Autoimmune conditions

Question 1

Signs/Symptoms of SLE?

Answer 1

DOPAMINE RASH

Discoid rash
Oral ulcers
Photosensitivity
Arthritis
Malar rash
Immune markers
Neurological change
Elevated ESR

Renal disorders
ANA positive
Serositis
Haemotological disorders (pancytopenia)

Question 2

Diagnosis of SLE?

Answer 2

History
Serology:
     \+ve ANA (maybe +ve in lots of conditions)
     \+ve dsDNA antibodies
     \+ve Ro/La Abs
     Low C3 and C4 complement

Question 3

Treatment for SLE?

Answer 3

Prednisolone +/- azathioprine
Also treat symptoms, eg NSAIDs for arthralgia
Hydroxychloroquine for myalgia, serositis

Question 4

Polymyositis/dermatomyositis diagnosis?

Answer 4

4/5 = polymyositis
3/4 (with rash) = dermatomyositis
1. Symmetrical proximal muscle weakness
2. Elevated muscle enzymes (CK, aldolase, LDH, transaminases)
3. Myopathic EMG abnormalities
4. Muscle biopsy changes
5. Rash of dermatomyositis

Question 5

Treatment for polymyositis/dermatomyositis?

Answer 5

Steroids + immunosuppresants

Question 6

Diagnosis of Sjorgen’s syndrome

Answer 6

+ve ANA
+ve Rheumatoid factor
+ve Anti-Ro + Anti-La

Symptoms:
Dry eyes/mouth
Rh. arthritis
Salivary gland enlargement
Purpura
(subclinical) renal tubular acidosis

Question 7

Treatment for Sjorgen’s syndrome?

Answer 7

Supportive mainly
Artificial tears/saliva, sugar free gum.

(increased risk of lymphoma)

Question 8

Systemic scleroderma types and treatment?

Answer 8

Diffuse:

• skin changes proximal to elbow, increased risk of pulmonary fibrosis and renal crisis.
• treated with mycophenolate mofetil

Limited:

• formerly known as CREST (calcinosis; raynauds; esophogeal dysmotility; sclerodactyly; telangiectasia)
• no disease modifying therapy

Question 9

Polymyalgia rheumatica diagnosis?

Answer 9

Identifying core features, excluding conditions that mimic PMR, and a response to oral corticosteroids.
(raised inflammatory markers)

Question 10

PMR treatment?

Answer 10

15mg Pred initially, until symptoms are controlled, then start to reduce levels.
Can be higher dose if response is not good enough

Question 11

GCA treatment?

Answer 11

40mg pred
60mg pred if ocular symtoms
Aspirin 75mg OD
PPI

Question 12

Wegener’s granulomatosis aka? And ANCA associated?

Answer 12

Granulomatous polyangiitis

c-ANCA

Question 13

ANCA associated with microscopic polyangitis

Answer 13

p-ANCA

Question 14

Treatment for inducing remission in vasculitis.

Answer 14

Generalised disease (organ-threatening):

• Cyclophosphamide
• Prednisolone

Localised/early disease:

• methotrexate OR mycophenolate mofetil
• Prednisolone

Question 15

Treatment for maintaining remission in vasculitis

Answer 15

Azathioprine

OR
mycophenolate mofetil, methotrexate, leflunomide

Question 16

Scleroderma antibody investigations?

Answer 16

Anti-centromere antibody = LIMITED scleroderma

Anti-scl70 antibody = DIFFUSE scleroderma

Question 17

PMR features?

Answer 17

Pain/stiffness in neck, shoulder, pelvic girdle
(worse in morning)
Malaise
Weight loss
Flu-like symptoms
Temporal arteritis

Question 18

Antibodies for rheumatoid arthritis?

Answer 18

Anti-cyclic citrullinated peptide (CCP)