Medical condition of the week – Raynaud’s phenomenon

The medical condition of the week this week, Raynaud’s, is timed very well, as not only is this week the “r” week, but this Saturday marks the start of February, Raynaud’s awareness month. Raynaud’s is also something close to my heart as I have several friends whom suffer with the condition, one of whom asked me to blog about it in my medical condition of the week.

Anyway, Raynaud’s phenomenon is a common condition in which the small blood vessels in the extremities are over sensitive to changes in temperature. The condition affects between 3-20% of the adult population worldwide, and is thought to affect as many as 10 million people with the condition in the UK. Although, the onset of Raynaud’s is more common when people are in there 20s or 30s, it can also affect children and adolescents.

During a Raynaud’s “attack” the main symptoms are changes to the skin colour which normally happen in three stages. 1 – the affects body part turns white because blood supply is restricted, 2 – the skin then turns blue due to lack of oxygen, during this stage the affected area can also feel cold and numb, 3 – the body part turns red as the blood returns to the area at a higher than normal rate, it is during this phase that sufferers sometimes feel tingling or throbbing sensation in the affected area.

The “attack” can last from several minutes to several hours, with the most commonly affected areas of the body being the fingers and the toes. However, other extremities can be affected including the ears and the nose. These episodes or symptoms are often triggers by expose to the cold or touching cold objects. However, they can also be triggered by emotions such as anxiety, and smoking.

Raynaud’s itself is split into two sub categories dependant on the cause of the condition Primary Raynaud’s and Secondary Raynaud’s.

Primary Raynaud’s is the most common form of Raynaud’s and is when the condition occurs by itself without being associated with another health condition. Scientists believe that primary Raynaud’s is caused by disruptions in the control of the blood vessels by the nervous system, (i.e. vasodilation and vasoconstriction) however the exact cause of these disruptions is still unknown. There is some evidence however that Primary Raynaud’s may have a genetic link, as cases have been known to run in families.

Secondary Raynaud’s is when an underlying reason causes the blood vessels to become oversensitive to temperature. Autoimmune conditions are associated with the majority of cases of secondary Raynaud’s, the most common being scleroderma, rheumatoid arthritis, Sjogren’s syndrome and lupus. Hepatitis B and C can also occasionally trigger Raynaud’s in some people. Some cancers can also cause secondary Raynaud’s. These are usually cancers which effect the blood, bone marrow or immune system including; acute lymphoblastic leukaemia; lymphoma and multiple myeloma.

In some cases, secondary Raynaud’s can also develop as a result of side effects of certain medications including; beta-blockers; some times of anti-migraine medication; chemotherapy medications; decongestants; the contraceptive pill; and hormone replacement therapy. Some cases have also been linked to taking illegal drugs such as cocaine and amphetamines.

The main treatment for Raynaud’s is often self-help techniques. These have the aim to help control symptoms and include things such as; keeping the whole body warm, especially the extremities and particularly in cold weather; stopping smoke – to improve circulation; regular exercise to help improve circulation and reduce stress levels; minimising stress levels through relaxation techniques, eating a healthy diet and avoiding stimulants such as coffee, tea and cola.

In some cases however medication is required to reduce symptoms. The only medicine licensed to treat Raynaud’s in the UK is Nifedipine, a calcium channel blocker which encourages the blood vessels to widen. This can be taken daily or alternatively just on a preventative basis for example during cold weather, and although it does not cure the condition it can help to relieve symptoms. However, as with all medication there can be side effects which include; oedema – swelling in the body due to a fluid build-up; headaches; dizziness and flushing. It is also recommended that people taking Nifedipine should avoid drinking grapefruit juice as it can make side effects worse.

If symptoms are very severe, rarely surgery is recommended. However, this is only in extreme cases when there is a risk of losing blood supply to the fingers. The surgery recommended is a sympathectomy which cuts the nerves which cause the blood vessels to spasm. However, the effects of such surgery are usually only temporary and more surgery/further treatment is required after a few years.

Overall, although Raynaud’s is a common condition many suffering with it have no idea that they actually have it. Although, Raynaud’s can be painful and get in the way of life, with self-help techniques and occasionally medication, the condition can often be well controlled.

