematosus (SLE) and an acute cerebellar ataxia. A history of poor appetite and vomiting preceded the inco-ordination. Ataxia in SLE has been well described, but is nevertheless uncommon. The clinical triad of mild confusion, ataxia and ophthalmoplegia also raised the possibility of Wernicke’s encephalopathy (WE). The diagnosis of WE was further supported by the magnetic resonance imaging features. Owing to overlapping causal factors, this case illustrates the complexity of diagnosing and managing neuropsychiatric syndromes in a patient with SLE. The limited published literature on SLE-related cerebellar syndromes adds to the challenge. Gastrointestinal manifestations of SLE are described as being common in SLE, with nausea and vomiting occurring in >50% of cases in some series. Poor eating habits and vomiting are well-described causes of non-alcoholic WE. This is the first description of gastrointestinal SLE as a possible cause of WE.http://www.samj.org.zaam2017Internal Medicin