Clinical Approach To Autoimmunity Flashcards
Autoimmune rheumatic disease features
Immune tolerance breakdown - autoimmune destruction
Production of pathogenic antibodies
Mutisystemic features - affecting skin, joints, heart etc.
Examples of autoimmune rheumatic diseases
Rheumatoid arthritis
SLE
Sjogren’s disease
Systemic sclerosis
Benefits of autoantibody detection
Aid diagnosis
Associated with specific clinical features
Aids prognosis
Tailor therapy
Risk factors for SLE
Female 9x more likely Women of child bearing age (15-45 yrs old) Afro Caribbean Genetic factor Environmental factors - sunny - smoking
Symptoms of ARDs
Pain
Stiffness
Swelling
Pattern of joint involvement
Malaise
Weight loss
Fevers
Night sweats
Involvement of other systems:
- eyes
- lungs
- skin
Gloves and sweater history approach
Gloves:
- Raynauds
- joint pains and swelling
- hand rash
Sweater:
- myalgia
- hair loss
- dry eyes and mouth
- nose bleeds
- mouth ulcers
- pleuritic chest pain
- pericardial pain
- truncal rash
- limb weakness
Investigations for ARDs
FBC U+Es eGFR Liver enzymes CRP Plasma viscosity and ESR Autoantibodies
CRP in SLE
Normal no matter how unwell with SLE
Signs of SLE
Joint swelling
Facial rash
Alopecia
Pleuritic chest pain
Treatments of ARDs
Patient education:
- lifestyle modification
- sunscreen
DMARDs
- hydroxychloroquine
- azathioprine
- mycophenolate
Steroids:
- prednisolone
Sever cases: IV cyclophosphamide
Rheumatoid arthritis risk factors
Females are 3x more likely
Genetic factors
Environmental factors - smoking or BAD DENTAL HYGIENE
Examination of rheumatoid arthritis
Proximal phalanges are swollen
Swollen feet
Investigation of Rheumatoid arthritis
FBC U+Es Liver enzymes CRP eGFR Plasma viscosity and ESR
- Xrays +/- ultrasound
- rheumatoid factor antibodies
- anti CCP antibodies
Treatment of rheumatoid arthritis
DMARDs early
- methotrexate
- hydroxychloroquine
- sulfasalazine (safe in pregnancy)
Steroids
- prednisolone
Combination therapy
