Systemic Lupus Erythematosus (SLE)

A systemic autoimmune disorder where antibodies are generated in the body which attack the body’s own cells leading to various manifestations. Most prominently patient will have a malar rash which is a butterfly shaped rash on the face covering the nasal and cheek areas. Other manifestations of the disease include joint pains, skin rashes, tiredness. Most often patient’s organs such as kidneys, liver, brain are affected in various degrees. There is apparently no cure to this disease which treatment aims at controlling disease severity includes anti-inflammatory painkillers, immunosuppressive drugs, steroid medications to control the disease.

Anti-phospholipid antibody syndrome

A rare autoimmune disease where in the blood in the body clots more readily than normal leading to unwanted blood clots forming within the blood vessels causing serious disability and even death in a pregnant woman. It is most commonly seen in pregnant women leading to unexplained fetal demise, severe preeclampsia, unexplained severe growth restriction, TIA, thrombocytopenia. Treatment involves platelet inhibitors and plasmapheresis to remove antibodies in the body.

Rheumatoid Arthritis

A very commonly seen autoimmune disorder in women these days , where the antibodies are generated against the synovial joints of the body leading to swollen, painful deformities and arthritic changes in the small joints of the bodies. Apparently there is no cure for this disease. However, treatment goals are directed towards reduction of pain, decreasing inflammation and improve a person’s overall functioning. Use of NSAIDS, pain medications, steroids, Disease-modifying antirheumatic drugs such as methotrexate,leflunomide, hydroquinone etc are the mainstay of treatment.

Crystallarthopathies : Gout/PPD

This is a class of joint disorder that is due to accumulation of small crystals in the joints leading to congestion and decreased blood flow causing severe pain in the accumulated joint. Commonly accumulated crystals are monosodium urate, calcium phosphate dehydrate, calcium hydroxyapatite, calcium oxalate etc. Gout and pseudo gout are the two main type of crystallopathies. Treatments includes settling of the symptoms of an acute attack. Repeated attacks can be prevented by medications NSAIDS, colchicine, steroids. Latest medications such as febuxostat, probenecid also relieve symptoms drastically.

Spondyloarthopathies:Ankylosing Spondylitis/PsoriaticArthritis

Spondyloarthropathies are a group of overlapping disorders with common clinical and genetic features. They are

These are autoimmune mediated inflammatory disorders of unknown cause mostly affecting the axial skeleton – the spinal vertebral bones, peripheral joints. They usually affect men more than women. Treatment usually aims to reduce the inflammatory aspect of the disease, pain-killers, immunosuppressant drugs to decrease the reactions in the body.

Primary Sjogren’s Syndrome

This is a chronic, slowly progressive autoimmune disease characterized by WBC infiltrating the hormonal glands. Main issue in this disease is dryness. Patients with this disease are bound to have very dry mouth and dry eyes leading to easy eye infections, decreased tearing, and irritation in the eyes. Primary disease is usually presenting as an isolated disease not associated with any other diseases. Usually female are affected more than men. Treatment involves lubrication of these areas like artificial tears, chewing gums to increase salivations, immunosuppressant drugs to decrease reactions in the body, treatment of complications arising due to the disease.

Scleroderma (systemic sclerosis)

This is a rare tissue disorder where many systems in the body is affected. It is chronic and usually has a progressive course, worsening with time. Patient usually have skin ulcers on the fingers, elbows, face, trunk, painful joints, respiratory involvements, renal disorders can accompany. There is no treatment available to cure the disease and the focus is to control and ameliorate disease symptoms which include immunosuppressant, antibiotics and pain-killers.

Vasculitis

These are heterogeneous group of diseases which causes inflammation and death of blood vessel walls with damage to skin, kidney, lungs, heart, brain and gastrointestinal tract. Some patients have only skin involvement and some have almost all organ involvements. Patients usually have nonspecific symptoms like malaise, fever, night, fever, weight-loss with arthralgia and myalgia, skin rash, respiratory illness etc. Treatment involves immunosuppressant drugs, pain-killers and symptomatic treatment for the associated complications.

Behcet’s Syndrome

One of the vasculitic syndrome of unknown cause that usually affects blood transporting vessels - small arteries and veins in the body. Patients mostly will have oral, genital ulcers that are deep and multiple. Most diagnostically, when the patient is pricked on any part of the body, there is a pustule formation in two days in the site of prick. Usual mode of treatment involves topical steroids, immunosuppressant drugs, and painkillers.

Fibromyalgia

This disease is a common cause of generalised regional pain and disability and is frequently present in patients along with unexplained symptoms. Females are more affected than males. Risk factors include stressful lifestyle, injury or assault, poverty, alcoholism etc. Patient usually has pain in many regions of the body with marked disability, low affect, irritability, poor concentration, numbness, tingling sensation in the fingers, throbbing headache, increase micturitions etc. Patients benefit from psychiatric counselling along with drugs to alleviate the symptoms. Some antipsychotic drugs are of benefit to patients with very severe disease.

