A Clinical Approach To Autoimmunity

Question 1

What are autoimmune rheumatic diseases (ARDs)?

Answer 1

Heterogenous group of diseases,

immune tolerance breakdown,

production of pathogenic antibodies,

multi-systemic features (2+)

Question 2

Risk factors for systemic lupus erythematous

Answer 2

Females (X9)

15-45yrs

Afro-Caribbean, then South Asians, then Caucasians

Family history

Environmental factors - UV light can trigger, smoking makes worse

Question 3

Symptoms of lupus

Answer 3

Gloves and sweater approach

Gloves: raynauds, joint pains/ swelling, hand rash, synovitis

Sweater: proximal muscle weakness (myalgia), hair loss, alopecia, eye/ mouth dryness, nose bleeds, mouth ulcers, face rash, pleuritic chest pain, pericardial pain (pleural/ pericardial rub), truncal rash/ photosensitivity, limb weakness, nerve involvement, limb rash

Question 4

Investigations for ARDs

Answer 4

FBC
U&Es
Liver enzymes
CRP (normally normal)
Plasma viscosity & ESR

Antinuclear antibodies
Anti-DsDNA antibodies
Anti-Sm antibodies
Anti Ro & La AB
Complements
Antiphospholipids ABs

Question 5

Treatment of lupus

Answer 5

Lifestyle modification: stop smoking, use sunscreen

Start DMARDs: hydroxychloroquine, azathioprine, mycophenolate

Use of steroids: prednisolone, methylprednisolone

Severe cases: IV cyclophosphamide

Question 6

Mnemonic for remembering lupus signs/ symptoms

Answer 6

A RASH POINts Medical Diagnosis

ANA +ve
Renal abnormalities
Arthralgia/ arthritis
Serositis
Haematological abnormalities
Photosensitive 
Oral ulcers
Immunological abnormalities
Neurological abnormalities
Malar rash/ discoid rash

4/11 criteria = definite lupus

Question 7

Risk factors for RA

Answer 7

Females (X3)

Genetic factors

Smoking

Bad dentition (activates cystroline can trigger)

Question 8

Investigations for RA

Answer 8

FBC
U&Es
Creatinine 
Liver enzymes
CRP
Plasma viscosity & ESR
X-rays +/- ultrasound 

+/- antinuclear ABs
Rheumatoid factor ABs
Anti- CCP ABs
Anti Ro and La ABs

Question 9

Classification criteria for RA

Answer 9

Joint distribution 0-5
>10joints (at least one small joint) = 5

Serology 0-3
High positive RF or ACpA = 3

Symptom duration 0-1
_>6 weeks = 1

Acute phase reactants 0-1
Abnormal CRP or ESR =1

_>6 definite RA

Question 10

Treatment of RA

Answer 10

Start DMARDs early (methotrexate, hydroxychloroquine, sulfasalazine, leflunomide)

Use of steroids (prednisolone, methylprednisolone)

Combination therapy is usual