Autoimmune Rheumatic Diseases Flashcards
Most rheumatic diseases are multi-system, how may the following systems be affected?
Joints
Lungs
Veins
Skin
Nervous system
Eyes
Kidneys
Muscles
Joints: synovitis
Lungs: alveolitis/pulmonary fibrosis
Veins/arteries: vasculitis, thrombosis
Nervous system: neuropathies, cerebral damage
Eyes: inflammation
Kidneys: nephritis
Muscles: myositis
Name 4 indicators that a disease is autoimmune
Auto-reactive T cells
Auto-reactive B/plasma cells - autoantibodies
Antibodies detectable at sites of damage
Immunosuppression treats the disease
Which organ specific autoimmune diseases affect the:
Brain
Thyroid
Muscle
Stomach
Adrenal
Pancreas
Brain: MS
Thyroid:
- Hashimoto’s thyroiditis
- Primary myxoedema
- Thyrotoxicosis
Muscle: Myasthenia gravis
Stomach: pernicious anaemia
Adrenal: addison’s disease
Pancreas: insulin dependent DM
Which non-organ specific autoimmune diseases affect the:
Muscle
Kidney
Skin
Joints
Muscle: dermatomyositis
Kidney: SLE
Skin:
- Scleroderma
- SLE
Joints: RA
Which extractable nuclear antigens (ENAs) can be found in Sjogren’s syndrome?
Anti-Ro
Anti-La
Which extractable nuclear antigens can be found in systemic sclerosis?
Anti-Scl70
Anti-centromere
Which extractable nuclear antigens can be found in SLE?
Anti-Sm
Which extractable nuclear antigen can be found in Anti-Jo-1 sydrome?
Anti-Jo-1
What is the limitation of finding a positive ANA?
Positive ANAs occur in healthy people, particularly with increasing age
Name some common symptoms in patients with autoimmune rheumatic diseases
Secondary Reynaud’s phenomenon
Joint pains
Rashes
Fatigue
Name the 2 phases of reynaud’s phenomenon
- White
- Blue
- Red
Name some multi-system rheumatic diseases
Rheumatoid arthritis
SLE
Primary Sjogren’ syndrome
Systemic sclerosis
Ankylosing spondylitis
Primary vasculitis e.g. granulomatous polyangitis
Describe the rash typical of SLE
‘Butterfly rash’ across nose and cheeks sparing naso-labial folds
What are the 2 types of Sjogren’s syndrome?
Primary: standalone disease
Secondary: in association with other diseases e.g. SLE, RA
What is Sjogren’s syndrome?
Autoimmune damage to secretory glands
Takes years to develop
More common in females than males
Most common in 50-60 age groups
What are the symptoms of Sjogren’s syndrome?
Sicca symptoms:
- Dry eyes
- Dry mouth (xerostomia)
- Vaginal dryness
- Cough (dryness of airways)
Increased dental decay
Inflammatory arthritis
Rashes- can look similar to SLE, vasculitic rashes
Pulmonary and renal involvement (rare)
What examination findings may be indicative of Sjogren’s syndrome?
Reduced tear flow
Dry oral mucosa/ dental decay
Oral candidiasis (thrush)
Salivary gland swelling
Skin rashes:
- Vasculitic: palpable purpura
- Annular: similar to SLE (due to Anti-Ro and Anti-La antibodies), appears in sun exposed areas
What investigation findings may be present in Sjogren’s syndrome?
Anaemia of chronic disease- low Hb
Raised immunoglobulins (IgG)
High ESR
ANA positive
Anti-Ro/Anti-La positive
What treatments are available for Sjogren’s syndrome?
To treat sicca symptoms:
- Humidifired environment
- Punctal plugs
- Tear/saliva substitutes
- Saliva stimulants
Oral candidiasis: topical antifungal (nystatin)
Dental care: avoid sweet foods, regular check ups, flouride toothpaste
Inflammatory arthritis: immunosuppressives (methotrexate)
Rashes: hydroxychloroquine
What other autoimmune diseases often exist alongside Sjogren’s syndrome?
Autoimmune thyroid disease
Coeliac disease
Primary biliary cirrhosis
Name some complications of Sjogren’s syndrome
40 fold increase in risk of lymphoma
Inflammatory lung disease
Vasculitis/peripheral neuropathies
