Gen Path Exam 3 - Autoimmune Disease - Systemic Sclerosis Flashcards
Another name for systemic sclerosis
Scleroderma
Chronic autoimmune disease of unknown etiology, characterized by diffuse fibrosis, degenerative changes, and vascular abnormalities in the skin, articular structures and other organs (kidneys, lung, heart, gastrointestinal and skeletal
muscles)
Systemic sclerosis
T/F: Systemic sclerosis can range from a mild disease, affecting only the skin, to a systemic disease that can cause death in a few months
True
What age range does systemic sclerosis effect?
16-40 yrs
40-75 yrs
When do symptoms of systemic sclerosis appear?
30s to 50s
Does systemic sclerosis affect men or women more frequently?
Women
Is there a genetic component to systemic sclerosis?
Yes, but it is rare
2 major forms of systemic sclerosis
Limited (localized)
Diffuse (progressive)
Limited (localized) or diffuse (progressive)?
Affects 80% of pts with systemic sclerosis
Limited (localized)
Limited (localized) or diffuse (progressive)?
Involves skin on fingers, forearms, and face
Limited (localized)
Limited (localized) or diffuse (progressive)?
If there is visceral/systemic involvement, it is mild and occurs late in disease process
Limited (localized)
Limited (localized) or diffuse (progressive)?
Clinical course is benign with minimal systemic involvement
Limited (localized)
Limited (localized) or diffuse (progressive)?
CREST syndrome
Limited (localized)
What antibodies is CREST syndrome associated with?
Anticentromere antibodies
What does CREST syndrome stand for?
subcutaneous Calcinosis
Raynaud’s phenomenon
Esophageal dysfunction
Sclerodactyly
Telangiectasia (spider veins)
Common form of limited (localized) systemic sclerosis
CREST syndrome
Limited (localized) or diffuse (progressive)?
Multisystem disease characterized by inflammation + fibrosis of many organs
Diffuse (progressive)
Limited (localized) or diffuse (progressive)?
Affects 20% of pts with systemic sclerosis
Diffuse (progressive)
Limited (localized) or diffuse (progressive)?
Constitutional symptoms, arthritis, carpal tunnel, swelling of hands and legs
Diffuse (progressive)
Limited (localized) or diffuse (progressive)?
Acute onset
Diffuse (progressive)
Limited (localized) or diffuse (progressive)?
Widespread skin thickening from fingers to trunk
Diffuse (progressive)
Limited (localized) or diffuse (progressive)?
Internal organ involvement including GI, pulmonary fibrosis, cardiac failure, renal failure
Diffuse (progressive)
Limited (localized) or diffuse (progressive)?
Overlapping with systemic lupus, Sjogren’s, RA, and dermatomyositis
Diffuse (progressive)
Describe the postulated sequence of events that may lead to systemic sclerosis
- Endothelial cell injury in small arteries
- T cells migrate to perivascular tissue
- CD4 cells respond to self antigen
- CD4 cells make cytokines: TGF-beta, IL-13, PDGF
- Repeated endothelial injury and platelet aggregation leads to proliferation and fibrosis
- Ischemic injury
- B cell activation: hypergammaglobulinemia + ANAs
What are the 8 clinical manifestations of systemic sclerosis?
Raynaud’s
Cutaneous
Oral
Musculoskeletal
GI
Cardiac
Pulmonary
Renal
Occurs in almost all pts with systemic sclerosis
Raynaud’s
Often the FIRST sign of systemic sclerosis
Raynaud’s
Some patients have recurrent episodes associated with digital pitting scars, nail fold infarcts, or digital ulcers
Raynaud’s
Diffuse, _________ __________ of the skin begins in fingers and upper extremities. Extends to involve upper arms, shoulders, neck, face
sclerotic atrophy
Early skin changes, starting with ____________ _________, often involve the whole hand and extremities
pitting edema
Edema is replaced by _____________ and ___________ of the skin, resulting in difficulty moving affected parts
tightening and hardening
Loss of blood supply leads to cutaneous ______________ and atrophic changes in fingers, including ________________
ulcerations; autoamputation
Hyperpigmentation, telangiectases, and subcutaneous ____________ may also occur, leading to _________ and severe cosmetic problems
calcifications; deformity
Sclerodactyly
Thick skin over fingers
En coup de sabre
Skin lesion on the middle forehead
Skin folds are lost around the mouth, giving a _____________ appearance to the face
mask-like
Lips become _________, and the oral aperture ______________
rigid; narrows
The ___________ can also become hard and rigid, making speaking and swallowing difficult
tongue