Watery discharge from nose or eyes. Also see Sinus and Sinusitis programs.Encyclopedia Entry for Rheum :Rheumatic fever - Streptococcus pyogenes (nonsuppurative complication of Strep throat)Encyclopedia Entry for Rheum :Rheumatic fever. Rheumatic fever is still common in countries that have a lot of poverty and poor health systems. It does not often occur in the United States and other developed countries. When rheumatic fever does occur in the United States, it is most often in small outbreaks. The latest outbreak in the United States was in the 1980s. Rheumatic fever occurs after infections with a germ or bacteria called Streptococcus pyogenes or group A streptococcus. This germ appears to trick the immune system into attacking healthy tissues in the body. These tissues become swollen or inflamed. This abnormal reaction seems to almost always occur with strep throat or scarlet fever. Strep infections that involve other parts of the body do not seem to trigger rheumatic fever.Rheumatic fever mainly affects children ages 5 to 15 who have had strep throat or scarlet fever. If it occurs, it develops about 14 to 28 days after these illnesses. Symptoms can affect many systems in the body. General symptoms may include: Fever Nosebleeds Pain in the abdomen Heart problems, which may have no symptoms, or may lead to shortness of breath and chest pain Symptoms in the joints can: Cause pain, swelling, redness, and warmth Mainly occur in the knees, elbows, ankles, and wrists Change or move from one joint to another Skin changes may also occur, such as: Ring-shaped or snake-like skin rash on the trunk and upper part of the arms or legs Skin lumps or nodules A condition that affects the brain and nervous system, called sydenham chorea can also occur. Symptoms of this condition are: Loss of control of emotions, with bouts of unusual crying or laughing Quick, jerky movements that mainly affect the face, feet, and hands.Your health care provider will examine you and will carefully check your heart sounds, skin, and joints. Tests may include: Blood test for repeated strep infection (such as an ASO test) Complete blood count (CBC) Electrocardiogram (EKG) Sedimentation rate (ESR -- a test that measures inflammation in the body) Several factors called major and minor criteria have been developed to help diagnose rheumatic fever in a standard way. The major criteria for diagnosis include: Arthritis in several large joints Heart inflammation Nodules under the skin Rapid, jerky movements (chorea, sydenham chorea ) Skin rash The minor criteria include: Fever High ESR Joint pain Abnormal EKG You'll likely be diagnosed with rheumatic fever if you: Meet 2 major criteria, or 1 major and 2 minor criteria Have signs of a past strep infection.If you or your child is diagnosed with acute rheumatic fever you will be treated with antibiotics. The goal of this treatment is to remove all of the strep bacteria from the body. After the first treatment is complete, more antibiotics are prescribed. The goal of these medicines is to prevent rheumatic fever from recurring. All children will continue the antibiotics until age 21. Teenagers and young adults will need to take antibiotics for at least 5 years. If you or your child had heart problems when the rheumatic fever occurred, antibiotics may be needed for even longer, perhaps for life. To help manage swelling of inflamed tissues during acute rheumatic fever, medicines such as aspirin or corticosteroids may be needed. For problems with abnormal movements or abnormal behaviors, medicines often used to treat seizures may be prescribed.Rheumatic fever can cause severe heart problems and heart damage.Long-term heart problems can occur, such as: Damage to heart valves. This damage may cause leakage in the heart valve or narrowing that slows blood flow through the valve Damage to the heart muscle. Heart failure. Infection of the inner lining of your heart ( endocarditis ). Swelling of the membrane around the heart ( pericarditis ). Heart rhythm that is fast and unsteady. Sydenham chorea.Call your provider if you or your child develops symptoms of rheumatic fever. Because several other conditions have similar symptoms, you or your child will need careful medical evaluation. If symptoms of strep throat develop, tell your provider. You or your child will need to be checked and treated if strep throat is present. This will decrease the risk of developing rheumatic fever.The most important way to prevent rheumatic fever is by getting quick treatment for strep throat and scarlet fever.Streptococcus - rheumatic fever; Strep throat - rheumatic fever; Streptococcus pyogenes - rheumatic fever; Group A streptococcus - rheumatic fever.Low DE. Nonpneumoccal streptococcal infections and rheumatic fever.Encyclopedia Entry for Rheum :Rheumatoid arthritis. The cause of RA is not known. It is an autoimmune disease. This means the immune system of the body mistakenly attacks healthy tissue. Rheumatoid