Anemia in Rheumatological diseases
Anaemia is due to decreased red blood cells in the blood. Haemoglobin is an iron-rich protein that helps in the transport of oxygen. Anaemia can be due to insufficient haemoglobin production due to iron deficiency due to malnutrition or chronic blood loss (in females, most commonly excess menstrual flow; in both males and females, it could be due to loss from the gut leak from any part of the intestine or haemorrhoids, etc.). In rheumatoid arthritis, it could be due to anaemia, another chronic disease where chronic inflammation impairs our body’s ability to use iron to make red blood cells. Anaemia due to blood cell destruction (hemolytic anaemia) is a rare one due to a direct inflammatory attack due to autoimmunity (self attack on own red blood cells). Patients look pale and dull and often complains of fatigues, breathlessness on activity
All these can occur in rheumatoid arthritis but are most commonly due to chronic inflammation. Prompt inflammation control can improve anaemia conditions.
Guideline for Exercise, Rehabilitation, Diet and Additional Integrative Interventions for Rheumatoid Arthritis
American College of Rheumatology (ACR) recommendations are coming up with new guidelines in 2023 regarding diet and exercise in RA patients
It strongly recommends
“Consistent engagement in exercise is advised over no exercise.”
It is the regular movement of any type within the physical capability of patient own state is more vital than any specific modality of exercise.
The conditional recommendations advise in Favor of aerobic, aquatic, resistance and mind-body exercises.
It also emphasises on rehabilitation part, and recommended conditionally for comprehensive occupational and physical therapy, hand therapy exercises, splinting bracing or taping, joint protection, the use of assistive devices and vocational rehabilitation.
It also recommends Mediterranean diet
In a recent study published in Arthritis care & Research two out of three rheumatoid arthritis patients have sleep disorders
In a telephonic-based interview of sleep questionnaire in 4200 RA patients the researchers noted that sleep disturbances are very common.
Noted among these are
* Sleep apnea
* Restless leg syndrome
* Short sleep (Sleep less than 6 hrs)
Remarkably Rheumatoid arthritis medications improved sleep quality and duration.
Quality sleep is important and much neglected by patients
Arthritis Care & Research 2022;doi:10.1002
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Myositis
Samantha Ruth Prabhu has recently been diagnosed with a rare medical condition called Myositis. She stated that doctors have expressed confidence in her full recovery. However, she claims that the disease’s remission is taking longer expected. The actress shared on her instagram post ” A few months back I was diagnosed with an autoimmune condition called Myositis. I was hoping to share this after it had gone into remission. But it is taking a little longer than I hoped. I am slowly realising that we don’t always need to put up a strong front. Accepting this vulnerability is something that I am still struggling with. The doctors are confident that I will make a complete recovery very soon. I have had good days and bad days…. physically and emotionally…. and even when it feels like I can’t handle one more day of this, somehow that moment passes. I guess it can only mean that I am one more day closer to recovery”
What is myositis (Muscle Inflammation) ?
Muscles are generally resistant to inflammation unlike joints (where we call it as Arthritis).
Muscles are immunologically privileged (The same thing holds for joints or any other organs in the body including skin and eye). The inflammatory cells has no much job to enter in to muscle or and the arrival of inflammatory cells (White blood cells) in to muscle interfere muscle function and leads to muscle pain or muscle swelling or muscle weakness.
So, in myositis there is entry of Inflammatory cells (No entry zone) and the cells starts attacking on their own muscle fibers leading to muscle injury (Autoimmune disease – Attacking on own self). These injuries predominantly noted in thigh and arm muscles in the beginning and then it has spreads to leg and forearm muscles too.
So, myositis is nothing but muscle inflammation.
It can present all of a sudden or gradual.
when it presents all of a sudden patients often feel difficulty in swallowing (due to involvement of tongue and first part of oesophageal muscles – muscles that helps in the initiation of swallowing of food)
What is CPK (Creatinine phosphokinase)?
Whenever there is a muscle injury the muscle enzymes are elevated. The more severe the elevation of muscle enzymes in the initial phase the more damage we expect.
The CPK is one such muscle enzyme we commonly measure just like serum creatinine for kidney and blood sugar for diabetes.
In some conditions like muscle necrosis the damage is much more severe, and the muscle enzyme may be elevated more than 10000 to 20000 U/L.
However, when it becomes chronic the muscle enzymes may not correlate with weakness.
Before it becomes chronic, we need to act promptly to protect muscles from permanent injury by using Immunomodulatory drugs.
So, myositis needs emergency attention.
All CPK elevations are autoimmune myositis ?
The answer is “NO”
There are many other causes of elevated CPK.
Viral infections, drugs, hypothyroidism, congenital muscular dystrophies etc.,
All muscle weakness are myositis?
The answer is “NO”
There are many causes of muscle weakness. Hypokalemia impairs muscle contraction function and it is one of the common causes. There are many other metabolic causes including hypothyroidism. Some drugs can also cause muscle weakness. There are many congenital causes and neuronal causes. Myositis is relatively rare when compared to other causes?
All muscle pains are myositis?
The answer is “NO”
There are many causes of muscle pain or soreness.
Physical exhaustion, general fatigue, hypothyroidism and any metabolic issues can cause muscle soreness or tenderness.
Generalised pain hypersensitivity syndromes like fibromyalgia can have wide spread body aches. Myositis is relatively rare when compared to other causes?
What are different types of Autoimmune myositis?
Primarily autoimmune myositis can be primary or secondary
primary myositis are three types
Dermatomyositis
Polymyositis
Inclusion body myositis
Secondary Autoimmune myositis
These are primary myositis due to underlying other systemic autoimmune disease like lupus, Sjogren’s syndrome, scleroderma, Mixed connective tissue disease
All these secondary autoimmune myositis are generally ANA (Antinuclear auto antibody) positive
What are different types of Autoantibodies noted in Autoimmune myositis?
All these secondary autoimmune myositis are generally ANA (Antinuclear auto antibody) positive
However plethora of autoantibodies can be positive in Autoimmune myositis (please see figure below)
