ACCP or CCP test—anti-cyclic citrullinated peptide antibody test
The anti-cyclic citrullinated peptide antibody (ACCP) test is prescribed along with or after the rheumatoid factor (RF) test in the diagnosis of rheumatoid arthritis. It is considered more specific than the RF test because RF can be found in other autoimmune diseases or even in healthy people.
Acute
Acute refers to symptoms or conditions that appear, change quickly, or worsen suddenly and last a short time, only a few days or weeks. It is the opposite of chronic.
Adaptive (specialized) immune system
Your immune system has two parts, innate and adaptive. The innate system is your body’s first line of defense against attack by germs and foreign substances. When the innate system fails, the adaptive system takes over. The first time it encounters a substance it responds slower than the innate system, identifying the substance and specifically targeting it. With subsequent exposures, it remembers the substance, and responds immediately. The resultant infection may be milder or go noticed. This is called immunological memory and accounts for your body’s development of immunity to that substance.
The ability to distinguish “foreign” from “self“ is critical to the proper functioning of the adaptive system. Sometimes it fails to do this and acts to destroy the host’s own cells resulting in autoimmune disease.
The adaptive immune system is made up of:
Allopurinol
Allopurinol is a drug used to prevent gout attacks, not treat them. It does this by reducing the production of uric acid by your body.
ALT test—alanine aminotransferase test
Alanine aminotransferase (ALT) is an enzyme that helps the liver convert food into energy. ALT tests that show high levels can indicate liver damage. Damage occurs mostly in patients with rheumatoid arthritis who are being treated with NSAIDs and methotrexate. ALT used to be called serum glutamic-pyruvic transaminase, or SGPT.
ANA test—antinuclear antibody test
The antinuclear antibody (ANA) test detects antinuclear antibodies in your blood, which are proteins that attack your body’s own tissues, targeting each cell’s nucleus.
Positive results usually indicate that your immune system has launched an autoimmune reaction, attacking your own tissue. This can indicate an autoimmune disease, including rheumatoid arthritis, lupus, scleroderma, and Sjögren’s syndrome. However, it’s important to note that some healthy people have positive ANA tests.
Analgesics
Analgesics, also referred to as painkillers or pain relievers, are medications used to relieve pain. There are two types. Anti-inflammatory ones reduce inflammation or swelling at the pain site and include acetaminophen, aspirin, COX inhibitors, and NSAIDs.
Analgesic opioids, also called narcotics, act on opioid receptors in the brain, changing how the brain perceives pain. They can be naturally occurring opiates derived from opium, and include morphine and codeine, or are semi-synthetic and synthetic, and include hydrocodone, oxycodone, and fentanyl.
Ankylosing spondylitis
Ankylosing spondylitis is a subgroup of axial spondyloarthritis that mainly affects the joints in the back resulting in stiffening of the spine. “Ankylosing” refers to the tendency of the spine to fuse or “ankylose.” “Spondylitis” refers to the inflammatory process (“itis”) of the spine.
As the disease progresses, new bone forms as your body attempts to heal. Over time this bone bridges the gaps between vertebrae, fusing sections together, and flattening the natural curve of the spine. The result is a hunched posture. Other joints can be affected, including the hips, knees, and chest wall, and it can cause inflammation at the entheses—areas where tendons attach to bone.
Although its cause is unknown, ankylosing spondylitis tends to run in families and most people with it have the gene HLA-B27.
Anti-dsDNA—anti-double stranded DNA
The anti-double stranded DNA (dsDNA) antibody binds to normal DNA in patients’ cells. High titers are found almost exclusively in those with lupus while low titers can occur in other rheumatic diseases, including rheumatoid arthritis. Not all patients with lupus have the anti-dsDNA antibody. Patients who have lupus but do not have anti-dsDNA often have a related antibody, anti-Sm.
Anti-RNP— antinuclear ribonucleoprotein
Antibodies to ribonucleoprotein (anti-RNP) occur in many patients with lupus and other rheumatic diseases.
Anti-Ro/SSA and anti-La/SSB
Elevated levels of these antibodies may indicate Sjögren’s syndrome or lupus.
Anti-Sm—anti-Smith
Anti-Smith (anti-Sm) is the antibody seen in most patients with lupus who do not have anti-dsDNA. Some patients have both anti-dsDNA and anti-Sm.
Antibody
Antibodies are proteins produced by B-lymphocytes to fight antigens, which are germs and other potentially harmful foreign substances. By detecting and then attaching to them, antibodies neutralize these “intruders” and attract other immune system cells to help. An antibody only attaches to an antigen if it matches exactly. They are part of the adaptive immune system.
Antigen
An antigen is a substance that tells your body something is foreign and induces production of an antibody against it. Exogenous ones come from outside the body entering through the nose, mouth, and cuts in the skin. Endogenous antigens exist on cells inside your body and let your immune system know if they are friendly or harmful. Autoantigens or self-antigens are impaired markers on your own cells that your immune system attacks by mistake, leading to autoimmune diseases. Tumor antigens are markers on the surface of tumors.
aPL—antiphospholipid antibodies
Antiphospholipid antibodies (aPL) are antibodies that attack phospholipids (a type of fat), which often make up the surface of cells. Approximately 50% of people with lupus possess these antibodies. Over time they can cause blood clots to form in arteries and veins. People without lupus can also have these antibodies.
Arthralgia
Arthralgia is pain in a joint caused by injury or other conditions. It can be linked to autoimmune diseases, including rheumatoid arthritis, lupus, gout, and osteoarthritis. Signs include swelling, warmth, tenderness, redness, and pain with movement.
Arthritis
Arthritis refers to joint pain or joint disease that usually involves inflammation or degeneration of your joints causing pain when the joint is used. There are more than 100 types of arthritis and related conditions, and it is the leading cause of disability in the US.
Each type of the disease has its own cause, diagnostic tools, and treatments. There is no cure but various treatments help manage the condition.
Arthritis Basic Panel
The Arthritis Basic Panel includes four tests that evaluate inflammation:
Arthropathy
Arthropathy is a term for any disease of the joints. Symptoms include joint swelling and stiffness as well as reduced range of motion. Arthritis is a form of arthropathy.
Arthroscopy
Arthroscopy is a procedure that involves inserting a fiberoptic camera through a small incision into the joint space to examine the interior of the joint. It can be used to help diagnosis rheumatoid arthritis and provide a way to repair damage to joint tissues, including removing bone or cartilage, or repairing ligaments.
Research indicates most patients with osteoarthritis do not benefit from this procedure because it usually doesn’t relieve pain, and there may be rare but serious complications as well as a long recovery time.
AST test—aspartate aminotransferase aka SGOT test (see liver enzymes)
The aspartate aminotransferase (AST) tests measure the amount of AST in your blood. AST is an enzyme found mostly in liver cells and is released into your blood when the cells are damaged. Abnormalities on liver function tests are not uncommon in patients with inflammatory arthritis and are commonly due to disease-modifying anti-rheumatic drugs (DMARDs).
Higher than normal levels of AST are a more reliable indicator of liver issues than ALT because AST is found in more parts of the body.
Autoantibodies
When you have an autoimmune disorder, your immune system fails to distinguish between “self” and “non-self” and attacks the cells, tissues, and organs of your body. Autoantibodies are the antibodies your body produces against an antigen of its own cells and tissues.
