A clinical approach to autoimmunity Flashcards
What does ARD stand for?
Autoimmune Rheumatic disease
What happens in ARDS?
A breakdown of immune tolerance
produces pathogenic antibodies
Multisystemic features
What is the importance of autoantibodies?
Aid to diagnosis
Associated with specific clinical feature
Disease prognosis
To stratify therpy
What does she have?
Shoguns
An 25yr old Afro-Caribbean lady goes to her GP with a recurrent history of painful hand joints for the last 18 months. She has a 3 year history of raynauds. She had missed a few days at work due to pleuritic chest pain. She is complaining of disabling fatigue. What is the likely diagnosis?
Systemic lupus erthyematosus?
Who is more likely to have systemic lupus erthematosus?
Afro caribeean females
Genetic and environmental factors are important
How would you take a history for ARDs?
Current symptoms
- Pain
- Stiffness
- Swelling
- Patternofjointinvolvement
Evolution
- Acute or chronic?
- Associated events
- Responsetotreatment/Familyhistory
Involvement of other systems
- Skin,eye,lung
- Malaise,weightloss,fevers,nightsweats?
Impact on patient’s lifestyle
What are constitutional symptoms?
Fever
Fatigue
Weightloss
Night sweats
poor appetite
What is the gloves part of gloves and sweater approach?
Raynauds
Joint pains and swelling
Hand rash
What is the sweater part of gloves and sweater?
Proximal muscle weakness > Myalgia Hair loss
Eye and mouth dryness
Nose bleeds
Mouth ulcers
Pleuritic chest pain
Pericardial pain
Truncal Rash/Photosensitivity
Limb weakness
What is a palendrome?
When goes from shoulder, elbow, wrist, wrist, elbow, shoulder
Palendronic arthritis
What would you examine in ARDs?
What investigations would you do for ARDs?
C reactive protein would be normal
check for autoantibodies- aids diagnosis
With Systemic lupus erthematosis (lupus) what would you see on examination?
What would the bloods be like in lupus?
low WCC, ANA 1:1600 and anti-Sm antibodies
What is A RASH POINts Medical Diagnosis?
ANA positive
Renal abnormalities
Arthralgia/arthritis
Serositis
Haematologic abnormalities
Photosensitivity
Oral ulcers
Immunological abnormalities
Neuologic abnormalites
Malar rash/discoid rash
4/11= definite lupus
An 25yr old south Asian lady goes to her GP with a recurrent history of painful bilateral hand joints for the last 3 months. She has no past medical history of note. She has missed a few days at work due to increasing joint pain and swelling also affecting her feet. She is complaining of disabling fatigue.
What is the likely diagnosis?
Rheumatoid arthritis
Who is most likely to have Rheumatoid arthritis?
Females
no race predilection
Genetic factos/environmental factors
How would you take a history for RA?
Current symptoms
- Pain
- Stiffness
- Swelling
- Patternofjointinvolvement
Evolution
- Acute or chronic?
- Associated events
- Responsetotreatment/Familyhistory
Involvement of other systems
- Skin,eye,lung
- Malaise,weightloss,fevers,nightsweats?
Impact on patient’s lifestyle
What is the starting point for reynards?
spasm
White
cyanotic- blue
red
What would you see on examination of RA?
200IU and anti ccp>340
What investigations would you do for RA?
What is the classification RA?
At least 10 joints
serology high positive
greater than 6 is defo RA
What is the treatment for lupus?
Patient education- lifesytle modifications and suncream use
DMARDs
Steroids
severe cases- IV Cyclophophamide
What is the treatment for RA?
DMARDs asap
steroids
combination therapy
What is the role of a rhematologist?
Prompt diagnosis of patients with suspected ARDs/non-ARDs
Oversee use of DMARDs
Holistic long term managment of patients with ARDs
What are DMARDs?
Disease modifying anti-rheumatic drugs
What is the prevalence of RA?
1% of population
quite common
1 in 100 people have it
