4.1.1 Clinical Approach To Autoimmunity Flashcards
What are the different features of Autoimmune Rheumatic Diseases (ARDs)?
Heterogenous group of diseases
Immune tolerance breakdown
Production of pathogenic antibodies
Multisystemic features
When do you treat patients with high levels of pathogenic antibodies?
Only treat if patient becomes intolerant to antibodies
Don’t treat if no effects
What is the importance of autoantibodies?
- Aid diagnosis
- Associated with specific clinical features
- Disease prognosis
- Stratify therapy
Who is affected by Systemic Lupus Erythematosus
Female : Male, 9:1
24 per 100,000
Genetic and environmental factors
What races are more at risk to lupus?
Afro-Caribbean > South Asians > Caucasians
Higher melanin skin types are more likely to be affected by lupus
What can trigger lupus?
UV light exposure
Why is smoking so dangerous in lupus patients?
8x more likely to have a cardiac event, increases thrombosis risk
Can die very early on, 30-40s
What types of joints are more likely to be affected by autoimmune conditions?
Small joints e.g. hand joints
What is significant about Reynauds?
5/100 people
Tendency to have overactive immune system
Does not mean disease
Why is pain worse in the morning in autoimmune rheumatic disease?
Cytokines and chemokines are highest in the morning which affects joints
How do you take a history for an autoimmune rheumatological disease?
Current symptoms
- Pain
- Stiffness
- Swelling
- Pattern of joint involvement
Evolution
- Acute or chronic
- Associated events
- Response to treatment
- Family history
Involvement of other systems
- Skin, eye, lung
- Malaise, weight loss, fevers, night sweats?
Impact on patient’s lifestyle
What approach can be used for history taking for ARDs?
Glove and sweater
What are the features of ‘gloves’ in the glove and sweater approach?
Raynauds
Joint pains and swelling
Hand rash
What are the features of ‘sweater’ in the gloves and sweater approach?
- Proximal muscle weakness
- Hair loss
- Eye and mouth dryness
- Nose bleeds
- Mouth ulcers
- Pleuritic chest pain
- Pericardial pain
- Truncal rash/photosensitivity
- Limb weakness
What should you ask about hair loss?
Do you wake up with hair in your pillow?
Shows hair loss with minimal pressure
