Autoimmune Flashcards
Autoimmune summary
WBC attack stimuli in body – Antibodies produced – Destroys normal tissue – Autoimmunity
Production of antibodies (T cells) antigens treated as foreign induces adaptive immune response:
Organ specific – Graves disease, DM
Systemic – Lupus, RA
Lupus Dx
ANA titer, CBC, CMP, UA, Elevated ESR/CRP, CXR, Renal US
Lupus Tx
Control symptoms. NSAID for pain.
Follow up – track course with CBC, UA, CRP, an ANA
Rheumatoid Arthritis (RA) Dx
Chronic and progressive, PIP & MCP joints. S/S pain, swelling, stiff, malaise, weight loss, anorexia
Dx: ESR, RF Factor (IgG), CRP, CBC ro r/o anemia, X-ray (bone erosions. Anti-CCP titers diagnostic for RA
Rheumatoid Arthritis (RA) Tx
Pain meds, NSAIDs, steroids, PT/OT, supplements, complementary medicine, and surgery for worn out joints
Osteoarthritis (OA) Dx
Degenerative joint disease. Most common chronic condition of the joints. Minimal or no swelling, tenderness, crepitus is common but late finding. Effusion in larger joints.
Dx: History and PE main indicator, radiographs to r/o other diagnoses. CBC, CRP, ESR are usually normal. ESR more likely to be elevated in older adults.
Osteoarthritis (OA) Tx
No cure, manage symptoms. Analgesics, NSAIDS, corticosteroids, hyaluronic acid (joint fluid shock absorber and lubricant, injections), PT/OT, assistive devices supplements
Fibromyalgia (FMS) Dx
Fibromyalgia (FMS) Dx:
* widespread pain
* pain in 11/18 trigger points
* >3 months
Tx:
* Cognitive behavioral therapy
* low impact exercise,
* local heat
* NSAID/ Tylenol,
* Tramadol for pain,
* Flexeril for muscle tension,
* Elavil and Prozac for mood issues
* Lyrica for fibromyalgia,
* Cymbalta or gabapentin
Chronic Fatigue Syndrome
(CFS) Dx
Not a fatal disease
Stress-relieving techniques, sleep promoting behavior, importance of stretching muscles several times daily
Encourage to use alternative mans they believe may help with pain: chiropractic, therapeutic touch, guided imagery, hypnosis, etc.
Physical and emotional stress can worsen symptoms
Chronic Fatigue Syndrome
(CFS)
Same as Fibromyalgia
Majority of patients with CFS meet criteria for FMS, and 70% of FMS patients meet CFS criteria. Management remains controversial – main goal is to have best quality of life possible within limitations of disability r/t pain
Lyme Disease Tx
Stage 1 – Early localized Lyme disease (erythema migrans, bullseye rash, flu-like symptoms, lasts 1-4 weeks)
Tx: Doxycycline 100mg BID 10-21d >8 yrs, Cefuroxime 500mg BID 14-21d, child 30mg/kg/d, Amoxicillin 500 TID 14-21d, child 50 mg/kg/d
Jarisch-herxheimer reaction first 24 of ABX tx= a worsening of symptoms
Stage II – Early disseminated (symptoms range from mild to severe, or not at all, flu-like, blurry vision, facial paralysis, pain/numb in bite area, palpitations)
Tx: Azithromycin, doxycycline 100mg BID 14-28d, amoxicillin
Stage III – Late disseminated (when not treated by I or II, months or even years after bite, severe headaches, large joint arthritis, arrhythmia, memory loss, mood, sleep, fogginess, amnesia, difficulty following convo or speaking, extreme fatigue, facial paralysis
Tx: Doxy 100mg BID 21d, Amoxicillin 500mg TID 21d, Cefuroxime 500mg BID 21d
Stage IV – Late stage or chronic Lyme (recurrent form of join inflammation may include severe arthritis symptoms, most common affected is knee) episodes lasting > 6 months, swelling, redness, fluid buildup
Tx: Ceftriaxone 2g IV daily for 14-28 days for more serious disease (symptomatic, second- or third-degree atrioventricular block, first-degree atrioventricular block with PR interval ≥300 milliseconds, encephalitis, persistent arthritis
Lyme Disease Dx
- ELISA for lyme disease test.
- Immunoblot test is done to confirm ELISA result.
- Pts are positive for Borrelia burgdorferi-specific IgM and IgG by the early disseminated phase 6-8 wks after exposure.
Sjogren’s Syndrome Dx
Clinical 6 defining criteria:
1. Inadequate tear production with Schirmer test (less than 5 mm of wetting in 5 minutes abnormal)
2. Signs of corneal epithelial damage from dry eye using fluorescein stain and slit lamp
3. Decreased saliva production
4. Lymphocytic infiltration of labial salivary gland biopsy-the closest test to gold standard for dx
5. Impaired salivary gland function by objective testing via radionuclide technetium scan
6. Autoantibodies including Ro (SSA) and/or anti-La (SSB)
Labs: CBC, rheumatoid factor, ANA, gamma-globulin. Electrophoresis are required to determine whether SS is present alone or in combo with other rheumatoid disease
Sjogren’s Syndrome Tx
Tx: Lubricants and hard candies, artificial tears/salivary gels
Dried fruits with malic acid, special toothpastes/brushes, Vaseline
Intravaginal lubricant jelly if vaginal dryness
Steroids, NSAIDS, immunosuppressive drug
Wear sunglasses, avoid alcohol, tobacco, spicy and salty food in mouth lesions
Feel of gritty grain particles in eyes, dry eyes, dry mouth, skin rash, arthralgias, myalgias. Joint pain, stiffness, swollen salivary glands, vaginal dryness, persistent dry cough, prolonged fatigue, difficulty swallowing/dryness
Risk factor – RA or SLE, women, 40 and older
HIV tx
HIV management: Anti-viral regimens, suppress virus: guided by CD4 &T-cell count and co-morbidities, Monitoring viral load and CD4 & T-cell count. Goal of antiretroviral therapy is to get to <50 copies/ml (undetectable) within 4 to 6 months of initiation.
Educate repeat testing in 3-6 months to confirm 1st negative result. CD4 & T-cell count every 3-6 months. Obtain HIV viral load when initiating HAART or switching regimens and in 2-8 weeks to determine response to therapy, then every 3-4 months
