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(also: chronic polyarthritis)
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Rheumatoid arthritis (RA) is an autoimmune disease that usually causes chronic inflammation of the joints. Autoimmune diseases occur when tissues are mistakenly attacked by the body's own immune system. Rheumatoid arthritis can also cause inflammation of tissue surrounding joints, blood vessels or other inner organs causing pain and reduction of function of the affected area. RA affects about 1% of the population usually developing in the 4th to 6th decade of life. Women are affected 4-3 times more often than men. Among women over 60 years, about 70 per 100.000 population are newly diagnosed with the disease annually. It has been estimated that the expected lifespan of an individual is shortened by 15-20% after the diagnosis has been made, i.e., by about 5 years with onset of the disease at age 50.
Inflammatory connective tissue diseases can affect not only joints, tendons and muscles, but also blood vessels, kidneys, skin, blood formation, and the nervous system. The most important disease in this group is systemic lupus erythematosus (SLE), which preferentially affects women between the ages of 20 and 40. The incidence of the disease is 4 - 6 new cases per 100.000 persons per year. In addition to a mild progression with rheumatic joint and muscle pains, photosensitivity and skin rashes, there are also severe forms with involvement of inner organs (kidneys, heart, liver, lungs, brain). Other diseases from this group include scleroderma, inflammatory muscle diseases, as well as inflammatory salivary gland diseases (Sjögren's syndrome). In the blood of these patients, self-destructive proteins (autoantibodies) directed against nuclear components (so-called ANA´s) are detectable.
(e.g., ankylosing spondylitis or Bechterew's disease, psoriasis, infection-reactive arthritis)
Spondylarthropathies primarily affect the spinal column, the sacral joint and peripheral joints, but can also affect connective tissue, skin, mucous membranes, intestine and urinary tract. There is often an association with HLA-B27, a surface marker of white blood cells. Incidence: ca. 1% of the population. For the principal disease of this group, ankylosing spondylitis, 6 new cases per 100.000 of the population can be expected annually. Age at presentation: 20 - 40 years old, sometimes also in childhood. Men are more frequently affected than women. The life expectancy is not reduced per se, but the quality of life is severely impaired, and here complications can also lead to death.
(e.g., temporal arteritis, Wegener's granulomatosis, panarteritis nodosa, Churg-Strauss granulomatosis, cryoglobulinemias, etc.)
Immunovasculitis affects blood vessels, connective tissues and inner organs, often endangering life. Ca. 50 persons per 100.000 of the population have the disease, and the incidence of new cases is 5 - 10 per 100.000 of the population. The life expectancy is still substantially shortened, but has clearly increased in recent decades thanks to improved therapeutic possibilities. Today the 10-year-survival rate after making the initial diagnosis is over 90%. In some of the patients (Wegner's granulomatosis) one finds autoantibodies (so-called ANCA´s) against cell components of phagocytes (granulocytes).
Immunocytopenias are diseases in which the immune system destroys certain cell types of the individual's own blood. Through the formation of autoantibodies against platelets, red blood cells or white blood cells dangerous disease states can arise, including autoimmune thrombocytopenia (Werlhoff's disease), autoimmune hemolytic anemias and leucopenias. These diseases can appear in isolated form or as complications of the inflammatory connective tissue diseases. The therapeutic possibilities are good, comparable to those for inflammatory connective tissue diseases.
Immunodeficiencies are either innate or acquired disorders of the immune system with increased susceptibility for infections by bacteria, viruses and fungi. Here one distinguishes between deficiencies of antibody formation (humoral immune deficiency, e.g., variable immune deficiency syndrome and IgA-deficiency), and disturbances of the cellular immune response (e.g., severe combined immune deficiencies, HIV-infection). In addition, there are regulatory disturbances of the immune system which can lead to an increased susceptibility to infection. The inborn defects of the immune system tend to be rare (approx. 1 newborn per 4.000 births). The acquired immune deficiencies, in contrast, are very frequent and are not limited to HIV-infections (in parts of Africa in some areas up to 30 percent of the population is infected with HIV), but also include weakening of the immune system through malnutrition, operations, chemo- and radiation therapy, as well as malignant diseases of blood formation (leukemias) and lymph nodes (lymphomas).
