Lecture 5- A Clinical Approach to Autoimmunity Flashcards
Autoimmune Rheumatic Diseases (ARDs)
A diverse group of conditions that primarily affect the joints, bones, muscle, and connective tissue
Result from a break in immune tolerance by producing pathogenic antibodies which result in a heterogenous group of diseases which affect multiple systems.
The presence of autoantibodies can be used as a guide along with clinical features and aid in the stratification of disease and treatment
Importance of autoantibodies (not present in all ARDs)
- Aid to diagnosis
- Associated with specific clinical features
- Disease prognosis
- To stratify therapy e.g. monoclonal antibody therapy
diagnose
Systemic lupus erythematosus
Systemic lupus erythematosus
- Female to male ratio: 9:1
- Prevalence:24/100,000
- Race: Afro-Caribbean > South Asians > Caucasians
- Genetic factors are important
- Environmental factors
History taking for ARDs
Current symptoms
- Pain (Socrates/squitas)
- Stiffness
- Swelling
- Pattern of joint involvement
Evolution
- Acute or chronic?
- Associated events
- Response to treatment/Family history
Involvement of other systems
- Skin, eye, lung
- Malaise, weight loss, fevers, night sweats?
Impact on patient’s lifestyle
history taking for Lupus
- constitutional symptoms
- glove and sweater approach
constitutional symptoms of lupus
- Fever
- Fatigue
- weight loss
- night sweats
- poor appetite
“Glove and sweater” approach for lupus
-
Gloves
- Raynaud’s
- Joint pain and swelling
- Hand rash
-
Sweater
- Proximal muscle weakness >myalgia
- Hair loss
- Eye and mouth dryness
- Nose bleeds
- Mouth ulcers
- Pleuritic chest pain
- Pericardial pain
- Truncal rash/photosensitivity
- Limb weakness
examination for ARDS (lupus)
how to diagnose lupus with acronymn
4/11 criteria items= definite lupus
Investigations for ARDs (Lupus)
-
Routine bloods
- FBC
- Urea, electrolytes and creatinine
- Liver enzymes
- C-reactive protein
- Plasma viscosity and ESR
-
Autoantibodies/lupus assoc bloods
- Antinuclear antibodies (>1:160)
- Anti-DsDNA antibodies
- Anti-Sm antibodies
- Anti Ro and La antibodies
- Complements
- Antiphospholipid antibodies
treatment of SLE
- Patient education RE: lifestyle modification, use of sunscreen (at least SPF 50)
- Start DMARDs : Hydroxychloroquine , Azathioprine, Mycophenolate
- Use of steroids: Prednisolone ,methylprednisolone
- In Severe cases: IV Cyclophosphamide
diagnose
Rheumatoid arthritis
Rheumatoid arthritis
History taking for RA
Current symptoms
- Pain (Socrates/squitas0
- Stiffness
- Swelling
- Pattern of joint involvement
Evolution
- Acute or chronic?
- Associated events
- Response to treatment/Family history
Involvement of other systems
- Skin, eye, lung
- Malaise, weight loss, fevers, night sweats?
Impact on patient’s lifestyle
examining for RA
Investigations for RA
-
Routine tests
- FBC
- Urea, electrolytes and creatinine
- Liver enzymes
- C-reactive protein
- Plasma viscosity and ESR
- X-rays +- ultrasound
-
Autoantibodies
- +- antinuclear antibodies
- Rheumatoid factor antibodies
- Anti-CCP antibodies
- Anti Ro and La antibodies
Treatment of RA
- Start DMARDs early!! : Methotrexate Hydroxychloroquine, Sulfasalazine, Leflunomide
- Use of steroids: Prednisolone, methylprednisolone
- Combination therapy is usual.
START EARLY
classification criteria for RA
