Immunopathology Again Flashcards
Macule
Flat lesion <1cm
Freckle
Patch
Macule >1cm
Birthmark
Papule
Elevated solid skin lesion <1cm
Mole, acne
Plaque
Papule >cm
Psoriasis
Vesicles
Small fluid filled blister <1cm
Shingles
Bulla
Large fluid filled blister >1cm
Bulluos
Pemphigoid
Pustule
Vesicles containing pus
Pustular psoriasis
Wheal
Transient smooth papule or plaque
Hives
Scale
Flaking off of stratum corneum
Eczema
Crust
Dry exudate
Impetigo
Signs and symptoms of lupus erythematosus
- Facial rash (photo Sensitivity) butterfly
- arthritis
- renal disorders
- Neuro disorders
- immunological disorders
- hemolytic anemia
- rashes
Great imitator
Classic triad for SLE
Fever, joint pain malar rash on bridge of nose and cheeks
Chronic inflammatory immune disorder primarily in women of childbearing age
SLE
Another name for butterfly rash
Malar rush
Women and men in SLE
Women outnumber men 10:1
Etiology of SLE
Unknown. Characterized by formation of an array of antinuclear antibodies (ANA) and formation of immune complexes
-type III
What test do we use for SLE
ANA
-very sensitive but not specific
Immune complex of SLE
Deposit and cause tissue damage and cause symptoms of disease
4 types of LE
- SLE (70%)
- discoid lupus (10%, skin and scarring, never goes internally )
- drug-induced lupus (10% resolves upon stopping drug)
- combination lupus + Sjogren or RA
Common cause of death in SLE
cardiovascular disease
Renal failure
Infections
Never goes internally, causes chronic eruptions and scarring of the skin
Discoid lupus
Most common diagnostic criteria for SLE
Malar rash
What blood tests do we use for SLE
ANA- sensitive, not specific
Anti-dsDNA- specific, poor prognosis
Anti-smith-specific, not prognostic
What can cause a false positive syphillis test
False positive RPR/VDRL, FTA-ABS
SLE
Ocular findings of SLE
20%
- dry eye
- recurrent episcleritis
- peripheral keratitis (infiltrates)
- photo Sensitivity
- uveitis
- central retinal artery occlusion (CRAO)
Drugs associated with drug induced lupus
Quietly Induce Harmful Pathology
- quinidine (cardiac)
- isoniazid (TB)
- hydralazine (cardiac)
- procainamide (cardiac)
How does drug associated lupus present in blood
Transient ANA, no anti-Sm antibodies
All the signs and symptoms of lupus but not the blood work for it
Inflamed vessels walls may occlude, may occur with other connective tissue diseases
Vasculitis
Affects large and small arteries, ophthalmic and aorta often involved
Giant cell arteritis (formal temporal arteritis)
Granuloma and inflammation can occlude the artery
Emergency
Presentation of giant cell arteritis
Evolves to severe
HA, scalp necrosis, jaw claudication, blindness
What is giant cell arteritis treated with
Steroids, prevent blindness
Focal or segmental lesions of small and medium arteries
Poly arteritis nodosum
Signs and symptoms of polyarteritis nodosum
Joint pain
Retinal vein occlusion
Cotton wool spots
Excessive fibrosis throughout the body, occurring mostly in women, 30-50 years old
Scleroderma
ANA in scleroderma
Positive in 95% of patients
Scleroderma if it moves internally
Pulmonary involvement is leading cause of death
Two major types of scleroderma
Diffuse
Limited
Diffuse scleroderma
Widespread skin involvement, rapid progression to viscera
Limited scleroderma
Skin, fingers and face, characterized by the CREST syndrome, benign course
Limited scleroderma with CREST syndrome
Diagnostic of limited scleroderma that is treatable and non lethal
- clacinosis
- raynaud phenomenon
- esophageal dysmotility
- sclerodactyly
- telangiesctasia
Formation of calcium deposit in any soft tissue
Calcinosis
Vasospasm in digits, white-blue-red
Raynaud phenomenon
Thickening and tightening of skin of fingers and toes
Sclerpdactylyl
Small, dilated vessels near the skin air mucus membrane surface
Telangiectasia
Another test that can test for limited scleroderma
Anti-centromere Ab
Anti-Scl-70
Diffuse/bad scleroderma outcome.
