The red flags in rheumatology: connective tissue diseases and vasculitides

The word ‘rheumatism’ is well known to most people. They understand it has something to do with joints. The knowledge we need to add here for them is that there is an interaction of the immune system with the joints in a way that result in these disorders. People need to understand the concept of autoimmunity which is basically a situation where the body’s immune system fights against it’s own cells I tissues. Autoimmunity is present to an extent in everyone’s body but when in some, and we don’t know the exact reason why these few are selected but probably as a consequence of genetic and environmental factors (eg., smoking / bad gums / microbes in our intestines etc), it leads to disease.

Connective tissue diseases and vasculitides are two such diseases which can in an occasional patient lead to a life threatening condition. While the former includes diseases like lupus (SLE), Sjogren’s syndrome, scleroderma, myositis etc, the latter includes conditions where there is inflammation of blood vessel walls and these could be supplying the lungs, kidneys, skin or even brain and the heart !

Connective tissue diseases like lupus have a strong propensity to affect females, mostly child bearing age group ones but it can occur at any age and in males too. Children also can be affected in them it is sometimes aggressive. These diseases manifest as rashes, joint pains, excessive hair fall, oral/palatal ulcers, excessively dry mouth and eyes (so much that they have to keep seeing specialist doctors for it), thick and tight skin over face I fingers, gangrene of digits, digital tip ulcers, muscle weakness (can’t lift arms and thighs many times with pain in these) and when vital organs like kidneys / brain are involved they also have swelling / puffiness all over, breathlessness I cough – occasionally with blood and paralysis/severe headaches etc.

IT’S THE CONSTELLATION OF FINDINGS THAT FORM A DISEASE PATTERN – NOT INDIVIDUAL COMPLAINTS WHICH ARE FAR MORE COMMON. So let your family doctor take a call on this.

Vasculitides can present with rashes, gangrene, neuropathies (severe burning tingling numbness of hands / feet with foot / wrist drop), non healing ulcers over legs or elsewhere, joint pains, blood in cough, breathlessness, puffiness all over, less urine or frothy urine and sometimes severe headaches I paralysis / seizures etc. Again let your family doctor take a call on these.

Treatment of both the above is with strong drugs like corticosteroids and other medicines that suppress your immunity. These can cause side effects but they are life saving and specialist doctors like rheumatologists would know how to monitor them.

So the three messages here would be:

  1. Connective tissue diseases and vasculitides are red flags and while you can report if any persistent complaints trouble you to your family doctor – DON’T GET UNNECESSARY TESTS DONE AND MAKE A DIAGNOSIS YOURSELF.
  2. Treatment is there with drugs like steroids which are essential and MOST LIVE A REASONABLE QUALITY OF LIFE ON THESE, SO ONCE ON THESE DON’T STOP YOURSELF FOR FEAR OF SIDE EFFECTS. Most will need to take them for years, if not decades.
  3. These diseases need specialist care and so FOLLOW UP WITH YOUR RHEUMATOLOGIST REGULARLY.

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