arthritis RA can occur at any age, but is more common in middle age. Women get RA more often than men. Infection, genes, and hormone changes may be linked to the disease. Smoking may also be linked to RA. It is less common than osteoarthritis (OA). OA which is a condition that occurs in many people due to wear and tear on the joints as they age.Most of the time, RA affects joints on both sides of the body equally. Fingers, wrists, knees, feet, elbows, ankles, hips and shoulders are the most commonly affected. The disease often begins slowly. Early symptoms may include: Minor joint pain Stiffness Fatigue Joint symptoms may include: Morning stiffness, which lasts more than 1 hour, is common. Joints may feel warm, tender, and stiff when not used for an hour. Joint pain is often felt in the same joint on both sides of the body. Joints are often swollen. Over time, joints may lose their range of motion and may become deformed. Rheumatoid arthritis Other symptoms include: Chest pain when taking a breath (pleurisy) Dry eyes and mouth ( Sj gren syndrome ) Eye burning, itching, and discharge Nodules under the skin (most often a sign of more severe disease) Numbness, tingling, or burning in the hands and feet Sleep difficulties.There is no test that can determine for sure whether you have RA. Most people with RA will have some abnormal test results. However, some people will have normal results for all tests. Two lab tests that are positive in most people and often help in the diagnosis are: Rheumatoid factor Anti-CCP antibody These tests are positive in most patients with RA. The anti-CCP antibody test is more specific for RA. Other tests that may be done include: Complete blood count C-reactive protein Erythrocyte sedimentation rate Joint x-rays Joint ultrasound or MRI Joint fluid analysis.RA most often requires long-term treatment by an expert in arthritis called a rheumatologist Treatment includes: Medicines Physical therapy Exercise Education Surgery, if required Early treatment for RA with medicines called Disease-modifying antirheumatic drugs (DMARDS) should be used in all patients. This will slow joint destruction and prevent deformities. The activity of the RA should be checked at regular visits to make sure the disease is under control. The goal of treatment is to stop the progression of the RA. MEDICINES Anti-inflammatory medicines: These include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen and celecoxib. These medicines work very well to reduce joint swelling and inflammation, but they can have long-term side effects. Therefore, they should be taken only for a short time and in low doses when possible. Since they do not prevent joint damage if used alone, DMARDS should be used as well. Disease modifying antirheumatic drugs (DMARDs): These are often the medicines that are tried first in people with RA. They are prescribed along with rest, strengthening exercise, and anti-inflammatory drugs. Methotrexate is the most commonly used DMARD for rheumatoid arthritis. Leflunomide and hydroxychloroquine may also be used. Sulfasalazine is a drug that is often combined with methotrexate and hydroxychloroquine (triple therapy). It may be weeks or months before you see any benefit from these drugs. These drugs may have serious side effects, so you will need frequent blood tests when taking them. Antimalarial medicines: This group of medicines includes hydroxychloroquine (Plaquenil). They are most often used along with methotrexate. It may be weeks or months before you see any benefit from these drugs. Corticosteroids: These medicines work very well to reduce joint swelling and inflammation, but they can have long-term side effects. Therefore, they should be taken only for a short time and in low doses when possible. Biologic DMARD agents: These medicines are designed to affect parts of the immune system that play a role in the disease process of RA. They may be given when other medicines, usually methotrexate, have not worked. Usually biologic drugs are added to methotrexate. However, because they are very expensive, insurance approval is generally required. Most of them are given either under the skin or into a vein There are now many different types of biologic agents. Biologic agents can be very helpful in treating RA. However, people taking these medicines must be watched closely because of uncommon but serious adverse reactions: Infections from bacteria, viruses, and fungi Skin cancer but not melanoma Skin reactions Allergic reactions Worsened heart failure Damage to nerves Low white blood count SURGERY Surgery may be needed to correct severely damaged joints. Surgery may include: Removal of the joint lining ( synovectomy ) Total joint replacement in extreme cases may include total knee replacement (TKR) and hip replacement. PHYSICAL THERAPY Range-of-motion exercises and exercise programs prescribed by a physical therapist can delay the loss of joint function and help keep muscles