It is thought that many cases of autoantibody production are the result of a genetic predisposition combined with an environmental trigger. There may also be a hormonal component.
Autoimmune disease
Autoimmune diseases occur when there is a malfunction of the body’s immune system and it attacks and destroys healthy organs instead of protecting the body.
Autoimmunity
In a normal immune system some lymphocytes are able to react against self, but are usually suppressed. Autoimmunity occurs when there is some interruption of the usual controls, allowing lymphocytes to avoid suppression, resulting in autoimmune disease. How this can happen is not completely understood.
Axial spondyloarthritis (axSpA)
Axial spondyloarthritis (axSpA) is an inflammatory rheumatic disease that causes pain and swelling in the spine and joints that connect the bottom of the spine to the pelvis (sacroiliac joint). It exhibits a characteristic pattern of back pain referred to as inflammatory back pain. Other joints can be affected as well. AxSpA tends to run in families.
There are two types of axSpA:
The exact cause of axSpA is not clear. Many people with axSpA have a gene called HLA-B27.
B lymphocytes
B lymphocytes are a type of white blood cell that produces antibodies. They are part of the adaptive or specialized immune system. B cells take their name from the “B” in “bone marrow,” which is where they are made and mature.
B cells are activated by helper T cells causing them to make copies of themselves. Some will become plasma cells that release antibodies in response to detected antigens. Others become memory cells that allow your immune system to remember particular antigens in the future and quickly mount a defense.
Sometimes abnormal B cells are produced that create antibodies in response to antigens associated with your body’s healthy cells and attack them. This results in an autoimmune disease.
Behçet’s disease
Behçet’s disease, also called Behçet’s syndrome or Silk Road disease, is a rare disorder characterized by blood vessel inflammation throughout your body. Inflammation in the eyes, also known as uveitis, is common in patients with Behçet’s disease. There is no cure, and the cause is unknown.
Biologics
Biologics are a subset of a class of medications called disease-modifying anti-rheumatic drugs (DMARDs). They consist of large molecules made in live cells that target specific parts of your immune system where there is inflammation. They include gene therapies, transplant tissue, recombinant proteins, stem cell therapies, and monoclonal antibodies.
Unlike conventional DMARDs, which suppress the overall immune system, biologics block specific parts of the immune system, such as proteins that promote inflammation. However, they may increase your risk for certain conditions, including serious infections and cancers.
The four types of biologics are:
Biologics don’t come in pill form. Some are in the form of a self-injection; others are given by intravenous infusion in a doctor’s office or clinic.
BLyS-specific inhibitors—B lymphocyte stimulator specific inhibitors
Abnormal B cells play a crucial role in the development of lupus. B lymphocyte stimulator (BLyS) is a factor in B cell differentiation, homeostasis, and selection. High levels may affect B cell selection, contributing to autoantibody production and worsening the disease state. Inhibitors that target it may provide a valuable treatment for patients with lupus.
Calcinosis cutis
Calcinosis cutis is a condition in which calcium salts are deposited in the skin and subcutaneous tissue. It represents a severe complication of several autoimmune disorders, including lupus. (Also see CREST)
Cartilage
Cartilage is strong, flexible connective tissue that coats the ends of your bones where they form joints. It acts as a shock absorber, cushioning your bones and preventing their ends from rubbing against each other.
As you age, wear and degradation of the cartilage occurs. As a result, your bones are not properly cushioned, and the joint becomes damaged. As bone starts to rub directly against bone, the loss of protective coating causes the pain, stiffness, reduced range of motion, and joint inflammation of osteoarthritis.
There are three types of cartilage:
CBC—complete blood count
A complete blood count (CBC) is a blood test that measures various levels of cells and chemicals in your blood, including:
A CBC can be used to detect diseases of the immune system, for example, low white blood cell counts or leukopenia are found in lupus. Low red blood cell levels indicate anemia, common in people with rheumatoid arthritis. Low platelet and white blood cells levels can sometimes occur in people taking biologics.
Chronic
Chronic conditions develop slowly and may worsen over time. They can last months or years and require ongoing medical attention or limit activities of daily living or both.
CMP—comprehensive metabolic panel
A comprehensive metabolic panel (CMP) is a test that measures 14 different substances in your blood, providing information about your body’s chemical balance and metabolism. It can also be used to assess whether changes to medication are needed. A CMP includes tests for glucose; calcium; sodium, carbon dioxide, potassium, and chloride; albumin; total protein; ALP, AST, and ALT; bilirubin; bun and creatinine.
Collagen
Collagen is the most abundant protein in your body. Its fiber-like structure provides support or strength to your skin, muscles, bone, tendons, ligaments, and other connective tissue. Your body produces less collagen as you age, and existing collagen breaks down faster.
Autoimmune diseases, including rheumatoid arthritis, lupus, and scleroderma are known to damage cartilage. But collagen is also known to decline with age.
Collagen’s use as a supplement has been extensively studied in osteoarthritis and the findings are positive.
Collagen vascular diseases
This group of diseases, also called connective tissue diseases, cause chronic inflammation in your connective tissue. Many are autoimmune, including lupus, ankylosing spondylitis, scleroderma, rheumatoid arthritis, and Sjögren’s syndrome. Their cause is unknown, and there is no cure.
Comorbidity
Comorbidity describes the existence of two or more disorders or illnesses occurring in the same person. They are often chronic and long term and can occur at the same time or one after the other. Comorbidity also implies interactions between the illnesses that can worsen the course of both. They are common among adults with rheumatic disease like arthritis.
Complement level: C3, C4, and CH50
The complement system is part of your body’s innate immune system. Its principal role is to help identify, destroy, and remove foreign pathogens as well as damaged self cells and proteins. It is so named because it “complements” or aids the natural body defenses, such as antibodies. The complement system is activated when your body makes antibodies, whether against itself or foreign invaders. Your body makes antibodies against its own tissues that it thinks are foreign (autoantibodies) in various autoimmune diseases.
Complement tests measure the amount or activity of complement proteins in the blood. If your complement protein levels aren’t normal or the proteins aren’t working with your immune system as they should, it can be a sign of an autoimmune disease such as lupus or rheumatoid arthritis.
Complement components may be measured individually or together to determine whether your system is functioning normally. It is generally enough to measure only two of the complement proteins, called C3 and C4. CH50, or total complement, is a blood test that measures all the complement proteins at once and may give additional information.
Corticosteroids
Corticosteroids, also referred to as steroids, are medications, including cortisone, hydrocortisone, and prednisone. They are the fastest, most effective way to reduce inflammation, easing symptoms of inflammatory conditions, including arthritis. They reduce inflammation because they are chemically similar to cortisol, one of your body’s natural anti-inflammatory hormones, made in the adrenal glands. However, because they are immunosuppressive there is a range of side effects, some very serious, associated with taking them, so they are generally prescribed at a low dose for a short period of time while disease-modifying anti-rheumatic drugs (DMARDs) or biologics take full effect or during a severe flare of symptoms.
Counterirritants
Topical counterirritants do not actually treat pain, but change how pain is perceived. They do this by irritating the skin and creating a temporary hot and/or cold sensation that interrupts pain signals to the brain, essentially distracting the brain.
