Four rather unusual and rare diseases are now being grouped together by medical investigators as a result of information derived from recent research. Their names, which are little known to the public, are polyarteritis nodosa, diffuse lupus erythematosus, scleroderma, and dermatomyositis.
They resemble each other in that all of them represent disturbances of connective tissue in the body, in contrast to glandular tissue or surface secreting tissue. The connective tissue of the body includes what is elastic and the material between the cells. Sometimes tumors consist almost wholly of connective or fibrous tissue. The walls of blood vessels contain much tissue of this type.
Now the big fact about these conditions is that all of them are benefited at least temporarily by use of ACTH or Cortisone. All of them resemble also the reactions that occur in tissues in response to hypersensitivity or allergy.
Polyarteritis nodosa is a disease in which the blood vessels are chiefly affected. Because this disease is primarily serious damage of blood vessels, it may be reflected in any part of the body. The condition affects men four times as often as women and, mostly, those between twenty and forty years old. Arthritis and many of the reactions associated with hypersensitivity are seen by the doctor in these patients.
Disseminated lupus erythematosus is chronic, usually severe disorder occurring mostly in females fifteen to forty years old. A characteristic is a butterfly-shaped inflammation over the nose. Other symptoms involve the joints and the heart. Fever a anemia and a progressive course make the disease fatal.
Scleroderma is a disease that affects the connective tissue of the body and particularly that in the skin where there is hardening. Chiefly women between thirty and fifty years old are affected. The swelling in the skin may be followed by calcification. This disease comes on slowly a insidiously, but as it progresses changes occur in the skin of the face, neck, and arms. The skin looks waxy and tight and loses its color a hair. When the face is involved there may be difficulty in moving the jaw. Fortunately this is not a common disease; certainly it is not serious as polyarteritis nodosa or diffuse lupus erythematosusw, which similar. In the older forms of treatment emphasis was placed on the use of thyroid and vitamins. Great care was given to prevent secondary infections. More recently attention is being focused on the use of ACTH and Cortisone.
Fourth in this group of collagen disorders is one called dermatomyositis. This is a common and often fatal disorder involving the skin and the muscles. The exact cause is still unknown. It affects people of all races and colors, both men and women, and in general those between the ages of ten and fifty years.
Characteristic of this condition is the involvement of the muscles. As they deteriorate the organs concerned show effects, as in the eyes, throat, diaphragm, or muscles between the ribs. The symptoms then are difficulties of vision, swallowing, breathing, speech, etc. Naturally such people lose weight and get weak. Unfortunately this condition progressive and few who have it live long. Until recently little was known about treatment, and vitamins, hormones and physical therapy were tried. Salicylates were thought to be beneficial. Now we know that the salicylates can to a small extent stimulate the condition.
Rheumatism is a word used to describe a number of diseases, acute or chronic, which are accompanied by pain and stiffness of the muscles, the joints and other tissues involved in movement. Arthritis is the term used to describe inflammation of the joints only.
The joint includes the ends of bones, cartilages between the ends, a capsule holding it all together, ligaments which attach the muscles to the bones, membranes and the joint fluid. Nerves accompany the blood vessels into the joints; while the bones and cartilage do not feel pain, inflammation and swelling with the pouring of extra fluid into the joint can produce exquisite pain.
People with arthritis can be quite eloquent about their joints. The pain may be described as excruciating, throbbing, burning, aching, squeezing, or just hurting. The patients also complain of crackling, stiffness, and loss of motion.
The American Rheumatism Association has classified arthritis into seven types:
- - due to infection
- - due to rheumatic fever
- - rheumatoid
- - degenerative
- - due to injuries
- - due to gout
- - arising from the nervous system
Rheumatoid arthritis is not just a disease of the joints, but a general condition affecting the whole body. While the exact cause or causes may not be known, the discovery of the effects of ACTH and Cortisone have led to new concepts of the nature of the disease. Now rheumatoid arthritis along with a number of other conditions is called a "collagen" disease. In all of these the connective tissue of the body is chiefly concerned. The tendency is to consider rheumatoid arthritis a reaction of the body to sensitivity to certain substances, perhaps coming from bacteria, with the sensitivity affecting the connective tissue chiefly. The suggestion has also been made that rheumatism is not a specific reaction to some single substance but a general reaction of the body resulting from several different stimulations.
Women are affected by rheumatoid arthritis three times as often as men. Rheumatoid arthritis varies from being an acute disease with fever and sudden disability of many joints to a condition that develops gradually in which the patient may at first notice only stiffness or pain in one joint. Some may have deformity of a joint without ever having felt any pain. Sometimes the first signs of rheumatoid arthritis are fatigue, loss of appetite and loss of weight. Patients complain of numbness and loss of feeling in hands and arms, feet or legs. Sometimes the lymph glands near the joint become swollen. Because of failure to move and use the muscles around the swollen joint, the tissue breaks down and the area looks thin and wasted.
Rheumatoid arthritis is a condition that comes and goes. Doctors have noticed particularly that it disappears during pregnancy and during jaundice. The sooner good treatment can be applied to rheumatoid arthritis the better are the results secured in stopping the progress and the damage done by the disease. While the disease is active, rest and freedom from motion are helpful. If there is fever and severe pain certainly confinement to bed is desirable. Then as these troubles subside motion is permitted, but never to the point of fatigue. During the severe stages the patients are anxious and disturbed, often by solicitous people, and the doctor must protect the patient against emotional upsets.
No special diet cures arthritis. Nevertheless the patient with rheumatoid arthritis needs to be sustained with sufficient proteins, vitamins and minerals and enough carbohydrates and fats to provide needed energy and to avoid damage to tissues. Good animal proteins, calcium and iron must be adequate in the diet.
For many years a mainstay in treating arthritis has been the application of heat. Heat may be applied by hot bricks wrapped in towels, hot water bottles, electric heat pads, infra-red heat lamps, heat cradles containing incandescent bulbs, and other methods. If many joints are involved relief frequently comes from a hot tub bath once or twice a day, but prolonged hot baths are weakening.
People do not die of rheumatoid arthritis but complications may occur which are especially serious for the arthritic patient. Troubles with the lungs including pneumonia, damage to the heart and secondary infections are a threat.
Rheumatoid arthritis may be especially serious for children because of deformities that persist throughout life. A severe form of rheumatoid arthritis in childhood is known as "Still's disease." Another form of rheumatoid arthritis is associated with psoriasis, and there are arthritic manifestations that affect women in the menopause.
Rheumatoid arthritis affecting the spine is a crippling condition responsible for much disability. This condition usually occurs in men rather than in women. Pains in the back, soreness on bending over, painful buttocks, and shooting pains in the sciatic nerve area are accompaniments.
With spasms of the spinal muscles comes a tendency to avoid movement and in some instances the stiff-poker spine develops. Hot, wet packs help to relieve the spasm of the muscles. Use of salicylates for relief, heat, mild massage and liniments are reported beneficial in securing relief for those with degenerative arthritis.