strong. Sometimes, therapists will use special machines to apply deep heat or electrical stimulation to reduce pain and improve joint movement. Other therapies that may help ease joint pain include: Joint protection techniques Heat and cold treatments Splints or orthotic devices to support and align joints Frequent rest periods between activities, as well as 8 to 10 hours of sleep per night NUTRITION Some people with RA may have intolerance or allergies to certain foods. A balanced nutritious diet is recommended. It may be helpful to eat foods rich in fish oils (omega-3 fatty acids). Smoking cigarettes should be stopped. Excessive alcohol should also be avoided.Some people may benefit from taking part in an arthritis support group.How well a person does depends on the severity of symptoms and the response to treatment. It is important to start the treatment as soon as possible. Regular follow up visits are needed to adjust the treatment. Permanent joint damage may occur without proper treatment. Early treatment with a three-medicine DMARD combination known as 'triple therapy,' or with the biologic DMARD medicines, can prevent joint pain and damage.If not well treated, RA can affect nearly every part of the body. Complications may include: Damage to the lung tissue. Increased risk of hardening of the arteries. Spinal injury when the neck bones become damaged. Inflammation of the blood vessels (rheumatoid vasculitis), which can lead to skin, nerve, heart, and brain problems. Swelling and inflammation of the outer lining of the heart ( pericarditis ) and of the heart muscle ( myocarditis ), which can lead to congestive heart failure. However, these complications can be avoided with proper treatment. The treatments for RA can also cause serious side effects. Talk to your provider about the possible side effects of treatment and what to do if they occur.Call your provider if you think you have symptoms of rheumatoid arthritis.There is no known prevention. Smoking appears to worsen RA. So it is important to avoid tobacco. Proper early treatment can help prevent further joint damage.RA; Arthritis - rheumatoid.ACL reconstruction - discharge Ankle replacement - discharge Elbow replacement - discharge.Rheumatoid arthritis Rheumatoid arthritis Rheumatoid arthritis Rheumatoid arthritis Rheumatoid arthritis Rheumatoid arthritis.Aronson JK. Methotrexate.Encyclopedia Entry for Rheum :Rheumatoid factor (RF). Most of the time, blood is drawn from a vein located on the inside of the elbow or the back of the hand. In infants or young children, a sharp tool called a lancet may be used to puncture the skin. The blood collects in a small glass tube called a pipette, or onto a slide or test strip. A bandage is put over the spot to stop any bleeding.Most of the time, you do not need to take special steps before this test.You may feel slight pain or a sting when the needle is inserted. You may also feel some throbbing at the site after the blood is drawn.This test is most often used to help diagnose rheumatoid arthritis or Sj gren syndrome.Results are usually reported in one of two ways: Value, normal less than 15 IU/mL Titer, normal less than 1:80 (1 to 80) If the result is above the normal level, it is positive. A low number (negative result) most often means you do not have rheumatoid arthritis or Sj gren syndrome. However, some people who do have these conditions still have a negative or low RF. Normal value ranges may vary slightly among different laboratories. Talk to your health care provider about the meaning of your specific test results.An abnormal result means the test is positive, which means a higher level of rheumatoid factor has been detected in your blood. Most people with rheumatoid arthritis or Sj gren syndrome have positive RF tests. The higher the level, the more likely one of these conditions is present. There are also other tests for these disorders that help make the diagnosis. Not everyone with a higher level of RF has rheumatoid arthritis or Sj gren syndrome. Your provider may do another blood test (anti-CCP antibody), to help diagnose rheumatoid arthritis. People with the following diseases may also have higher levels of RF: Hepatitis C Systemic lupus erythematosus Dermatomyositis and polymyositis Sarcoidosis Mixed cryoglobulinemia Mixed connective tissue disease Higher-than-normal levels of RF may be seen in people with other medical problems. However, these higher RF levels cannot be used to diagnose these other conditions: AIDS , hepatitis , influenza , infectious mononucleosis , and other viral infections Certain kidney diseases Endocarditis , tuberculosis, and other bacterial infections Parasite infections Leukemia , multiple myeloma , and other cancers Chronic lung disease Chronic liver disease In some cases, people who are healthy and have no other medical problem will have a higher-than-normal RF level.Blood test Blood test.Andrade F, Darrah E, Rosen A. Autoantibiodies in rheumatoid