The most common types of counterirritants include salicylates, capsaicin, and lidocaine and are available as creams, gels, or patches that stick to the skin. Menthol, eucalyptus, camphor, and wintergreen are all counterirritants. They provide modest pain relief but are not effective for relieving severe pain.
COX 1 & 2—cyclooxygenase inhibitors 1&2
Both cyclooxygenase (COX)-1 and COX-2 are enzymes that produce prostaglandins that contribute to pain, fever, and inflammation. But COX-1 also protects the stomach and intestines so using drugs that inhibit this cyclooxygenase can lead to unwanted side effects.
Traditional nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, aspirin, and naproxen, are nonselective, which means they are COX-1 and COX-2 inhibitors commonly prescribed to treat many types of arthritis. They work by inhibiting prostaglandins but can cause gastrointestinal problems.
In the late 1990s, NSAIDs that only target COX-2 were developed with the goal of reducing pain and inflammation without losing the protection of COX-1 in the gastrointestinal tract. Celecoxib is the only COX-2 inhibitor that remains on the market in the United States today, but it carries a warning about cardiovascular risk.
CREST—calcinosis, Raynaud’s phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia
CREST is an acronym for the clinical features of scleroderma, a connective tissue disease that can involve many parts of your body. The “C” stands for calcinosis— calcium deposits that form in the subcutaneous layer of the skin. The “R” stands for Raynaud’s phenomenon—extreme sensitivity to cold or stress. The “E” represents esophageal dysfunction, which can cause difficulty in swallowing. The “S” is for sclerodactyly—tightening of the skin causing your fingers to bend. And the letter “T” is for telangiectasia—spider veins. Usually only 2 of the 5 symptoms of the CREST syndrome are necessary for you to be diagnosed with the disease.
CRP test—C-reactive protein test
C-reactive protein (CRP) is made by the liver, which releases more into your bloodstream if you have inflammation in your body. The test checks for the amount of inflammation, but it can’t reveal where or why it exists. It is often done with the erythrocyte or sedimentation rate (ESR) test, which also looks for inflammation.
High levels of CRP may mean the presence of a serious health condition that causes inflammation, including autoimmune diseases like rheumatoid arthritis (RA) and lupus. However, CRP levels may not be increased in some people with RA and lupus. The reason for this is unknown.
CT—computed tomography
A computerized tomography (CT) scan consists of a series of X-ray images taken from different angles around your body. It produces cross-sectional images or “slices” of your bones, blood vessels, and soft tissues. CT imaging is also known as computerized axial tomography (CAT) scanning.
Magnetic resonance imaging (MRI), CT scans, and ultrasound images are more sensitive than regular X-rays for the detection of early signs of rheumatoid arthritis.
Cytokines
Cytokines are proteins that function as chemical messengers regulating inflammation in your body by signaling your immune cells how to fight threats and repair tissue. Pro-inflammatory cytokines trigger or heighten a response. Anti-inflammatory ones decrease or stop your body’s immune response when it is no longer needed. Too many cytokines can lead to excess inflammation and autoimmune disease. Several types of cytokines exist, including chemokines, interferons, interleukins, tumor necrosis factor, colony-stimulating factors, lymphokines, and monokines; each affects the immune system differently.
Dactylitis
Dactylitis is a condition consisting of severe swelling of your fingers and/or toes giving your digits a round, puffed up appearance commonly referred to as “sausage fingers.” Arthritis is the most common cause of dactylitis.
DAS28—Disease Activity Score with 28 joint counts
The Disease Activity Score with 28 joint counts (DAS28) test is used to assess disease activity in rheumatoid arthritis and combines a count of tender and swollen joints, an assessment of health, and lab tests to identify inflammation.
Degenerative joint disease
Commonly referred to as osteoarthritis, degenerative joint disease is the most common form of arthritis and is characterized by inflammation and joint damage resulting from the chronic, repetitive motion of your joints. As the disease progresses, this leads to the breakdown of cartilage, the substance that cushions your joints and provides them with a smooth gliding surface. The resulting pain, stiffness, swelling, and loss of cartilage limit activity and reduce your quality of life. It most frequently affects the knees, hands, hips, and spine.
DMARDs—disease-modifying antirheumatic drugs
Disease-modifying antirheumatic drugs (DMARDs) stop or slow the disease process in inflammatory forms of arthritis. They are immunosuppressive and immunomodulatory agents classified as either conventional or biologic. Each DMARD has a unique mechanism of action that ultimately interferes with critical pathways in the inflammatory cascade.
Nonbiologic or conventional DMARDs are composed of small molecules made from chemicals in a lab. Biologics are large molecules produced in living cells. Both help protect against the effects of inflammation, but in different ways. Conventional DMARDs include methotrexate and hydroxychloroquine. Biologic DMARDs are usually prescribed after the failure of conventional DMARD therapy and include infliximab, adalimumab, etanercept, and rituximab, and are very selective in their mechanism of action.
DNA—deoxyribonucleic acid
Deoxyribonucleic acid (DNA) carries the genetic information for the development and functioning of an organism also known as its genome. Shaped like a double helix, it is comprised of two linked strands.
Enthesitis
An enthesis occurs where a tendon or ligament inserts into a bone. When one becomes inflamed due to repeated stress on it, microscopic damage builds up over time. The immune system responds by releasing proteins called cytokines, causing the enthesis to become inflamed, a condition called enthesitis.
One in three people with psoriatic arthritis (PsA) will develop enthesitis, and it is found in other forms of axial spondyloarthritis. Symptoms include pain and stiffness, especially when you move. Constant inflammation may promote abnormal bone growth, producing uncomfortable bone spurs. It is also linked to changes in the finger- and toenails seen in many PsA patients.
Enzyme
An enzyme is a type of protein that acts as a catalyst allowing certain bodily processes to happen without being affected itself. They are needed for all bodily functions.
ESR test—erythrocyte sedimentation rate or sed rate test
The erythrocyte sedimentation rate (ESR) blood test determines the amount of inflammation in your body by measuring how fast red blood cells (erythrocytes) cling together and settle to the bottom of a tube over the course of an hour. It is not specific as to what kind of inflammation there is or where it occurs, but most people with an elevated rate will have an autoimmune disease. Doctors may use it, along with other tests, to diagnose an inflammatory condition or to monitor an existing condition like arthritis.
Fibromyalgia
Fibromyalgia is a disorder characterized by widespread aching and burning musculoskeletal pain that is accompanied by fatigue, sleep, cognitive, and mood issues. You have heightened sensitivity to pain because the pain signals sent through your central nervous system (brain and spinal cord) are turned up too high, a condition called centralized pain or central amplification. That’s why you react more strongly to pressure, heat, sound, or light than people without the condition. Your body is also tender to the touch at trigger points.
Women and those with rheumatoid arthritis, lupus, or other autoimmune diseases are more likely to develop fibromyalgia, which is not an autoimmune disease but is considered a pain disorder. What causes fibromyalgia is not fully understood, but it tends to run in families and environmental factors may play a role. There is no cure for fibromyalgia, but symptoms can be treated and managed.
Flare
A disease flare occurs when your symptoms worsen and/or your medications don’t seem to be working. Flares are common in arthritis, but their triggers are different for different types of arthritis. Being aware of how your body feels and what seems to trigger a flare can help in their management.
