Connective Tissue Disease Flashcards
Overview- what is Rheumatoid Arthritis (RA)?
Inflammatory arthritis associated with wrist and hands. Inflammation and thickening of the joint capsule. Also may impact bone and cartilage.
Difference between Rheumatoid arthritis and osteoarthritis
Rheumatoid- autoimmune disease where self Ab attacks joints.
Osteo- Due to mechanical wear and tear of joints.
Who is more likely to have RA?
- Women 3x more likely
- Genetic predisposition
Symptoms of RA
pain and swelling in joints. Worsens after rest.
How to diagnose RA
Rheumatoid factor, erythrocyte sedimentation rate (ESR), C-reactive protein, Anti CCP
Ocular implications of RA
-Dry eye is the most common. (Women are 9x more commonly affected)
-Scleritis: Deep intolerable boring pain, redness, photophobia and tenderness
-Episcleritis: Painless red eye, minimal vision impact.
Peripheral ulcerative keratitis- Thinning of cornea that may lead to ulcers and loss of the eye
Treatment of RA
- Steroids to suppress immune system, plaquenil (side effect of building up in cells and causing toxicity to photoreceptor cells)
- Scleral lenses, preservative free artificial tears, restates to help dry eye
Sjogren Syndrome (SS) Overview
Excessive dryness of eyes, mouth, and other mucous membranes. Due to WBC damaging glands such as lacrimal, or salivary.
SS diagnosis
Labs- antinuclear Ab, Sio (blood work), biopsy of salivary glands
Who is most likely to have SS
Middle age women, with lower estrogen levels. Often comes along with other autoimmune diseases.
SS symptoms
Vary greatly as can be associated with RA, SLE, more
ocular implications of SS
Dry eye syndrome is the most common
-SPK (tight junctions in between cells are unstable) or ulceration also possible.
Treatment of SS
-Steroids, artificial tears, restasis, gum to enhance salivary production (no excess water).
SLE (lupus) overview
Problems in joints, nervous system, blood, skin, kidneys,Gi tract, lungs.
Other tissues and organs may be impacted
Diagnosis of SLE
Antinuclear antibody test (ANA) and blood counts. (low RBC, WBC, and platelets.)
There are 17 criteria for classification of the disease. To be diagnosed, patients must have 4 of the 17 classifiers.
Who is mostly likely to have SLE
Women of childbearing ages (20-30). More common in African American and asian women.
Treatment of SLE
Steroids (immune suppression) Consequences- weight gain, sugar level increase
Symptoms of SLE
Very hard to diagnose. Pt must have 4/17 symptoms.
Ocular implications of SLE
Dry eye is most common- Range from SPK to ulceration.
Retina is the 2nd most commonly involved- vasoclusive retinopathy such as cotton wool spots, micro aneurysms, neovascularization.
Marfan Syndrome overview
Genetic disease resulting in a decreased number of functional fibril. (Fibrillin typically is composed of elastin in the center and fribrillin protein that forms microfibrils around the core. It is stretchy.
Marfan Syndrome characteristics
Tall and thin
long arms, legs, fingers, and toes
flexible joints
Scoliosis (sideways curve to spine)
Marfan syndrome impacts
- bones
- eyes: lens dislocation due to weak Zonules. lens most often goes up and out.
- Lungs
- Heart: Mitral valve prolapse, aortic aneurysm due to weakening in the artery wall. Causes rupture.
Ehler-Danlos Syndrome (EDS) Overview
Collagen disorder that is a defect in the structure or processing of collagen.
Characteristics of EDS
Joint hyper flexibility, stretchy skin, hyper extensibility
This indicates that joints will wear out quicker.
EDS impacts to musculoskeletal system, skin, cardiovascular system, and ocular system?
Musculoskeletal- Hyper flexible joints, joint disease, tearing of tendons or muscles, spin deformities
Skin- Fragile, tears easily. Skin folds, easy bruising.
Cardiovascular- Dilation of rupture of ascending aorta, heart murmur
Ocular- High myope, lens dislocation, keratoconus, strabismus, angled streaks (streaks coming out from optic nerve in fungus photo)
