autoimmune disorders Flashcards
rheumatoid arthritis
chronic inflammatory disease presenting with a wide range of articular and extraarticual findings
females are affected 3x more than men (reproductive years)
rheumatoid arthritis etiology
joint inflammation is a result of a massive infiltration of immune cells into the synovial fluid (symmetrical and bilateral presentation)
edematous (Swelling)
mycoplasma fermentans
rheumatoid arthritis pathogenesis
PANNUS –> thickened synovium, a destructive granulation of tissue
inflammation and destruction target joint capsule
TNF-alpha (tumor necrosis factor)
IL-1, IL-6 –> pro-inflammatory, leads to tendon/lig laxity altering biomechanics/deformities
clinical manifestations RA
swan neck and boutonniere’s deformities
ulnar drift
Lhermitte’s sign (sudden shock feeling when moving head forward)
RA diagnostic criteria
sign and symptoms for 6 weeks
RA pharmacology
NSAIDs
corticosteroids
DMARDs
BRMs
immunosuppressants
Synovectomy
goal of RA treatment
reduce pain
maintain mobility
minima stiffness
edema
joint destruction
DMARDs RA
disease modify anti-rhematic drug
slow disease interfere w/ immune response
BRMs RA
biologic response modifiers
block or inactive TNF-alpha
immunosuppressants RA
methotrexate
anti-metabolite
synovectomy RA
reduce pain
joint damage
joint replacement
treatment RA
synovectomy
joint replacements
PT intervention RA
manage irrelevant damage
decrease pain, effusion (swelling), stiffness
correct/prevent joint deformity
maximize strength. flexibility, function
manage neurological issues
adaptive equipment
systemic disease = treat whole person
Sjogren’s syndrome
chronic arthritis-related disease that can affect several organs
most commonly the moisture producing glands but also joint, lungs, kidneys, liver
second most common autoimmune rheumatic disease in postmenopausal women
sjogren’s syndrome pathogenesis
exocrine gland destruction by t-lymphatic infiltrates
hallmark symptoms of sjogrens
dry mouth
dry eyes
fatigue
submandibular and parotid glands are swollen
Raynaud’s phenomenon
sjogren’s diagnosis
slit lamp test –> detect damage
schirmer’s test –> assesses degree of dryness
blood test –> to detect ANA, anti-SSA/anti-SSB, RF
sjogren’s treatment
no cure
can benefit from exercise
Behcet’s
rare disorder that cause chronic inflammation of the blood vessels
Behcet’s manifestations
mouth sores
eye inflammation
skin rashes
lesions
genital sores
Behcet’s treatment
lead to blindness
aim to reduce sign and symptoms
systemic lupus erythematosis
chronic inflammatory autoimmune disorder can affect any organ or system in the body
3x more common in african american women
4 types of systemic lupus
latent lupus
drug-induced lupus
anti-phospholipid antibody syndromes
late stage lupus
latent lupus
persist w/ sign/symptoms w/o develop classic SLE
drug-induced lupus
people w/o prior history whom the clinical/serologic manifestation when person taking drugs
anti-phospholipid antibody syndrome
b/w arterial/venous thrombosis, recurrent fetal loss, immune thrombocytopenia w/ anti-bodies against cellular phospholipis
late stage lupus
chronic disease
clinical manifestations of systemic lupus
butterfly/malar rash
cardiopulmonary abnormalities, emotional instability, anemia, amenorrhea
systemic lupus pharmacology
NSAIDS
corticosteroids
anti-coagulants
anti-malarial agents
systemic lupus interventions
energy conservation
ergonomic instruction
conditioning and pain management
monitor signs of infection
discoid lupus
chronic inflammatory disorder which affects only the skin (usually face, neck, scalp)
discoid lupus clinical manifestations
marked by skin eruptions on sun-exposure
risk factor for discoid lupus
smoking is a risk factors for discoid lesions (raised red, scaling plaques w/ follicular plugging)
discoid lupus treatment
topical
intralesional or systemic medication
polymyositis v. dermatomyositis
two most common idiopathic inflammatory disease of muscle
diffuse inflammatory myopathies that produce symmetrical weakness of striated muscles
affects muscles of the shoulder and pelvic girdles, neck and pharynx (anterior thigh is most common)
-presents w/ difficulty going up stairs or getting out of a chair
3 prong intervention (medication, exercise, rest)
85% survival rate, 50% left with weakness, 20% disabled
dermatomyositis
when a rash is associated w/ polymyositis
characteristic purplish rash appears on the eyelids w/ edema
grotton’s papules (red/violet, smooth or scaly patch on knuckles, knee, medial malleoli)
anti-pruritic drugs (relieve itching)
systemic sclerosis
a diffuse connective tissue disease that causes fibrosis of the skin, joints, blood vessels and internal organs
affects women 2-3x more than men with ration peaking at 15:1 during child bearing years
systemic sclerosis pathology
deposition of collagen in lining of the blood vessels and in b/w the skin cells
endothelial injury, obliterative microvascular lesions
increased vascular wall thickness
ANS dysfunction
another name for systemic sclerosis
progressive systemic sclerosis
scleroderma
what can systemic sclerosis be triggered by
mycoplasma
clinical manifestations of systemic sclerosis
mask like face
sympathetic NS in overdrive
Raynaud’s
neuropathy from carpal tunnel
stages of systemic sclerosis
edematous
scleoritic
atrophic
systemic sclerosis treatment
penicillamine to improve skin
regular exercise maintains dermal/joint flexibility
active/passive stretching
contraction prevention
antibiotics
polymyalgia rheumatica
“pain in many muscles”
marked by diffused pain and stiffness that primarily affects the shoulder and pelvic girdle
may be first manifestations of other serious illnesses
occurs in elderly white females
polymyalgia rheumatica pathogenesis
subacromial and sub-deltoid bursitis
iliopectineal bursitis and hip synovitis and predominant lesions
clinical manifestations polymyalgia rheaumatica
symmetrical and bilateral painful stiffness last more than one hour in the morning
diagnosis polymyalgia rheaumatica
rapid response to prednisone
presence of C-reactive protein
juvenile rheumatoid arthritis
before 16 years of age
TNF and interleukins (IL-1 and IL-6) seem to be the primary cytokines responsible for many systemic features
often mistake for “growing pains” arthritis in one or more joints for at least 6 weeks
pauciarticular JIA (PaJIA)
oligoarthritis
generally affects 4 or few joints
three subtypes (ANA uvetis (eye), spinal involvement and only joint involvement (50% of cases))
polyarticular HIA (PoJIA)
affects 5 or more joints
two subtypes (rheumatoid factor positive and only having joint involvement (40% of cases)
systemic onset JIA (SoJIA)
still’s disease
most severe extra articular manifestations
Psoriatic JIA
presents with psoriasis, arthritis and at least two of the follow: dactylitis (inflammation of a digit), nail abnormalities and a family history of psoriasis
enthesitis related arthritis
presents as inflammation of the tendon attachments to the bone, especially along the spine and Achille’s tendon
along with arthritis