Floaters
Floaters consist of strands of your vitreous (the gel-like fluid that fills your eye) that stick together and cast shadows on your retina. These are seen as small dark shapes that float across your vision. They can be a natural result of aging or a symptom of uveitis, a type of eye inflammation.
Treatment for floaters depends on the cause. If they are the result of aging and don’t bother you, there is no need to treat them. If they make it hard to see clearly and interfere with your daily life, a surgical procedure to remove them, called a vitrectomy, can be performed. However, if your floaters are caused by another condition, like uveitis, you need to determine if you need treatment for that condition.
Gout
Gout is the most common form of inflammatory arthritis and is caused by hyperuricemia, a condition that results when there is too much uric acid in the body. However, you can have hyperuricemia and not develop gout.
Uric acid is produced when your body breaks down purines, substances found naturally in your body and in certain foods like red meat, shellfish, and alcohol. When there is too much uric acid in your body, uric acid crystals can build up in the joints, fluids, and tissues, especially the big toe, resulting in sudden, severe attacks of pain, swelling, redness, and tenderness that often occur at night.
There are four stages of gout. Tophaceous gout is the most severe and usually only develops in people with chronic, untreated gout. It occurs when the uric acid crystals form masses of white growths called tophi around the joints and tissues. These can become infected, cause pain, and lead to reduced function.
Men are three times more likely to develop gout. The disease alternates between times when symptoms get worse, known as flares, and times when you are asymptomatic, known as remission. Multiple recurrences can lead to gouty arthritis, a form of arthritis, which gets progressively worse.
Drugs used to treat gout include NSAIDs; corticosteroids; colchicine, a drug that relieves gout pain; and allopurinol, a drug that helps limit the amount of uric acid your body produces. Lifestyle changes, including reducing or eliminating purine-rich foods and alcoholic beverages, are also important.
HCT test—hematocrit test
The hematocrit (HCT) test measures the percentage of red blood cells in your blood. Red blood cells carry oxygen throughout your body and low or high red blood cell counts may indicate blood disorders or suggest medications, such as NSAIDs or corticosteroids, might be causing gastrointestinal bleeding. Conditions such as rheumatoid arthritis and lupus may also reduce your red blood count.
The test is part of a complete blood count (CBC).
Hgb test—hemoglobin test
The hemoglobin (Hgb) test measures the level of hemoglobin in your blood, a protein in your red blood cells that carries oxygen from your lungs to the rest of your body. Abnormal levels may indicate a blood disorder like anemia. About 80% of people with rheumatoid arthritis have anemia.
This test is part of a complete blood count (CBC).
HLA—human leukocyte antigen
Most genes associated with arthritis belong to a family called the human leukocyte antigen (HLA) complex. It helps your immune system tell the difference between your own cells and harmful pathogens like viruses and bacteria.
When faulty HLA genes are active, your immune system may not be able to do its job as well as it should. There are hundreds of HLA genes, but one gene, HLA-B27, is strongly associated with the family of rheumatic diseases called spondyloarthropathies. It is believed that HLA-B27 may disrupt the functioning of your gut microbiome, the trillions of bacteria, viruses and fungi that reside in your digestive tract.
A positive result on a test for HLA-B27 suggests a greater-than-average risk for developing or having certain autoimmune disorders that also include ankylosing spondylitis, psoriatic arthritis, uveitis, and juvenile idiopathic arthritis.
Hydroxychloroquine
Hydroxychloroquine is a DMARD used to treat lupus, juvenile idiopathic arthritis, and rheumatoid arthritis. It may work by decreasing the activity of the immune system.
Hydroxychloroquine can reduce pain, swelling, and joint stiffness. It may also improve the rash in lupus. Hydroxychloroquine is often taken in combination with other drugs such as methotrexate.
Hyperuricemia
Hyperuricemia indicates the presence of high uric acid levels in your body. Uric acid is a waste product produced when your body breaks down purines, chemicals found naturally in the body or in certain foods like red meat, shellfish, and alcohol. Uric acid can clump forming sharp crystals, called urate crystals that settle in your joints spurring an immune response that causes joint inflammation and can lead to gout.
Idiopathic
Any disease of uncertain or unknown origin is classified as idiopathic.
IgG—immunoglobulin G
Immunoglobulin G (IgG) is your body’s most abundant class of immunoglobulin. It binds to many kinds of pathogens, protecting the body from infection. Your body retains an “immunologic memory” of all the IgG antibodies you have made so if you’re reexposed to the same pathogen, your immune system can quickly make more antibodies.
Individuals with lupus and rheumatoid arthritis are characterized by the presence of high levels of circulating IgG autoantibodies.
IgM—immunoglobulin M
Immunoglobulin M (IgM) is the first immunoglobulin produced when your body is exposed to an antigen. It provides short-term protection while your body makes other antibodies. Individuals with lupus and rheumatoid arthritis are characterized by the presence of high levels of circulating IgM autoantibodies.
Immunoglobulins
Immunoglobulins, also called antibodies, are proteins produced by plasma B white blood cells. They bind to antigens such as bacteria and viruses, and aid in their destruction.
You have five classes of immunoglobulin—IgA, IgD, IgE, IgG, and IgM—each with a different role in the immune response. Immunoglobulin levels are useful for monitoring autoimmune diseases. Individuals with lupus and rheumatoid arthritis are characterized by the presence of high levels of circulating IgM and IgG autoantibodies.
Intravenous immunoglobulin (IVIG) therapy is effective in treating symptoms associated with a variety of autoimmune disorders including, but not limited to, rheumatoid arthritis and lupus. These symptoms include fatigue, joint pain, muscle weakness, skin rashes, and neurological disturbances. IVIG accomplishes this by regulating the immune response, neutralizing autoantibodies, exerting immunomodulatory effects, suppressing aberrant immune reactions, and mitigating inflammation.
Immunological memory
Immunological memory, a part of the adaptive immune system, is specific for a particular antigen. It is the ability of that system to recognize and quickly respond to pathogens it has previously encountered.
Immunosuppresents
Immunusuppresents are drugs that lessen or stop the action of the immune system in autoimmune forms of arthritis resulting in a reduction in chronic inflammation and pain and a slowing down of the destruction of joint tissue. They include both conventional and biologic DMARDs. All of these weaken your immunity resulting in a higher risk of both common and serious infections.
Inflammation
Inflammation is your body’s way of fighting things that harm it, like infections, injuries, and toxins. In acute inflammation, innate system immune cells rush to the offending area and initiate an inflammatory response resulting in the redness, heat, swelling, and pain we commonly associate with inflammation. If this response continues, when there is no longer a need, the result is chronic inflammation. In chronic inflammation, your body’s inflammatory response can eventually start damaging healthy cells, tissues, and organs. Chronic inflammation is associated with autoimmune diseases like rheumatoid arthritis and ankylosing spondylitis.
Inflammatory arthritis (IA)
Inflammatory arthritis (IA) consists of a group of diseases caused by an overactive immune system. It typically affects the joints, but it can also be systemic, with symptoms that affect other areas of the body.
