RHEUMATOID ARTHRITIS

What is rheumatoid arthritis (RA)?

Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints. Rheumatoid arthritis can also cause inflammation of the tissue around the joints, as well as in other organs in the body. Autoimmune diseases are illnesses that occur when the body's tissues are mistakenly attacked by their own immune system. The immune system contains a complex organization of cells and antibodies designed normally to "seek and destroy" invaders of the body, particularly infections. Patients with autoimmune diseases have antibodies in their blood that target their own body tissues, where they can be associated with inflammation. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.

While rheumatoid arthritis is a chronic illness, meaning it can last for years, patients may experience long periods without symptoms. However, rheumatoid arthritis is typically a progressive illness that has the potential to cause joint destruction and functional disability.

A joint is where two bones meet to allow movement of body parts. Arthritis means joint inflammation. The joint inflammation of rheumatoid arthritis causes swelling, pain, stiffness, and redness in the joints. The inflammation of rheumatoid disease can also occur in tissues around the joints, such as the tendons, ligaments, and muscles.

In some people with rheumatoid arthritis, chronic inflammation leads to the destruction of the cartilage, bone, and ligaments, causing deformity of the joints. Damage to the joints can occur early in the disease and be progressive. Moreover, studies have shown that the progressive damage to the joints does not necessarily correlate with the degree of pain, stiffness, or swelling present in the joints.

Rheumatoid arthritis is a common rheumatic disease, affecting approximately 1.3 million people in the United States, according to current census data. The disease is three times more common in women as in men. It afflicts people of all races equally. The disease can begin at any age, but it most often starts after 40 years of age and before 60 years of age. In some families, multiple members can be affected, suggesting a genetic basis for the disorder

LEPTOSPIROSIS

What is leptospirosis?

Leptospirosis is an infectious disease caused by a particular type of bacteria called a spirochete. Leptospirosis can be transmitted by many animals such as rats, skunks, opossums, raccoons, foxes, and other vermin. It is transmitted though contact with infected soil or water. The soil or water is contaminated with the waste products of an infected animal. People contract the disease by either ingesting contaminated food or water or by broken skin and mucous membrane (eyes, nose, sinuses, mouth) contact with the contaminated water or soil.

Leptospirosis occurs worldwide, but it is most commonly acquired in the tropics. The U.S. Centers for Disease Control and Prevention states 100-200 cases of leptospirosis are reported each year in the United States, with about 50% of cases occurring in Hawaii.


What are symptoms of leptospirosis?
Leptospirosis symptoms begin from two to 25 days after initial direct exposure to the urine or tissue of an infected animal. This can even occur via contaminated soil or water. Veterinarians, pet shop owners, sewage workers, and farm employees are at particularly high risk. People participating in outdoor sporting activities like canoeing, rafting, hiking, and camping can also come into contact with contaminated water or soil.

The illness typically progresses through two phases:
•The first phase of nonspecific flulike symptoms includes headaches, muscle aches, eye pain with bright lights, followed by chills and fever. Watering and redness of the eyes occurs and symptoms seem to improve by the fifth to ninth day.

•The second phase begins after a few days of feeling well. The initial symptoms recur with fever and aching with stiffness of the neck. Some patients develop serious inflammation of the nerves to the eyes, brain, spinal column (meningitis), or other nerves. Right upper area abdominal pain may occur. Less common symptoms relate to disease of the liver, lungs, kidneys, and heart.

Leptospirosis associated with liver and kidney disease is called Weil's syndrome and is characterized by yellowing of the eyes (jaundice). Patients with Weil's syndrome can also develop kidney disease and have more serious involvement of the organs affected.

How is leptospirosis diagnosed?
The diagnosis of leptospirosis is made by culture of the bacterial organism Leptospira from infected blood, spinal fluid, or urine. However, many doctors must rely upon rising Leptospira antibody levels in the blood in order to make the diagnosis, as the technique required to perform the culturing is delicate and difficult.