Sjogren syndrome and Gouty arthritis

1. Nwabuezeadaobipatricia 624 Sjogren syndrome and Gouty arthritis

2. An Autoimmune T- cell disorder characterized by destruction of exocrine glands (especially lacrimal and salivary). Present with Dry eyes and dry mouth (mikulicz syndrome), arthritis Predominantly affects females 50-60 years old Definition

3. Sjogren syndrome secondary Primary

4. Among the associated disorders, RA is the most common, but some patients have SLE, polymyositis, systemic sclerosis, vasculitis, or thyroiditis. 5% of sjogren patients develop lymphoma

5. There is also systemic B-cell hyperactivity. Most patients with primary Sjögren syndrome have autoantibodies to the RNP antigens SS-A (Ro) and SS-B (La) these antibodies are also present in some SLE patients and are therefore not diagnostic for Sjögren syndrome The disease is probably initiated by a loss of tolerance in the CD4+ T-cell population Etiology

6. Involved tissues show an intense lymphocyte (primarily activated CD4+ T cells) and plasma-cell infiltrate, forming lymphoid follicles with germinal centers. Approximately 25% of the patients (especially those with anti-SS-A antibodies) develop extraglandular disease affecting the CNS, skin, kidneys, and muscles. Morphology

7. Dry mouth and lymphoid infiltration

8. Dry eyes;burning, itch or feel gritty (sand feeling) aka keratoconjunctivitissicca Dry mouth (difficult to swallow or speak) aka xerostomiaTooth decay Joint pain, swelling and stiffness Swollen salivary glands (particularly the set located behind your jaw and in front of your ears) due to lymphocytic infiltrates Skin rashes or dry skin Vaginal dryness Symptoms

9. Inflamed salivary gland and parotid gland

10. Blood tests Eye tests; Shirmer test (filter paper) and Slit-lamp test(slit lamp, drops also help) Imaging Sialogram. dye injected into your parotid glands. This procedure shows how much saliva flows into your mouth. Salivary scintigraphy.  Involves injection of a radioactive isotope, which is used to measure your salivary gland function. Diagnosis

11. Chest X-ray. Because of lung inflammation, a chest X-ray can be done. Biopsy; a small sliver of tissue is removed from salivary glands located in your lip and examined under a microscope. Spit test. In this test, patient spits into a test tube every minute for 15 minutes. The total amount of saliva collected is then measured to determine the severity of dry mouth. Urine sample. urine sample can be analyzed in the laboratory to determine if the kidneys have been affected . Diagnosis

13. Increase production of saliva and tears .pilocarpineand cevimeline. Side effects may include sweating, abdominal pain, flushing and increased urination. Address specific complications.nonsteroidalanti-inflammatory drugs (NSAIDs) or other arthritis medications. Yeast infections in the mouth should be treated with antifungal medications. Treat system-wide symptoms.Drugs that suppress the immune system, such as methotrexate or cyclosporine, may also be prescribed. Surgery surgical procedure to seal the tear ducts that drain tears from your eyes . collagen or silicone plugs are inserted into the ducts for a TEMPORARYclosure. Alternatively, a laser maybe used to PERMANENTLYseal your tear ducts. Treatment

14. GOUTY ARTHRITIS

15. Gout is a disorder of purine metabolism, and occurs when uric acid, crystallizes in the form of monosodium urate, precipitating in joints, on tendons, and in the surrounding tissues Hence gouty athritis is a complex form of arthritis resulting from the condition gout Definition

16. Gout is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the (metatarsal-phalangeal) joint at the base of the big toe (podagra). Tophi occur in some cases

17. Gout occurs when urate (needle-like) crystals accumulate in the joint, causing the inflammation and intense pain of a gout attack. Sometimes your body either produces too much uric acid or your kidneys excrete too little uric acid. Cause

18. Men are more likely to get gout, but women become increasingly susceptible to gout after menopause people with kidney disease, obesity, hypertension (high blood pressure), hyperlipidemia and diabetes. Risk factors

19. Tophi

20. These crystals trigger a local immune-mediated inflammatory reaction, with one of the key proteins (interleukin 1β) in the inflammatory cascade  An evolutionary loss of uricase, which breaks down uric acid, in humans and higher primates has made this condition common. Pathophysiology

23. Intense joint pain;The pain is likely to be most severe within the first 12 to 24 hours after it begins. Lingering discomfort.After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints. Inflammation and redness, tophi Urate nephropathy Symptoms

24. pathophysiology

25. Prognosis

26. Recurrent gout: Without treatment, an acute attack of gout usually resolves in five to seven days; however, 60% of people have a second attack within one year. Advanced gout: Without treatment, episodes of acute gout may develop into chronic gout with destruction of joint surfaces, joint deformity, and painless tophi. With aggressive treatment, they may dissolve.  Kidney stones also frequently complicate gout Other forms of chronic renal dysfunction may occur. Prognosis

27. Joint fluid test; fluid from affected joint when examined under the microscope, the joint fluid may reveal urate crystals. Blood test; measures the uric acid level in your blood. {Some people have high uric acid levels, but never experience gout} Urate level above (6.8 mg/dl) Diagnosis

28. Nonsteroidal anti-inflammatory drugs (NSAIDs).Eg; ibuprofen (Advil) and naproxen (Aleve), indomethacin NSAIDs carry risks of stomach pain, bleeding and ulcers. Colchicine.  A type of pain reliever. A low daily dose helps prevent future attacks. Treatment

29. Corticosteroids. prednisone, may control gout inflammation and pain. Can be administered in a) pill form, or they can be b) injected into the joint. (Pegloticase) Treatment

30. Medications that block uric acid production; xanthineoxidase inhibitors, including allopurinol. Side effects include a rash and low blood counts. Febuxostat (SE; rash nausea and reduced liver function) treatment

31. Medication that improves uric acid removal. Probenecid improves your kidneys' ability to remove uric acid from your body. treatment

32. controlling weight, limiting alcohol consumption, and limiting meals with meats, shellfish and fish rich in purines, can be helpful in controlling gout. Control measures

33. Robbins pathology 8th edition Umsle first aid series 2014 Medscape MayoClinic.com Gout Informationwww.mayoclinic.com/health/gout-diet/MY01137/rss=1 The Arthritis Foundation www.arthritis.org REFERENCE

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