Introduction
Common ailments remain one of the most frequently emerging and multi-faceted subjects in casual medical practice. It is therefore important for medical professionals to be able to operate the concepts that fit under this umbrella, both in terms of diagnosis and symptoms. This assignment includes four separate entries on the topic, three of which can be seen as case studies, with the remaining focusing on examining the differences between osteoarthritis and rheumatoid arthritis.
Genetical Impact on Arthritis Development
As stated in the question itself, the patient has been diagnosed with juvenile arthritis: a rarer form of the condition which is primarily observed in older patients. It is reasonable to assume that his disorder is genetic and mainly caused by heredity. Scientifically a link between arthritis and the genetic structure of those who suffer from it has been established. Family studies indicate that a person is more likely to suffer from arthritis if they have relatives with the same disease.
Numerous twin studies have identified a further link between genetics and the anatomy of this condition. In identical twins, who are known to share 99 to 100% of their DNA, arthritis on both sides was severely more likely than in non-identical twins. As identified by UK research on the topic, 15% of identical twins suffered from Rheumatoid Arthritis, compared to 5% of non-identical ones (Okada et al., 2019). Intergenerationally, however, the disease transmission is substantially more complicated, as the genes are influenced by ancestors but not fully replicated. Furthermore, the environmental and circumstantial factors have also been proven to influence the emergence of the condition. Nevertheless, currently, scientists agree on two genes controlling the pre-disposition of Rheumatoid Arthritis, the HLA-DRB1 gene and the protein tyrosine phosphatase 22 gene, also known as PTPN22.
Osteoarthritis and Rheumatoid Arthritis
Rheumatoid arthritis and osteoarthritis are the two different types of arthritis and should therefore be identified when discussing the diagnosis and the treatment plans for patients. Osteoarthritis is generally considered to be the most common and well-known form of the condition. By comparison, rheumatoid arthritis affects only a tenth of the people when compared to osteoarthritis, and obtaining treatment for it is often functionally more difficult. The prime difference between the two types lies in the causes behind the condition variants, as well as the progression speed and pain intensity.
Osteoarthritis is caused by mechanical exhaustion of the joints and is a direct consequence of them being overworked throughout the years. It is characterized by persistent ache with little to no swelling and without acute pain. By contrast, rheumatoid arthritis is a form of autoimmune disorder and is predominantly symmetrical, which is unusual for osteoarthritis (Ataoğlu et al., 2018). Rheumatoid arthritis may begin early in life and is generally characterized by intense levels of pain and swelling.
Cellulitis and Erysipelas: A Diagnosis Dilemma
Cellulitis and erysipelas are very similar in their manifestations, including reddened skin, edema, and a general sense of warmth in an affected body part. The diseases tend to develop asymmetrically, affecting one limb at a time, which is the case in the question. The differences are subtle and concern the layers of skin at which conditions originate and develop. Erysipelas is an infection of the superficial skin layer, and upper dermis, while cellulitis affects the deeper layers and the subcutaneous fat. Cellulitis tends to have a longer onset, manifesting slowly over several days, while erysipelas progresses rapidly and quickly. Fever, nausea, and headache have been identified as secondary symptoms in both cases.
The primary way of distinguishing the two conditions lies in the examination of the rush. Cellulitis rash tends to display blurriness around the edges, which complicates the observation process for the infected area. By extension, cellulitis is generally less noticeable to the doctors and patients alike, with the latter ignoring the symptoms at their initial stages. With erysipelas, one can see a sharp delineation between the infected area and healthy skin (Brindle, O’Neil & Williams, 2020). Furthermore, the condition can often manifest in the butterfly-like rash areas on a patient’s face.
At the moment, the question lacks specific information to distinguish between the diagnoses with absolute certainty. The patient’s leg should be monitored, preferably over an extended period, to achieve an outlook on the condition’s progression. Cellulitis is statistically more common, which gives it a preference in the diagnosis process unless specific factors point towards erysipelas. Such, erysipelas is reasonable to suspect first if a patient has recently been in contact with a streptococcal bacterium. In terms of the treatment practices, however, the distinction is non-existent, as both conditions are addressed identically by healthcare professionals, with antibiotics, usually cephalexin, being prescribed to the patient.
Oral Candidiasis: A Summary
Oral Candidiasis would be the correct diagnosis for the patient, in this case, considering the symptoms discussed in the question and her demographical characteristics. The Candida Albicans fungus causes oral candidiasis, which can be found in the natural flora of the mucosa without generating lesions. However, any change in the balance can then provoke the emergence of symptoms, with inciting factors ranging in severity and prevalence. A common case would be antibiotic use in the clinical setting, where one of the effects results in the drug killing not only the pathogenic bacteria but also destroying the normal flora (Vila et al., 2020). It causes an imbalance within the organism that allows the microorganisms that aren’t susceptible to the treatment to grow, with candida yeast being one of the frequent examples.
Candida possesses the ability to adapt to the oropharyngeal epithelium and produce protein lipases which later cause the liaisons in the mucosa. The fungus then grows and develops within a suitable environment with the contribution of moisture, heat, and nutrients from the circulatory system. Due to its adaptive capacities and general presence in the body before the condition’s emergence, the disease does not always cause pain or any notable symptoms in general. However, as a result, the person may be late in contacting their dentist, when the condition has already sufficiently progressed. Generally, an outbreak can be prevented by maintaining appropriate mouth hygiene, conducting regular dental check-ups, and reducing the consumption of sugar-heavy foods that often facilitate yeast development.
Conclusion
The process of diagnosis is often a complicated and multi-layered one since the medical professional has to account for a wide variety of factors of influence. Genetical, environmental, and circumstantial variables affect the human body in ways, that need to be considered before analyzing even the most straightforward symptoms. Unfortunately, despite the levels of scientific development in medicine, diagnosis mistakes are still largely common, with the human factor dominating the field for better and for worse.
References
Ataoğlu, S., Ankaralı, H., Ankaralı, S., Ataoğlu, B., & Ölmez, S. (2018). Quality of life in fibromyalgia, osteoarthritis and rheumatoid arthritis patients: Comparison of different scales. The Egyptian Rheumatologist, 40(3), 203-208.
Brindle, R., O’Neill L., Williams, O. (2020). Current Dermatology Reports, 9 (1), pp. 73-82. Web.
Okada, Y., Eyre, S., Suzuki, A., Kochi, Y. & Yakamoto, K. (2019). Genetics of rheumatoid arthritis: 2018 status. Annals of the Rheumatic Diseases, 78 (4), pp. 446 – 453.
Vila, T., Sultan, A. S., Montelongo-Jauregui, D., & Jabra-Rizk, M. A. (2020). Oral Candidiasis: A Disease of Opportunity. Journal of fungi (Basel, Switzerland), 6(1), 15.