There are two basic types:
Inflammatory forms of arthritis are much less common than osteoarthritis, which is the most common type of arthritis. Although there are many exceptions, inflammatory arthritis generally starts earlier in life, and osteoarthritis later in life. The causes are as varied as the types of conditions,
Innate (general) immune system
The innate immune system consists of barriers, including the skin, mucous membranes, immune system cells, and proteins. It is the defense system you were borne with and your body’s first line of defense against antigens, including viruses, fungi, bacteria, toxins, drugs, and foreign particles. But it responds in the same way to all “germs” and foreign substances, which is why it is sometimes referred to as the “nonspecific” immune system. It acts very quickly but has only limited power to stop germs from spreading.
The adaptive immune system takes over if the innate immune system is not able to destroy the germs.
Interferons (IFNs)
Interferons (IFNs), a type of cytokine, are proteins released by your cells in response to the presence of pathogens such as viruses, bacteria, parasites, or tumor cells. Interferons “interfere” with viral replication within host cells; activate immune cells, such as natural killer cells and macrophages; increase recognition of infection or tumor cells; and increase the ability of uninfected host cells to resist new infection. Symptoms, including aching muscles and fever, are related to the production of IFNs during infection.
If levels of interferon are too high, instead of playing a protective role, interferons can contribute to the development of autoimmune disease such as lupus and Sjögren’s syndrome.
IL 17—interleukin 17
Interleukin 17 (IL17), aka 17A, is a pro-inflammatory cytokine. Although protective in infections, overproduction of IL-17 promotes inflammation in autoimmune diseases. In rheumatoid arthritis, IL-17A acts locally contributing to synovitis and joint destruction.
IL-17 inhibitors are used successfully in the treatment of rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.
Interleukins (IL)
Interleukins (IL) are a subset of a larger group of cellular messenger molecules called cytokines. They have a variety of functions that play an essential role in activating and directing other immune cells to divide and differentiate. They also have pro-inflammatory and anti-inflammatory properties.
Interleukins get their name from “inter,” which means between and “leukocyte,” which is another name for white blood cell.
Interleukins are not stored within cells but get secreted in response to a stimulus, such as an infectious agent. Once produced, the interleukin travels to its target cell and binds to it via a receptor on the cell’s surface. This launches a cascade of signals within the target cell that ultimately alter the cell’s behavior.
JAK inhibitors—Janus kinase inhibitors
The Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway is a signaling pathway involved in the pathogenesis of inflammatory and autoimmune diseases. Polymorphisms in JAK and STAT genes are associated with autoimmune diseases.
Small-molecule JAK inhibitors (Jakinibs) suppress the signaling involved in these pathological processes. In addition to rheumatoid arthritis, JAK inhibition has potential for treatment in other autoimmune diseases, including lupus, Sjögren’s syndrome, scleroderma, and spondyloarthritis.
Juvenile idiopathic arthritis (JIA)
Juvenile idiopathic arthritis (JIA), sometimes referred to as juvenile arthritis, refers to a group of inflammatory and rheumatic diseases that develop in children under the age of 16.
It consists of:
“Idiopathic” means unknown because researchers aren’t sure why kids develop JIA. Kids with JIA may have certain genes that are activated by a virus, bacteria, or other external factors. There is no cure for JIA but remission is possible. Several kinds of medications are used to treat JIA, including corticosteroids and DMARDs. Early aggressive treatment is key to getting the disease under control as quickly as possible.
Leukocytes
Leukocytes are another name for white blood cells. They circulate in your bloodstream, protecting your body from injury or infection. When a part of your body is under attack, white blood cells rush in to help destroy the harmful substance and prevent illness.
There are five types of leukocytes:
Leukopenia
Leukopenia is a condition in which your blood contains less than normal counts of white blood cells called neutrophils. Neutrophils serve as your immune system’s first line of defense, and low counts make you more susceptible to infection. Autoimmune disorders that attack the white blood cells or bone marrow cells, such as lupus or rheumatoid arthritis, can cause leukopenia. Almost all untreated patients with lupus will have the condition.
Leukotrienes
Leukotrienes are chemical messengers that play pivotal roles in acute and chronic inflammation and allergic diseases by activating the immune response after infection, injury, or contact with allergens. Although their role in inflammatory processes is beneficial to help fight diseases, higher levels of these chemicals can provoke most signs and symptoms of rheumatoid arthritis. They do this by initiating, coordinating, sustaining, and amplifying the inflammatory response through recruitment of leukocytes.
Liver enzymes
Elevation of results on liver function tests is commonly observed in systemic autoimmune diseases, including lupus, rheumatoid arthritis, and Sjögren’s syndrome. Measuring levels of enzymes in the blood can help your doctor determine if you have liver damage, which may be related to that condition. It can also help doctors determine if medications have damaged your liver.
A liver panel checks for albumin, a protein made by the liver; bilirubin, a component of bile that is made by the liver; and liver enzymes, including alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and gammaglutamyl transpeptidase (GGT).
Lupus
Lupus is a chronic, autoimmune disease that can damage any part of your body. It is sometimes referred to as systemic lupus erythematosus, but that is just the most common form of the disease.
Lupus is more common among women aged 15 to 44 years. It can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. This is why it is often called “the great imitator.”
Lupus consists of:
The most distinctive sign of lupus is a facial rash that resembles the wings of a butterfly unfolding across both cheeks. It occurs in many but not all cases of lupus. Other symptoms include fatigue or extreme exhaustion, fever, hair loss, and recurrent mouth sores.
The cause of lupus in most cases is unknown. It may result from a combination of your genetics and environment. If you have an inherited predisposition, you may develop lupus when you come into contact with a trigger in your environment. Some potential triggers include: sunlight, infections, and medications.
If you have you lupus can have periods of flares, followed by symptom-free periods called remissions. There is no cure for lupus, but many with the disease can manage their symptoms with proper treatment, which can include hydroxychloroquine, NSAIDs, corticosteroids, and immunosuppresants.
Lupus nephritis
Lupus nephritis occurs when lupus autoantibodies affect parts of the kidneys that filter out waste causing swelling and irritation. It might lead to blood in the urine, protein in the urine, high blood pressure, kidneys that don’t work well, or even kidney failure. Lupus nephritis is treated with medicines that suppress your immune system to stop it from attacking and damaging your kidneys.
Kidney damage is one of the more common health problems caused by lupus and typically occurs three years after the onset of the disease.
Lymphocytes
Lymphocytes are white blood cells that circulate in your blood and help protect you from disease and infection. There are two main types of lymphocytes that are part of your adaptive immune system: T cells and B cells. B cells produce antibodies that target viruses, bacteria, and other foreign invaders. T cells are direct fighters of foreign invaders and also produce cytokines, which are biological substances that help activate other parts of the immune system. Natural killer cells are also lymphocytes that destroy infected and cancer cells but are part of your innate immune system.
Lymphopenia
Lymphopenia, also known as lymphocytopenia, occurs when you don’t have enough white blood cells called lymphocytes, which play an important role in your immune system, protecting you from infection. Reduced lymphocyte counts are found in several autoimmune diseases, including rheumatoid arthritis, lupus, and Sjögren’s syndrome.
Macrophages
Macrophages are a type of white blood cell that play a critical role in the initiation, maintenance, and resolution of inflammation. They are part of the innate immune system.
