Clinical approach to autoimmunity

Question 1

What are Autoimmune Rhematic Diseases?

Answer 1

• Heterogenous group of diseases
• Immune tolerance breakdown
• Production of pathogenic antibodies
• Multisystemic features
• Includes: RA, SLE, Systemic Sclerosis, Sjogen’s Syndrome

Question 2

Describe the disease demographics of Systemic Lupus Erythematosus

Answer 2

• Female: male ratio 9:1
• Prevelence 24/100,000
• Race: Afro Carribean > South Asian > Hispanic > Caucasians
• Genetic factos important
• Environmental factors: hot weather / UV light can trigger. Smoking can make SLE worse

Question 3

What questions should you ask when taking a history of a patient with ARD?

Answer 3

Question 4

What is the glove and sweater approach for examining a patient for SLE?

Answer 4

Gloves: start at the hands

• Raynauds - fingers go white
  
  • White-blue-red (triphasic)
  • White-red (biphasic)
• Joint pain and swelling
• Hand rash

Sweater:

• Proximal muscle weakness > Myalgia
• Hair loss
• Eye and mouth dryness
• Nose bleeds
• Mouth ulcers
• Pleuritic chest pain
• truncal rach/ photosensitivity
• Limb weakness

Question 5

What investigations should you do to help diagnose an ARD?

Answer 5

Routine bloods:

• Full blood count
• Urea, electrolytes, creatinine
• Liver enzymes
• C-Reactive Protein ( will usually be normal in SLE)
• Plasma viscosity

Autoantibodies tests

Question 6

What steps are taken to treat SLE?

Answer 6

• Patients education: lifestyle modifcation (stop smoking), use of sunscreen
• Start DMARDs: Hydroxycloroquine, Azathioprine, Mycophenolate
• Use of steroids: Prednisolone, methylprednislone
• In severe cases: IV cyclophosphamide

Question 7

Describe the disease demographics of rheumatoid arthritis

Answer 7

• Female: male ratio 3:1
• Prevalence: 1%
• No race predilection
• Genetic factors
• Environmental factors: smoking, bad dental health

Question 8

What are the 3 S’s for helping diagnose RA?

Answer 8

• Stiffness: early morning joint stiffness >30 minutes
• Swelling: persistent swelling of >1 joint (esp hands)
• Squeezing: squeezing the joint is painful in inflammatory arthritis

Question 9

What investigations can be done to help diagnose RA?

Answer 9

Question 10

How do you manage rheumatoid arthritis?

Answer 10

• Start DMARDS early: Methotrexate, Hydroxychloroquine, Sulfasalazine, Leflunomide
• Use of steroids: Prednisolone, Methyprednisolone (limited amount of time)
• Combination therapy is usally ~2-3 drugs