Sources:
http://www.nhs.uk/Conditions/Raynauds-phenomenon/Pages/Introduction.aspx
http://www.raynauds.org.uk/
http://www.bupa.co.uk/individuals/health-information/directory/r/raynauds-phenomenon
http://www.patient.co.uk/health/raynauds-phenomenon

Medical condition of the week – Gout

Gout is this week’s medical condition of the week. Gout is a metabolic disorder in which uric acid crystals are produced by the body and form inside joints. The condition affects approximately 1 in 70-100 people in the UK, being more prevalent in men than women, leading it to be the most common cause of inflammatory joint disease in men over 40. Most commonly the condition first appears as a sudden severe pain in the joint, with the big toe being the first joint affected in over 50% of cases. In most cases gout will continue to only effect one joint, however in up to 10% of cases it affects more than one joint, including the food, knew, ankle, hand, elbow and wrist.

The symptoms of gout often develop at night, and often develop rapidly to their worst point in 6-24 hours and usually last for 3-10 days, known as a gout attack. During this time symptoms can include swelling and inflammation in and around the affected joint; red, shiny skin over the affected joint; peeling, itchy and flaky skin over the affected joint as the inflammation subsides. However after a gout attacks any pain or discomfort usually disappears completely and the joint will begin to feel “normal” again. The amount of time between gout attacks varies from person to person, approximately 62% of people experience a repeat attack within a year, however some will only experience a couple of attacks in their lifetime.

If gout reoccurs over many years it may lead to further symptoms. This can include the development of tophi, firm, white lumps beneath the skin which are made up or uric acid crystals, which can sometimes become inflamed and cause discomfort.

Gout itself is caused by a build-up of uric acid in the blood. Uric acid is normally found in low levels in the blood, as it is a waste product of the breakdown on chemicals in cells called purines, and is normally excreted by the kidneys. However, the saturation of uric acid in tissues by too much production of uric acid of excretion of too little uric acid during urination causes crystals of urate to form in and around the joints causing the symptoms of gout.

It was often thought in the past that this risk of gout was greatly increased by eating a diet rich in purines, giving it the association of being a rich man’s disease. However, recent research in New Zealand, had discovered instances of gout in the indigenous Maori population in pre-European times. As the Maori did not live a lifestyle of luxurious as their European counterparts the discovery has caused scientists to look more towards a genetic link in the development of the condition. However, this is still being investigated.

However it is still known that there are certain factors which may increase the risk of developing gout. This includes age, gender, obesity, high blood pressure and long term kidney problems. It has also been investigated that alcoholic drink, in particular beers and spirits can raise the level of uric acid in the body by increasing its production in the liver, and decreasing the level or urination.

When treating gout there are two main goals in consider; relieving symptoms during a gout attack and preventing further gout attacks. Relieving symptoms of a gout attacks is often treated using a type of pain killer known as non-steroidal anti-inflammatory drugs or NSAIDs. It is also thought that self-help techniques such as resting and elevating the affected limb can help reduce pain. Also applying an ice pack to the affected joint for approximately 20 minutes can cool the joint and help to alleviate pain. It is also possible to take corticosteroids to treat severe cases of gout if not other treatment has been successful.

Preventing future attacks can be done though both medication and lifestyle changes. The main medications used are known as urate-lowering therapy of ULT, which help to lower the levels of uric acid to below the levels requires for crystals to form, known as the saturation point. This included medication such as allopurinol and febuxostat which inhibit the enzyme xanthine oxidase responsible for converting purines into uric acid.
Lifestyle changes can include avoiding eating food which contain a large amount of purines such as some meats including kidney, liver, veal, turkey and venison, and sea-food. It is also often thought that being overweight can contribute to the development of gout, so sometimes eating a more calorie-controlled diet can help to control gout attacks. It is also important to when possible avoid potential environmental trigger factors of gout, such as alcohol, drugs, crash-dieting, injury and illness and prolonged stress.

However, gout can often be controlled well and complication of the condition such as kidney stones and tophus formation are uncommon. Like with any chronic illness gout had to be well controlled and often involved major lifestyle changes, however, it is also relatively easy to diagnoses and control, with many people having long periods of time between gout attacks.

Sources:
UK Gout Society ‘All About Gout’ patient information booklet (revised 2009) can be found at: http://www.ukgoutsociety.org/docs/2009FinalGoutBooklet.pdf
http://news.xinhuanet.com/english/health/2013-10/21/c_132817182.htm
http://www.bupa.co.uk/individuals/health-information/directory/g/gout
http://www.nhs.uk/Conditions/Gout/Pages/Treatment.aspx

Medical condition of the week – Crohn’s disease

This week’s medical condition of the week is Crohn’s disease, a relatively uncommon inflammatory bowel disease. It is estimated that approximately 1-2 people in every 1,000 people in the UK suffer from the condition which normally develops between the ages of 16 and 30.