When damage or infection occurs, macrophages release cytokines, initiating an inflammatory response at the site. Upon arriving, pro-inflammatory M1 macrophages function as the first responders, consuming pathogens or damaged cells via a process called phagocytosis. Then the site is taken over by anti-inflammatory M2 macrophages that work toward reducing inflammation and assist in the restoration of damaged blood vessels.
The macrophage is also involved in assisting other immune cells to mount an immune response at the site of inflammation. This includes roles in identifying pathogens and communicating with other immune cells to mount an adaptive immune system response.
MBDA test—multi-biomarker disease activity test (see Vectra DA)
The multi-biomarker disease activity (MBDA) blood test measures 12 biomarkers to provide an objective measure of disease activity in those already diagnosed with rheumatoid arthritis.
Memory B and T cells
Memory cells are able to recognize foreign particles they were previously exposed to. They don’t respond immediately when they first encounter an antigen but facilitate a more rapid secondary response when the antigen is reencountered.
Memory B and T cells are subsets of B and T lymphocytes. Memory B cells are cloned from the original B cell that produced an antigen and have memory of it. But unlike memory B cells, memory T cells do not produce antibodies. Re-exposure to pathogens causes them to clone themselves immediately and respond to the infection.
Memory B and T cells persist in the body for many years, providing lifelong protection against reinfection by the same pathogen.
Methotrexate
Methotrexate is a conventional DMARD used to reduce the activity of an overactive immune system. It is one of the most effective and widely used medications for treating inflammatory types of arthritis, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, lupus, Sjögren’s syndrome, juvenile inflammatory arthritis, and scleroderma.
Microbiome
Your microbiome consists of all microbes, such as bacteria, fungi, viruses, and their genes, that naturally live on your body and inside you. Everyone has their own unique microbiota that protect against pathogens, help your immune system develop, and enable you to digest food.
These microbes are your immune system’s first teachers, training it to attack foreign invaders but not your own cells. When something major disturbs your microbiome, its signals to the immune system can go awry, leading to chronic inflammation. Studies suggest that imbalances in the microbiome may be a factor in the activation of autoimmune conditions like rheumatoid arthritis and lupus.
Monocytes
Monocytes are a type of white blood cell in your innate immune system that play a role in both the inflammatory and anti-inflammatory processes that take place during an immune response.
They travel through your blood to sites of infection or inflammation where they migrate out of blood vessels and become macrophages or dendritic cells. As macrophages, they eat pathogens and dead cells and tissues, helping your body fight infection and repairing damage after infection or injury. Receptors on dendritic cells recognize foreign invading antigens or aberrant self-antigens and uptake, process, and present antigens to T cells, initiating immune responses.
An increased number of monocytes occur in response to autoimmune disease.
MRI—magnetic resonance imaging
In magnetic resonance imaging (MRI) radio waves and a powerful magnet are linked to a computer and used to create 3D images of structures inside your body. Unlike X-rays, MRIs can show inflammatory changes in bone and soft tissue making them useful in the diagnosis of autoimmune diseases like rheumatoid arthritis and ankylosing spondylitis.
Natural killer cells (NK)
Natural killer (NK) cells are a part of the innate immune system and play a major role in your immune system’s defense of your body. NK cells influence the functions of other cells, including macrophages and T cells. They patrol your body, scanning cells to see which indicate they are healthy or diseased. If they detect that a cell is harmful, NK cells are activated and release cell-killing granules, which destroy the altered cells. Unlike cytotoxic T cells they do not require prior exposure to a pathogen to destroy it, which is why they are called “natural.”
When NK cells function as they should, you have a lower chance of developing an autoimmune disease. When they start to malfunction, they may actually contribute to various autoimmune diseases. However, researchers have found that in some autoimmune disorders, NKs are actively preventing disease progression.
Neutrophils
Neutrophils, also known as polymorphonuclear leukocytes, are a type of white blood cell (leukocyte) that act as your immune system’s first line of defense as the earliest cells to gather at the site of infection or inflammation. They are the short-lived white blood cells that form pus, but their functions exceed this.
Neutrophils are essential components of the innate immune system, constantly patrolling for signs of microbial infections, and when found, respond quickly, trapping and killing the invaders. They also play a vital role in the pathogenesis of autoimmune disorders by releasing cytokine and chemokine cascades that accompany inflammation. Evidence also shows that neutrophils contribute to tissue damage during a broad range of disorders, including rheumatoid arthritis, lupus, Sjögren’s syndrome, and gout.
NSAIDs—nonsteroidal anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most prescribed medications for conditions such as arthritis and include common over-the-counter drugs like aspirin, ibuprofen, and naproxen. They not only relieve pain, but they also reduce inflammation and lower fevers.
NSAIDs prevent an enzyme called cyclooxygenase (COX) from making hormone-like chemicals called prostaglandins, one of the body’s biggest contributors to inflammation.
Opiates vs Opioids
The terms opiates and opioids are often used interchangeably, but they are different. Opiates refer to natural substances derived from the opium poppy and include heroin, morphine, and codeine. Opioids refer to all natural, semisynthetic, and synthetic drugs. Semisynthetic and synthetic opioids are manmade but use the same chemical structure as opiates. Synthetic opioids include tramadol, methadone, and fentanyl, the later being prescribed in some cases, and semisynthetic pain relievers available by prescription, including oxycodone and hydrocodone.
Opioids act on opioid receptors in the brain to produce morphine-like effects, including pain relief. Those who use opioids over time can develop tolerance and physical dependence leading to addiction and the risk of overdose and death.
Osteoarthritis (OA)
Osteoarthritis (OA), also known as degenerative joint disease or “wear and tear” arthritis, is the most common form of arthritis and involves deterioration of the joints. It occurs most frequently in the hands, hips, and knees causing thinning of cartilage and bony overgrowths called osteophytes or bone spurs, which result in pain, swelling, and stiffness. A crackling or grinding sound called “crepitus” often accompanies pain felt during movement of the joint. OA can result in reduced function and disability leaving some no longer able to do daily tasks or work.
OA develops slowly over time, and unlike rheumatoid arthritis, it is not a chronic disease of the immune system. You are more likely to develop it if you are a woman over 50 and/or other family members have it. Other risk factors include joint injury or overuse and being overweight. If you already have OA in one joint, you are more likely to develop it in another.
There is no cure for OA; symptoms are treated with a combination of self-therapies including physical therapy, maintaining a healthy weight, and preventing injury. Medications typically include NSAIDs and the use of joint injections. Joint replacement is considered when other treatment fails. The goal of treating OA is to ease your pain, help you move better, and stop it from getting worse.
Osteophytes
Osteophytes or bone spurs are smooth, bony growths that usually form near your joints; typically feet, hands, knees, and spine are affected. They develop with the progression of osteoarthritis or joint damage and result in pain, stiffness, and limited motion.
Paresthesia
Paresthesia is the sensation of tingling, numbness, or “pins and needles.” It can be a symptom of an autoimmune disease that attacks your nerves, including lupus, rheumatoid arthritis, and Sjögren’s syndrome.
Pathogen
A pathogen is an organism or agent, including viruses, bacteria, fungi, and parasites that invades your body and causes health issues.
Plasma cells
Plasma cells are differentiated B-lymphocyte white blood cells capable of secreting immunoglobulin or antibodies that target and bind to foreign invaders. These cells play a significant role in the adaptive immune response. Without them you are highly susceptible to recurrent infection.