Myositis

Myositis literally translates to inflammation of the muscles used to move your body. An injury, any infection or an autoimmune disorder can lead to Myositis. Major two categories are involves vizPolymyositis and Dermatomyositis. Performing a specific examination and a few tests help detect the type and offer an accurate mode of management.

Metabolic Bone Disease

These are disorders of the bone where the strength of the bone is drastically reduced due to abnormalities in minerals, vitamin D, bone mass or structure. Osteoprosis, osteomalacia, rickets, paget’s disease are some of the most common metabolic bone disorders. Patients is thoroughly evaluated by imaging, blood investigations to find the type of disease and accurate replacement of the deficient nutrient will eventually cure the disease.

Osteoporosis

This is a most common bone disease affecting millions of people worldwide. Most fractures in the world are attributed to this disease where there is reduced bone density leading to microarchitectural deterioration of bone tissue. Mainstay of treatment is to reduce the risk of fractures and this is achieved by Lifestyle changes like adequate exercises, physiotherapy, bone supplements, vitamin, mineral consumption. Drug treatments involve oral bisphosphonates and hormone replacement therapies.

Osteoarthritis

It is by far the most common form of arthritis – inflammation of the joints in the body, seen in the world. Mostly seen with increased ageing and is a major cause of pain and disability in the older people. There is loss of cartilage and bone mass with abnormal remodelling of the joint which inhibits normal flexibility of joints causing joint stiffness and severe pain during motion of the joint. Hips, knee, neck, spine, hands are the involved joints. Treatment aims at muscle strengthening exercises, physiotherapy, oral painkillers for pain, steroid injections for severe cases. If none of the options work total joint replacement is the treatment.

Juvenile Idiopathic Arthritis

This is an inflammatory arthritis that occurs rarely in children. There are many types such as Systemic JIA, oligoarthritis, polyarthritis, enthesis-related arthritis, rheumatoid factor positive arthritis, psoriatic arthritis. Patients usually present with fever, rash, joint pain, enlargements of liver, spleen and painful swelling of the joints. Treatments involve immunosuppressant drugs like methotrexate, Steroids, and pain-killers.

Auto-inflammatory Syndromes

These are conditions caused by exaggerated response by patient’s immune system resulting in increased spontaneous inflammation affecting multiple organs. Many syndromes are seen, to name a few: Familial Mediterranean fever, Hyper-IgD syndrome, Blau Syndrome, Cryoprin associated periodic syndromes, Majeed syndrome, Mevalonicaciduria, Crohn’s disease etc. Treatment depends on the type of syndrome affecting the patients. Usually Intravenous corticosteroids, biologic agents have dramatic effects on the patient’s health improvement.

Pediatric Rheumatology

A speciality branch that deals with autoimmune disorders in the age group less than 18 years. Tertiary care and management is offered to patients with Rheumatic fever Musculoskeletal syndromes, juvenile idiopathic arthritis, SLE, Juvenile dermatomyositis, scleroderma, Kawasaki disease, Henoch-Schonleinpurpura, sarcoidosis. Rheumatology is a novel branch and is at its developing stage and it is essential to have a sister-concern focusing on management of its disease in the pediatric age group. And at our hospital we have some of the best doctors focusing on the same.

Primary ImmunodeficiencyDisorders

If the immune system is not fighting due to its absence or decreased functionality, a patient is said to have immunodeficiency disorder. And if it hereditary or genetic then the patient is said to have Primary immunodeficiency disorder. More than 300 types have been found. Serious diseases present within the infancy stage and cause repeated respiratory tract infections, poor growth, loss of weight, abcess in skin, swollen lymphnodes etc. Research is doing its best to improve treatment options and enhancing quality of life in people with these diseases. Bone marrow transplant, immunoregulations, gene therapies are some of the most promising approaches.

Biological Therapy

With the use of living organisms, substances are derived from them, laboratory-modifications of these substances are injected into the patients to obtain necessary results. Mostly used in treatment of cancer, this therapy works with many mechanisms. They are used to either treat cancer or to alleviate cancer related side effects in the patient. Lately these therapies have found to be effective in treatment of various autoimmune disorders as well. Some of the agents used are Interleukin-2, interferon, monoclonal antibodies.

Intra-articular Injections

Lately, a trending topic of research and established benefits are seen in intra-articular injections. This approach consists of injecting a desired drug or substance into the joints in the body to see immediate benefits. In diseases such as Rheumatoid arthritis, gout, Tendinits, bursitis, Carpal tunnel syndrome, Osteoarthritis, injection of corticosteroids have been found to provide tremendous benefit in relieving pain. Also whenever there is a decreased joint mobility, hyaluronic acid is injected that promotes fluidity and restores joint mobility.

Technology

At Jaypee hospital the department of Rheumatology & Clinical Immunology is fully equipped for world class investigative & therapeutic services of all kinds of rheumatological and primary immunodeficiency disorders.