arthritis.Encyclopedia Entry for Rheum :Rheumatoid lung disease. Lung problems are common in rheumatoid arthritis. They often cause no symptoms. The cause of lung disease associated with rheumatoid arthritis is unknown. Sometimes, the medicines used to treat rheumatoid arthritis, especially methotrexate, may result in lung disease.Symptoms may include any of the following: Chest pain Cough Fever Shortness of breath Joint pain, stiffness, swelling Skin nodules.The health care provider will perform a physical examination and ask about your symptoms. The provider may hear crackles (rales) when listening to the lungs with a stethoscope. Or, there may be decreased breath sounds, wheezing, a rubbing sound, or normal breath sounds. When listening to the heart, there may be abnormal heart sounds. The following tests may show signs of rheumatoid lung disease: Chest x-ray CT scan of the chest Echocardiogram (may show pulmonary hypertension) Lung biopsy (bronchoscopic, video-assisted, or open ) Lung function tests Needle inserted into the fluid around the lung ( thoracentesis ) Blood tests for rheumatoid arthritis.Many people with this condition have no symptoms. Treatment is aimed at the health problems causing the lung problem and the complications caused by the disorder. Corticosteroids or other medicines that suppress the immune system are sometimes useful.Outcome is related to the underlying disorder and the type and severity of lung disease. In severe cases, lung transplantation can be considered. This is more common in cases of bronchiolitis obliterans, pulmonary fibrosis, or pulmonary hypertension.Rheumatoid lung disease may lead to: Collapsed lung ( pneumothorax ) Pulmonary hypertension.Call your provider right away if you have rheumatoid arthritis and you develop unexplained breathing difficulties.Lung disease - rheumatoid arthritis; Rheumatoid nodules; Rheumatoid lung.Interstitial lung disease - adults - discharge.Bronchoscopy Bronchoscopy Respiratory system Respiratory system.Corte TJ, Du Bois RM, Wells AU. Connective tissue diseases.Encyclopedia Entry for Rheum :Rheumatoid pneumoconiosis. RP is caused by breathing in inorganic dust. This is dust that comes from grinding metals, minerals, or rock. After the dust enters the lungs, it causes inflammation. This can lead to the formation of many small lumps in the lungs and an airway disease similar to mild asthma. It is not clear how RP develops. There are two theories: When people breathe in inorganic dust, it affects their immune system and leads to rheumatoid arthritis (RA). RA is an autoimmune disease in which the body's immune system attacks healthy body tissue by mistake. When people who already have RA or are at high risk for it are exposed to mineral dust, they develop RP.Symptoms of RP are: Cough Joint swelling and pain Lumps under the skin (rheumatoid nodules) Shortness of breath Wheezing.Your health care provider will take a detailed medical history. It will include questions about your jobs (past and present) and other possible sources of exposure to inorganic dust. Your provider will also do a physical exam, paying special attention to any joint and skin disease. Other tests can include: Chest x-ray CT scan of the chest Joint x-rays Pulmonary function tests Rheumatoid factor test and other blood tests.There is no specific treatment for RP, other than treating any lung and joint disease.Attending a support group with people who have the same disease or a similar disease can help you understand your condition better. It can also help you adjust to your treatment and lifestyle changes. Support groups take place online and in person. Ask your provider about a support group that might help you.RP rarely causes serious breathing trouble or disability due to lung problems.These complications can occur from RP: Increased risk for tuberculosis Scarring in the lungs (progressive massive fibrosis) Side effects from medicines you take.Call for an appointment with your provider if you have symptoms of RP. Talk to your provider about getting the flu and pneumonia vaccines. If you've been diagnosed with RP, call your provider right away if you develop a cough, shortness of breath, fever, or other signs of a lung infection, especially if you think you have the flu. Since your lungs are already damaged, it's very important to have the infection treated promptly. This will prevent breathing problems from becoming severe, as well as further damage to your lungs.People with RA should avoid exposure to inorganic dust.RP; Caplan syndrome; Pneumoconiosis - rheumatoid; Silicosis - rheumatoid pneumoconiosis; Coal worker's pneumoconiosis - rheumatoid pneumoconiosis.Respiratory system Respiratory system.Corte TJ, Du Bois RM, Wells AU. Connective tissue diseases.Encyclopedia Entry for Rheum :Rheumatoid Arthritis. Can be caused by the bacteria Proteus mirabilis, Chlamydia Pneumoniae, Prophyromonas gengivalis and Parvovirus B19.Information from Marcello Allegretti.