Platelet-rich plasma
Platelet-rich plasma is used to reduce pain and speed healing for a number of conditions including osteoarthritis. It consists of removing, processing, and re-introducing a small portion of your own blood. Your blood is then spun in a centrifuge, which separates the platelets from the red blood cells. The collected platelets are then injected into an injured or diseased part of your body to accelerate the healing of damaged tendons, ligaments, muscles, bones, and joints.
Plasma is the liquid portion of whole blood that provides a medium for red blood cells, white blood cells, and platelets to circulate through the body. Platelets are blood cells critical to blood clotting that also secrete growth factors and other proteins that stimulate tissue regeneration and promote healing.
Concentrating platelets in platelet-rich plasma stimulates and increases the number of reparative cells your body produces. It is not clear how platelet-rich plasma therapy alleviates symptoms, but it is thought to inhibit and slow down disease progression, stimulate new cartilage formation, and increase production of naturally occurring lubricating fluid in the joint. Research into its effectiveness is mixed, and most insurance plans do not cover the cost.
Prednisone
Prednisone is a synthetic steroid with potent anti-inflammatory and immunosuppressive activity used in treating autoimmune disease. It belongs to a class of drugs known as corticosteroids. It decreases your immune system’s response to various diseases, reducing symptoms such as swelling and allergic-type reactions.
Prostaglandins
Prostaglandins are hormone-like substances produced at the site of tissue damage or infection where they cause inflammation, pain, and fever as part of the healing process. However, sometimes excess and chronic production occurs, which exacerbates chronic inflammation and leads to various autoimmune diseases.
Pseudogout
Pseudogout is formally known as calcium pyrophosphate deposition disease or CPPD. But it is commonly called pseudogout because of its similarity to gout. In both diseases crystal deposits form within a joint, although the type of crystal differs for each condition. Pseudogout most commonly affects the knees. Less often, it affects the wrists and ankles.
Psoriatic arthritis (PsA)
Psoriatic arthritis (PsA) is a form of arthritis that affects about 30% of people with psoriasis—a disease characterized by red patches of skin topped with silvery scales. It affects men and women equally and usually develops after age 30.
The signs and symptoms of PsA often resemble those of rheumatoid arthritis and include joint pain, stiffness, and swelling. It can affect joints on one or both sides of your body, including your fingertips (a condition called dactylitis) and spine, and can range from relatively mild to severe and disease flares can alternate with periods of remission.
There are two types of PsA:
There’s no cure for PsA. Treatment is aimed at controlling symptoms and preventing joint damage. It includes a combination of medication and non-drug therapies like exercise, massage, heat, and cold. It is personalized to your symptoms and the severity of your disease. Medications can include NSAIDs, DMARDs, biologics, corticosteroids, and topicals.
A small percentage of people with PsA develop arthritis mutilans—a severe, painful, and disabling form of PsA. Over time, it destroys the small bones in the hands, especially the fingers, leading to permanent deformity and disability.
Both genetic and environmental factors play a role in PsA. Many people will have a family history of either psoriasis or PsA. Certain genetic markers also appear to be associated with the disease.
Punctal occlusion (punctal plug)
One way to alleviate dry eye in Sjögren’s syndrome is to help the eyes retain tears by closing off the small funnel-like drain hole found in the inner corner of the upper and lower eyelids. These drain holes, called punctums, are closed with tiny plugs called punctal plugs.
Raynaud’s syndrome
In Raynaud’s syndrome your fingers and toes become numb and pale in response to cold temperatures or stress. This is because they tighten more than they should and results in your skin turning white then blue because your blood lacks oxygen. As your blood vessels relax and reopen, your skin may look red or tingle.
There are primary and secondary forms of the condition:
Raynaud’s syndrome refers to either. Raynaud’s syndrome can occur in people with autoimmune disorders such as rheumatoid arthritis, lupus, Sjögren’s syndrome, and scleroderma.Relapsing-remitting disease
In relapsing-remitting disease, symptoms are sometimes worse (relapse) and other times are improved or gone (remitting). These conditions may follow a pattern or stop and start with seemingly no rhyme or reason.
Rheumatoid arthritis and lupus are often classified as relapsing-remitting diseases.
Remission
Autoimmune symptoms may change over time. During partial remission, symptoms are reduced whereas in complete remission they disappear completely.
Rheumatoid arthritis (RA)
Rheumatoid arthritis (RA) is an autoimmune and inflammatory disease where your immune system attacks healthy cells in your body by mistake, causing inflammation. Unlike the wear-and-tear damage of osteoarthritis, RA affects the lining of your joints, called the synovium, causing a painful swelling that can eventually result in bone erosion and joint deformity. It most commonly starts in the smaller joints in a symmetrical pattern, for example, in both hands or wrists at once. In some people, the condition can damage a wide variety of body systems, including the skin, eyes, lungs, heart, and blood vessels.
With RA, there are times when symptoms get worse, known as flares, and times when symptoms get better, known as remission. Diagnosis includes several blood tests, including RF, ESR, and C-reactive protein tests.
There is no cure but symptoms are treated with DMARDs, NSAIDs, steroids, and physical therapy. It is important to remain active, maintain a healthy weight, and learn about self-management tools.
Rheumatoid factor (RF)
Rheumatoid factor (RF) is the autoantibody produced by your immune system that can attack healthy tissue. It was first found in rheumatoid arthritis but also appears in other autoimmune diseases, including lupus and Sjögren’s syndrome.
RF can be detected in some healthy people, and sometimes people with autoimmune diseases have normal levels of RF.
Schirmer’s test
Schirmer’s test is used to determine if your tear glands produce enough tears to keep your eyes adequately moist. It is one of the tests used to determine if you have Sjögren’s syndrome whose defining clinical features include dryness of the eyes.
Sclerodactyly
Sclerodactyly is a type of skin tightening and a classic symptom of scleroderma. Your skin cells react to this process by overproducing a protein known as collagen. Collagen is what allows your skin to have elasticity; however, when too much collagen is produced, your skin develops fibrosis or scar tissue. It can become difficult to bend the fingers or they can begin to curl inward due to the severe tightening of the skin.
Scleroderma
Scleroderma is an autoimmune disorder where your body produces too much collagen resulting in skin and other tissue that is thicker and more fibrous than it should be. It can also involve internal organs such as the heart, lungs, kidneys, and the gastrointestinal tract. If it affects tissue in your organs, the result can be life-threatening complications.
There are two main categories of scleroderma:
Doctors don’t know exactly what causes this process to begin, but the body’s immune system appears to play a role. Most likely, scleroderma is caused by a combination of factors, including immune system problems, genetics, and environmental triggers.
There is no treatment that can cure or stop the overproduction of collagen that is characteristic of scleroderma. But a variety of treatments can help control symptoms and prevent complications. If you have scleroderma you are more likely to have Raynaud’s syndrome and Sjögren’s syndrome.
Seronegative
When the results of rheumatoid factor and anti-CCP antibody tests are both negative, but the clinical presentation resembles rheumatoid arthritis, you are said to be seronegative for the disease.
