Autoimmune disease

Question 1

what is autoimmune disease

Answer 1

when the immune system attacks self molecules/antigens

Question 2

some symptoms of MSK. autoimmune conditions

Answer 2

arthralgia/arthritis 
muscle pain/weakness
photosensitivity 
raynauds 
sicca symptoms (dry eyes, mouth, throat, vagina) 
dysphagia, shortness of breath 
neurological symptoms 
recurrent miscarriage

Question 3

what antibody is the general screening for all autoimmune diseases

Answer 3

ANA (higher titre= more significant)

if ANA is positive then analyse for specific antibodies

Question 4

what is primary raynauds

Answer 4

seen in teenagers with no underlying autoimmune disease, benign

Question 5

what is secondary raynauds

Answer 5

older age group, underlying autoimmune disease

if ulcers or gangrene present- usually secondary

Question 6

treatment for raynauds

Answer 6

keep warm
vasodilators
treat digital ulcers

Question 7

what is systemic sclerosis

Answer 7

skin thickening
more common in women
90% of patients with systemic sclerosis present with Raynaud’s

Question 8

what are the two types of systemic sclerosis

Answer 8

diffuse cutaneous systemic sclerosis
(above and below elbows and knees, plus face and trunk)

limited cutaneous systemic sclerosis (only below elbows and knees, and face)

Question 9

what are the symptoms of systemic sclerosis (CREST)

Answer 9

Calcinosis - calcium deposites in skin
Raynauds -blood vessel spasm
Esophageal dysfunction -acid reflux and decreased motility
Sclerodactly- thickening and tightening of skin on fingers and hands
Telangiectasis- dilation of capillaries causing red marks on the surface of skin

Question 10

what is a late complication of systemic sclerosis

Answer 10

pulmonary hypertension

Question 11

systemic sclerosis management

Answer 11

yearly ECHO and PFTs
treat raynauds and digital ulcers 
treat reflux with PPi+/_ranitine+/-gaviscon
immunosuppression 
ACEi - tight blood pressure control

Question 12

what is sjogren’s syndrome

Answer 12

an autoimmune disease characterised by lymphocytic infiltration of exocrine glands

Question 13

what is one main feature of sjogrens’s syndrome

Answer 13

gritty, dry eyes
needing to wake up to drink water
need to drink water to swallow
vaginal dryness in premenopausal women

Question 14

symptoms of sjorgrens syndrome

Answer 14

red swollen eyes 
salivary gland inflammation 
tooth decay 
lymphoma 
dry cough 
multisystem involvement

Question 15

antibody markers present in sjorgens syndrome

Answer 15

ANA positive

Anti Ro and Anti La

Question 16

what investigation do u do when u suspect sjorgens but antibody test negative

Answer 16

saliva gland ultrasound and biopsy

Question 17

treatment for sjogren’s syndrome

Answer 17

therapeutic spectrum
artificial tears, salivary supplements, vaginal lubricants
good dental hygiene
hydroxyxholoquine (anti-malarial for fatigue and arthralgia)
immunosuppression if major organ involvement

Question 18

what is antiphospholipid antibody syndrome

Answer 18

a mixed connective tissue disease with the presence of antiphospholipid antibodies on two occasions 12 weeks apart

Question 19

what are the two types of antiphospholipid syndrome

Answer 19

primary- no other underlying immune disease

secondary- seen in 20% of patients with lupus

Question 20

treatment for antiphospholipid syndrome

Answer 20

life long anticoagulation if thrombosis

Question 21

investigations for antiphospholipid syndrome

Answer 21

asses severity 
urinalysis 
CXR, pulmonary function, ECHO 
manage cardiovascular risk 
immunosuppression if major organ involvement 
If not- symptomatic management