The condition mainly affects the bowel, causing painful inflammation in the walls of the last part of the small bowel, the ileum and the large intestine. However, inflammation can occur in any part of the digestive system, from the mouth to the anus. Due to this inflammation common symptoms of Crohn’s can include abdominal pain, diarrhoea, blood and mucus in faeces and extreme tiredness and unintended weight loss from the decreased absorption of nutrients from the bowel. However, as Crohn’s disease is a ‘relapsing and remitting’ condition this means that the severity of the symptoms can vary throughout the condition, and a sufferer may go many years without any symptoms, a period of remission, and then a time where symptoms are particularly severe, a period of relapse or a flare-up.

Crohn’s disease can also cause other symptoms such as a high temperature, nausea and vomiting, arthritis, uveitis – inflammation and irritation of the eyes, mouth ulcers and skin rashes, often seen on the legs. When a young child develops Crohn’s disease they may also have a slower growth rate than expected due to the decrease in absorption of nutrients from food.

At present the exact cause of Crohn’s disease is unknown. However, research into the condition has found that a combination of many factors may contribute to the onset of the disease. These include;

•Genetics – researchers have identified over 200 different common genes in sufferers of Crohn’s disease. Also approximately 3 in 20 people with the condition have a close relative who also has Crohn’s, suggesting that there is a genetic link seen in the condition.

•The immune system – some evidence suggests that the inflammation seen in Crohn’s disease could be caused by an immune response in the body, i.e. the body’s own immune system attacks the “normal flora” bacteria in the gut, the destroying of this “good” bacteria is thought to lead to the inflammation.

•Previous infection – it is thought that a previous infection of the bacterium Mycobacterium avium subspecies paratuberculosis (MAP) commonly found in cows, sheep and goats could contribute to the development of Crohn’s disease. However, this theory is still widely disputed.

•Smoking – apart from family history and ethnicity, smoking is thought to be one of the most contributing factors to the development of Crohn’s disease, and as a result smokers are twice as likely to develop the condition.

•Environmental factors – there are two interesting theories as to why Crohn’s is more prevalent in westernised countries in comparison to less developed countries such as those in Africa. One is the hygiene hypothesis, suggesting that as children grow up in increasingly “germ-free” environments, their immune systems do not adequately develop due to lack of exposure to agents of disease, and so are at a higher risk of developing Crohn’s. An alternative theory is the cold-chain hypothesis, which links the increase in Crohn’s disease since the 1950’s with the increased use of the refrigerator after WWII. However, both theories have not been proven with hard evidence.

As Crohn’s disease is a chronic condition, it is mainly managed through reducing symptoms and maintaining remission. Reducing symptoms normally involves the use of steroid medication to reduce the inflammation, which can be given aurally as a tablet or as a hydrocortisone injection. However, in some cases additional treatment is required which can include immunosuppressants to try to decrease the frequency and regularity of flare-ups. In some cases surgery to remove the elements of bowel which are inflamed may be appropriate. Although 8 out of 10 people with the condition will have an operation at some point in their life health care professionals would have to feel that the benefits of surgery outweigh the risks.

The maintenance of remission can often be helped though diet. Such as avoiding foods a sufferer knows they are sensitive to, and eating a liquid diet during periods of relapse, as they are easier to digest.

Although periods of relapse can make daily life difficult; during periods of remission many sufferers find that Crohn’s disease has very little impact in their daily life. The condition also has very little effect on life expectancy, and symptoms and every flare-ups can very often be managed.

Sources:
http://www.nhs.uk/Conditions/Crohns-disease/Pages/Introduction.aspx
http://www.bupa.co.uk/individuals/health-information/directory/c/crohns-disease#textBlock198942

Medical condition of the week – Behçet’s disease

This week’s medical condition of the week is Behçet’s disease, a rare condition in the UK with a prevalence of about 1-5 in every 100,000 people. It is however more common in the Middle East, Far East and Mediterranean. It was in deed first recorded in 1993 by the Turkish dermatologist Hulusi Behçet, who was the first to realise that a group of symptoms, all previously thought to be unrelated, are caused by a single condition.

Behçet’s disease of Behçet’s syndrome is a chronic condition affecting the immune system in the body, causing uncontrolled and exaggerated inflammation (swelling) of the blood vessels, namely the smaller ones. This causes areas of swelling, responsible for the symptoms of the condition. Two of the main areas affected by inflammation are the mouth – causing severe, painful mouth ulcers, and the genitals – causing genital ulcers, which appear in 75-90% of cases.

However, as Behçet’s disease causes inflammation of the blood vessels, swelling can occur anywhere in the body where there is a blood supply. This can include joints, producing arthritis like symptoms in two-thirds of people with Behçet’s, as well as skin liaisons usually seen on the lower limbs which are present in around 80% of people with the condition.