Seropositive
When the results of the anti-CCP test is positive for rheumatoid arthritis, you are seropositive
SGOT—serum glutamic oxaloacetic transaminase aka AST (see AST and liver enzymes)
SGPT—serum glutamate pyruvate transaminase aka ALT (see ALT and liver enzymes)
Sialogram
A sialogram checks for blockages in your salivary ducts or glands. It can help diagnose infections or diseases, like tumors, in your mouth. This procedure is useful in the diagnosis of Sjögren’s syndrome, an autoimmune disease that affects the lacrimal and salivary glands, causing reduced tears and saliva production.
Sicca symptoms
Symptoms of dry eyes or dry mouth, otherwise known as sicca symptoms, are present in the majority of patients with Sjögren’s syndrome. Approximately 20% of patients with SS do not have sicca symptoms.
Sjögren’s syndrome
Sjögren’s syndrome is a chronic condition whose defining clinical features, dryness of the eyes and mouth, come from an autoimmune process that affects the lacrimal and salivary glands. It may also affect the nervous system, lungs, and kidneys.
Sjögren’s syndrome has a unique predilection for post-menopausal women. It may occur either alone or in the context of another autoimmune disease, such as rheumatoid arthritis or lupus.
There are two forms of Sjögren’s syndrome:
Researchers do not know what causes Sjögren’s, but they believe that both genetic and environmental factors are involved. Although it is often treatable, it cannot be cured with current medications. Treatment can include artificial tears, punctal plugs for dry eyes, drugs to increase salivation, NSAIDs, and hydroxychloroquine. A sialogram, that checks for blockages in your salivary ducts or glands, may be performed if the syndrome is suspected.
Spondyloarthritis (SpA)
Spondyloarthritis (SpA) is a family of inflammatory rheumatic diseases that have some key features in common, including inflammation, enthesitis, and a gene called HLA-B27.
The most common type of SpA is axial spondyloarthritis (axSpA), a term that covers both ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA). Both mainly cause inflammation in joints in the spine and pelvis. The SpA family also includes psoriatic arthritis, reactive, and enteropathic arthritis.
If you have spondyloarthritis you should get physical therapy. Medications for symptom relief are NSAIDs, DMARDs, and biologics.
Steroids (see corticosteroids)
Synovial fluid
Synovial fluid, also known as joint fluid, is the thick liquid between your joints. It cushions the ends of bones and reduces friction when you move your joints. In joint diseases like arthritis, the synovium of the joint is the main place where inflammation occurs.
When you have swollen, painful joints, a synovial fluid analysis can provide valuable information about the underlying source of the problem. Fluid is extracted from the joint through a procedure called arthrocentesis.
Synovium
The synovium refers to the membrane that encases your joints in synovial fluid, protecting them and helping them move smoothly. When arthritis develops in a joint, the membrane thickens and produces a large amount of fluid causing the joint to swell.
Synovial joints are involved in a number of immunological and inflammatory disorders, including rheumatoid arthritis, lupus, and spondyloarthritis.
T lymphocytes
T lymphocytes are a type of white blood cell in your adaptive immune system whose “T” in their name comes from “thymus.” As immature cells produced in your bone marrow they move to your thymus and are called thymocytes. They mature, differentiate, and finally travel to tissues and organs in your lymph system or circulate in your bloodstream waiting until they are needed.
The types of T cells include:
Telangiectasia
Telangiectasias are “spider veins,” dilated or broken blood vessels located near the surface of the skin or mucous membranes. They occur in autoimmune diseases that affect the skin and other connective tissues (also called connective tissue diseases) including scleroderma and lupus.
Thrombocytopenia
Thrombocytopenia occurs when your bone marrow doesn’t produce enough platelets, the blood cells that form clots to stop bleeding. It affects people with conditions like autoimmune disease, including rheumatoid arthritis and lupus. Approximately 25% of people with lupus develop thrombocytopenia.
TMJ—temporomandibular joint syndrome
The temporomandibular joint (TMJ) acts like a sliding hinge, connecting your jawbone to your skull, facilitating movements necessary in chewing and talking. TMJ syndrome can cause pain, reduced mouth opening, joint noises, locking, and difficulty eating and can be debilitating if left untreated.
TMJ is not an autoimmune disease, but its symptoms can result from one. Diseases that have an affinity toward TMJ are rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, and ankylosing spondylitis.
TNF—tumor necrosis factor
Tumor necrosis factor (TNF) is a protein produced by your body that normally helps it fight off infections. If macrophages detect an infection, they release TNF to alert other immune system cells as part of an inflammatory response.
Normally, the body deactivates any excess TNF in the blood so it does not cause excess inflammation. When this doesn’t happen, high levels of TNF in the blood can cause unnecessary inflammation, resulting in painful symptoms and autoimmune diseases like rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis, and ankylosing spondylitis. These disorders are sometimes treated by using a TNF inhibitor.
TNF inhibitors—tumor necrosis factor inhibitors
Tumor necrosis factor (TNF) is a protein in your body that normally helps fight infection but can cause inflammation if not controlled. TNF inhibitors or blockers are drugs that help stop the inflammation and are used to treat rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis, and ankylosing spondylitis.
TNF inhibitors include infliximab, adalimumab, and etanercept and can be used by themselves or in combination with other medications such as prednisone, methotrexate, or hydroxychloroquine.Tophus/tophi
Tophi are masses of white growths that occur when uric acid crystals develop around the joints and tissues that gout has affected. If you’ve developed tophi, you’re considered to have chronic or tophaceous gout.
Tyrosine kinases
Tyrosine kinases are enzymes that function as an “on” or “off” switches in immune cell activation and regulation. They initiate a variety of immune cell functions, including pathogen detection and killing, phagocytosis, clonal expansion, and migration to sites of infection or damage. Dysregulation of tyrosine kinase signaling pathways is associated with many diseases, including autoimmune and inflammatory disease.
Uric acid
Uric acid is produced when your body breaks down purines, a substance normally produced in the body and also found in certain foods and drinks. If there is too much uric acid in the body, crystals can form in your joints, fluids, and tissues resulting in a condition called hyperuricemia. This can result in gout, although not all people with hyperuricemia will have gout.
Uvea
The uvea is the part of your eye made up of the iris, ciliary body, and choroid. Swelling of the uvea is called uveitis.
Uveitis
Uveitis consists of swelling, redness, pain, floaters, blurred vision, and light sensitivity in the uvea. The uvea is the middle layer of the eye between the sclera and the retina and is composed of the iris, ciliary body, and choroid.
Uveitis can be due to infection or injury or be associated with an autoimmune disease, including rheumatoid arthritis, lupus, psoriatic arthritis, ankylosing spondylitis, and juvenile idiopathic arthritis.
The types of uveitis are classified by where they occur:
Because uveitis may be the initial symptom of autoimmune diseases, diagnosis of the underlying condition is the key to treating both uveitis and the systemic disease. Corticosteroids are the gold standard for therapy. Immunosuppressive drugs may be useful in addition to steroids and biological therapies have shown promising results.
Vectra DA test (see MBDA)
The Vectra DA blood test is the commercial name for the MBDA test. It checks for 12 proteins, hormones, and growth factors that are biomarkers for rheumatoid arthritis (RA). It provides a single disease activity score that indicates how aggressive your disease is, the likelihood of having a flare if your medication is stopped, and what combination of drugs may work best for you. It is not used to diagnose RA, but instead to assess RA disease activity in those already diagnosed.
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