Anti-centromere Ab
Limited/benign scleroderma
Ocular implications of scleroderma
May involve lacrimal glands
Autoimmune destruction of exocrine glands (especially lactimal and salivary glands)
Sjogrens sysndrome
Triad in Sjogrens
Dry mouth, dry eyes, and arthritis
Who is affected nu Sjogrens
40-60 y/o females
Labs for Sjogren syndrome
ANA and RF positive
Antiribonucleoprotein Ab: SS-A (anti-Ro) and SS-B (anti-La)
Attacks moisture producing glands
Sjogrens
A term a relates to inflammation of the joints
Arthritis
Applied to 100+ rheumatic diseases
Arthritis
Number one cause of arthritis
Osteoarthritis (OA)
Friction disease, not autoimmune disease leading to arthritis
Osteoarthritis
Damage to joint, related to overuse on weight bearing joints
Who is impacted by OA
10% of all Americans
Systemic inflammatory disease of symbolical membranes/joints of hands, feet, wrists, also involves heart/lung/liver/skin/vasculature
RA
Pathology of RA
Starts as retype IV, and then very quickly goes to type III
Rheumatoid factors
Used to ID and Dx RA
- the antibody that help forms the immune complex
- IgM!! (Usually everything class switches to IgE, by RA does not)
- Anti-IgG Ab
- autoimmune
What is unique about the IgG in RA
It does not activate complement
RA immunoglobulin
RF is the IgM that is bound to the IgG FC portion that is attached to a cell membrane and causes complement
-anti-IgG Ab
What HS is RA
Type III
Starts as 4 but very transient
Ocular manifestations in RA (percent)
25%
What are the ocular manifestations of RA
- keratoconjunctivitis sicca
- scleromalacia perforans
- choroiditis, retinal vasculitis, RD
What is the most common ocular manifestation of RA
Keratoconjunctivitis sicca (deacreased porduction and subsequent corneal damage) in 15-25% of patients
Necrotizing scleritis with inflammation occurring in RA
Scleromalacia perforans
Deep, boring pain exacerbated by palpating the eye. Vessels are purplish and dont blanch with pehnyl
Scleritis. Not the case for conjunctivitis
Formerly known JRA, most common form of arthritis in children
Juvenile idopathic arthertis
Who does JIA target
Young females and affects multiple joints
Blood test for JIA
ANA positive
RF neg 50% of cases
What patients are at a higher risk of ocular manifestations from JIA
Patients under the age of 6 with recent onset of disease
JIA control
Can be easily controlled and can totally go away
The number one cause of uveitis in children
JIA
Accounting for 80% of cases
Arthertis without rheumatoid factor, no anti-IgG Ab
Seronegative spondyloartheropathies
What is there a strong association with in seronegative spondyloartheropathies
HLA-B27 (MHC-1)
Signs and symptoms of seronegative spondyloartheropathies
- Inflammatory back pain- improves with exercise
- extraarticular GI symptoms, dactylitis (sausage fingers)
seronegative spondyloparthropathies mnemonic
PAIR
- psoriatic arthritis
- ankylosing spondylitis
- inflammatory bowel disease (IBD)
- reactive arthritis
Associated with skin psoriasis and nail bed pitting, dactylitis and uveitis
Psoriatic arthritis
Spinal and sacroiliac ankylosis (joint fusion), lower back pain, bamboo spine, uveitis
Ankylosing spondylitis
Most common extracurricular manifestation of ankylosing spondylitis
Uveitis
What can people with IBD develop
Can have joint pain
Post venerial and post diarrheal, present with triad of conjunctivitis, urethritis, and arthritis
Reactive arthritis
-cant pee, cant see, cant climb a tree
Non-rhematologic autoimmune, inflammatory up disease with an associated of iveiuti and hypercalcium
Sarcoidosis
Signs and symptoms of sarcoidosis
Non caseating granulomas skin lesions
- associated with pulmonary infiltrates
- hilar adenpathy
When’s someone has high calcium levels what do we consider
Parathyroid gland problems, sarcoidosis, and lung cancer