Another major area effected can be the eyes, which inflammation of the eyes seen in an estimated 30% of people with Behçet’s disease. This often takes the form of uveitis, inflammation of the uveal tract – the group of connected structures inside the eye, including the iris (coloured part of the eye), ciliary body (the ring of muscle behind the iris) and the choroid (the layer of tissue supporting the retina). Symptoms characteristically seen with uveitis are painful red eyes, photophobia (sensitivity to light), dots moving across the field of vision and blurred vision. In severe cases, this can lead to permanent visual impairment.

Behçet’s disease can also lead to an inflammation of the stomach and intestine leading to gastrointestinal disease, with symptoms such as vomiting, diarrhoea, loss of appetite and abdominal pain. It is also estimated that 5-10% of sufferers will develop inflammation of the central nervous system, leading to symptoms such as headaches, double vision, loss of balance, drowsiness and uncontrollable twitching or shaking.

Naturally, as Behçet’s disease causes an inflammation of the blood vessels, blood clots are also more likely in suffers of the condition. However, the treatments greatly reduces these risks.

At the moment there is no specific diagnosis for Behçet’s disease, however, once diagnosed it can be treated by immunosuppressant in order to reduce the inflammation. With medication it is possible for sufferers of the condition to lead a health life. However, relapses of the condition can occur which must then be treated accordingly, often by a specialist in that area.

Sources:
http://www.nhs.uk/Conditions/Behcets-disease/Pages/introduction.aspx
http://behcets.org.uk/

Medical Condition of the Week – Addison’s disease

Addison’s disease or primary adrenal insufficiency or hypoadrenalism is a rare, chronic condition caused by failure of the adrenal glands. Addison’s disease affects approximately 8,400 people in the UK, and is most common between the aged of 30 and 50 with a higher prevalence in woman then men.

The adrenal glands themselves are two small, pyramid-shaped glands situated just above the kidneys. Each gland has an inner layer or medulla which produces the hormone adrenaline, the typical fight-or-flight hormone, and an outer layer or cortex which produces the hormone cortisol and aldosterone. It is the cortex which is damaged in Addison’s disease, which leads to reduced production of cortisol and aldosterone.

The damage to the cortex seen in Addison’s disease is often caused by an autoimmune condition (accounting for approximately 70-90% of causes of the condition). In Addison’s disease the immune system attacks the adrenal glands, severely damaging the adrenal cortex. When 90% of the cortex is destroyed the adrenal glands are no longer able to produce cortisol and aldosterone effectively, causing the symptoms of the condition.

Within the body cortisol mobilises nutrients, enabling the body to fight inflammation while also stimulating the liver to produce blood sugar and help control the water levels in the body. Aldosterone is involved in the regulation of salt and water in the body, both of which can affect blood volume and pressure. Without these two hormones, the initial symptoms of Addison’s disease can begin. These include can include, fatigue, lethargy, low mood or irritability, increased thirst and frequent need to urinate, craving for salty foods, loss of appetite and unintentional weight loss and muscle weakness.

As the adrenal cortex is also responsible for holding a large functional reserve called upon by the body in times of intense stress or illness, many suffers of Addison’s disease can find that symptoms can become worse during times of additional stress. This can include, low blood pressure, nausea and vomiting, abdominal, joint or back pain, muscle cramps, chronic exhaustion, brownish discolouration of the skin, lips and gums, diarrhoea and reduced libido.

If Addison’s disease is left untreated it can cause the symptoms to get progressively worse leading to adrenal crisis, due insufficient levels of cortisol and aldosterone. An adrenal crisis is a medical emergency and must be treated in hospital immediately. Symptoms of an adrenal crisis include; pale, cold, clammy skin; sweating; rapid, shallow breathing; severe dehydration; headache; severe vomiting and diarrhoea; severe muscle weakness; dizziness and severe drowsiness or loss of consciousness.

However, in the majority of cases the symptoms of Addison’s disease can be treated with hormone replacement oral medication. With medication, many people with Addison’s can lead a normal life with minimal changes to life style and daily routine. Most people with Addison’s disease also carry emergency medication in case of an episode of high stress such as an injury. This is often an emergency injection of hydrocortisone; however after every dose of this a medical professional must be informed. In the case of an adrenal crisis this can only be treated in hospital and is done through a hydrocortisone injection and an IV drip to rehydrate the body and replace to salts and sugars lost.

For more information please visit:
http://www.nhs.uk/Conditions/Addisons-disease/Pages/Treatment.aspx
http://www.addisons.org.uk/info/addisons/page1.html