Autoimmune Rheumatic Diseases Flashcards
What are autoimmune rheumatic diseases
ARDs are a heterogenous group of diseases where there is an immune tolerance breakdown with production of pathogenic autoantibodies
What is Raynaud’s disease
Raynaud’s disease is a disease where there is vasospasm of the arteries supplying an area, limiting the blood supply to that area resulting in hypoxia
Vasospasm occurs in response to cold temperatures and stress
Areas of the body feel numb and cold
What are the risk factors fro SLE
Being a women
Being Afro-Caribbean or South Asian
Genetic risk - increased risk if family member has SLE
Environmental risk factors, e.g. sunlight (triggers and worsens SLE)
Describe how autoimmunity in SLE occurs
Blebs produced from apoptosis are not removed efficiently and so are transferred to lymph nodes where they are taken up by antigen presenting cells
These blebs have self antigens and B cells produce antibodies against these antigens resulting in:
- Development of autoantibodies that form circulating complexes or deposit by binding directly to tissues
- Activation of complement and influx of neutrophils causing inflammation
- Abnormal cytokine production
What is the treatment for SLE
Patient eduction - lifestyle modification and use of sunscreen
DMARDs - hydroxychloroquine, azathioprine, mycophenolate
Steroids - prednisolone, methylprednisolone
IV cyclophosphamide if severe
Name the criteria needed for a person to definitely have lupus
ANA positive
Renal abnormalities
Arthralgia/arthritis
Serositis
Haematological abnormalities
Photosensitivity
Oral ulcers
Immunological abnormalities
Neurological abnormalities
Malar rash/Discoid rash
What is lupus nephritis
Lupus nephritis - systemic lupus erythematosus nephritis is renal disease occuring in SLE
Immune deposits are found in the glomeruli and mesangium
What does a raised CRP in SLE suggest
Raised CRP in SLE suggests infection
What is the glove and sweater approach when taking a history of an ARD
Gloves:
- Raynaud’s
- Joint pains and swelling
- Hand rash
Sweater:
- Proximal muscle weakness and myalgia
- Hair loss
- Eye and mouth dryness
- Epistaxis
- Mouth ulcers
- Pleuritis chest pain
- pericardial pain
- Truncal rash/photosensitivity
- Limb weakness and rash
How does synovitis occur in RA
Chemo-attractants produced in the joint recruit circulating inflammatory cells to the joint
Overproduction of TNF-alpha, by macrophages, T cell and B cells, leads to synovitis and joint destruction
TNF-alpha stimulates overproduction of IL-6 and other cytokines
Name some non-articular presentations of RA
Rheumatoid nodules in the lung
Vasculitis
Pericarditis
Scleritis
Amyloidosis
Anaemia
Ankle oedema
Lymphadenopathy
With autoimmune disease, what does a lowered c3 with a high autoantibody level show
Lowered c3 with a high autoantibody level shows a flare up of an autoimmune disease
What is the treatment of rheumatoid arthritis
DMARDs - methotrexate, hydroxychloroquine, sulfasalazine, leflunomide
Steroids - prednisolone, methylprednisolone
