Autoimmunity and Vasculitis

Question 1

What is autoimmunity?

Answer 1

A breakdown in the mechanisms that maintain ‘self-tolerance’. Leads to activation of self-reactive clones of T and B cells, and generation of autoantibodies and/or cell-mediated responses to self-antigens.

Question 2

What can cause a positive ANA?

Answer 2

1. Connective tissue diseases (SLE, mixed disease, Sjogren’s, systemic sclerosis)
2. Autoimmune diseases (RA, thyroid disease)
3. Chronic infectious disease (mononucleosis, hep C, bacterial endocarditis, TB)
4. Some drugs (hydralazine, isoniazid, procainamide)

Question 3

What would these antibodies being positive likely indicate?

IgA endomysial and IgA tTG

Answer 3

Coeliac disease

Question 4

What would these antibodies being positive likely indicate?

Anti-gastric parietal cell Abs

Answer 4

Atrophic gastritis, pernicious anaemia

Question 5

What would these antibodies being positive likely indicate?

Anti-intrinsic factor

Answer 5

Pernicious anaemia

Question 6

What would these antibodies being positive likely indicate?

Anti-mitochondrial and anti-PDH(M2)

Answer 6

Primary biliary cirrhosis

Question 7

What would these antibodies being positive likely indicate?

Anti-smooth muscle

Answer 7

Autoimmune hepatitis

Question 8

What would these antibodies being positive likely indicate?

Anti-glomerular basement membrane (GBM)

Answer 8

Goodpasture’s syndrome

Question 9

What would these antibodies being positive likely indicate?

Anti-PR3 (c-ANCA)

Answer 9

Wegener’s granulomatosis and Churg-Strauss syndrome

Question 10

What would these antibodies being positive likely indicate?

Anti-MPO (p-ANCA)

Answer 10

Microscopic polyangiitis, cresenteric glomerulonephritis, Churg-Strauss syndrome.

Question 11

What would these antibodies being positive likely indicate?

Anti-cardiolipin

Answer 11

Anti-phospholipid syndrome

Question 12

What would these antibodies being positive likely indicate?

Anti-skin

Answer 12

Autoimmune bullous skin disease (pemphigus and pemphigoid)

Question 13

What would these antibodies being positive likely indicate?

Anti-adrenocortical

Answer 13

Addison’s

Question 14

What would these antibodies being positive likely indicate?

Anti-cyclic citrullinated peptide (CCP)

Answer 14

Rheumatoid arthritis

Question 15

What would these antibodies being positive likely indicate?

Anti-Lo and anti-Ra

Answer 15

Sjogren’s syndrome

Question 16

What is vasculitis?

Answer 16

1. Blood vessel inflammation and necrosis causing ischaemia and organ damage.
2. Multisystem involvement common, because inflammation can involve a number of vascular beds.

Question 17

What are these conditions an example of?

Giant cell arteritis and Takayasu arteritis

Answer 17

Large vessel vasculitis

Question 18

What are these conditions an example of?

Polyarteritis nodosa and Kawasaki disease

Answer 18

Medium vessel vasculitis

Question 19

What are these conditions an example of?
Wegener’s granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome, Henoch-Schoenlein purpura, and Cryoglobulinaemic vasculitis

Answer 19

Small vessel vasculitis