The most common cause of osteomalacia and rickets is vitamin D deficiency, which can result from either lack of sunlight exposure, from which the majority of vitamin D is derived; dietary deficiency or malabsorption of vitamin D in patients with gastrointestinal disease.
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Systemic lupus erythematosus (SLE) is a rare disease with a prevalence that ranges from about 0.03% in Caucasians to 0.2% in Afro-Caribbeans. Some 90% of affected patients are female and the peak age at onset is between 20 and 30 years.
Rheumatoid arthritis (RA) is the most common persistent inflammatory arthritis, occurring throughout the world and in all ethnic groups. The prevalence is lowest in black Africans and Chinese, and highest in Pima Indians. In Caucasians, approximately 0.8–1.0% are affected, with a female to male ratio of 3 : 1. The clinical course is prolonged, with intermittent exacerbations and remissions. Patients with RA have an increased mortality when compared with age-matched controls, primarily due to an increased risk of cardiovascular disease.
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Gout is an inflammatory disease caused by deposition of monosodium urate monohydrate crystals in and around synovial joints.
Causes of hyperuricaemia and gout
Diminished renal excretion
Osteoarthritis (OA) is by far the most common form of arthritis. It is strongly associated with ageing and is a major cause of pain and disability in older people. Osteoarthritis is characterised by focal loss of articular cartilage, subchondral osteosclerosis, osteophyte formation at the joint margin, and remodelling of joint contour with enlargement of affected joints.
Urticaria is caused by localised dermal oedema secondary to a temporary increase in capillary permeability. If oedema involves subcutaneous or submucosal layers, the term angioedema is used. Acute urticaria may be associated with angioedema of the lips, face, tongue, throat and, rarely, wheezing, abdominal pain, headaches and even anaphylaxis .
Psoriasis is a chronic inflammatory, hyperproliferative skin disease. It is characterised by well-defined, erythematous scaly plaques, particularly affecting extensor surfaces and scalp, and usually follows a relapsing and remitting course.
Exacerbating factors in psoriasis
Trauma
The terms ‘eczema’ and ‘dermatitis’ are synonymous. Eczema can be acute or chronic and there are several causes. Acutely, epidermal oedema and intra-epidermal vesiculation predominate, whereas with chronicity there is more epidermal thickening . Vasodilatation and T-cell lymphocytic infiltration of the upper dermis also occur.
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Acne is chronic inflammation of the pilosebaceous units. The condition is extremely common; it generally starts after puberty and there are reports of it affecting over 90% of adolescents. It is usually most severe in the late teenage years but can persist into the thirties and forties.
Itch is an unpleasant sensation that leads to scratching or rubbing. The terms ‘itch’ and ‘pruritus’ are synonymous; however, ‘pruritus’ is often used when itch is generalised. Itch can arise from primary cutaneous disease or from systemic disease, which may cause itch by central or peripheral mechanisms.
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