Lecture 6 - Clincal Approach To Autoimmunity Flashcards
Why do Autoimmune Rheumatic Diseases occur?
Immune tolerance breakdown (body attacks cells it shouldn’t be attacking)
B cells producing pathogenic antibodies
What 2 things do we need to rule out in order to suspect Autoimmune Rheumatic Disease due to multi systemic features?
Infection
Cancer
Does auto-antibodies being present mean autoimmune disease?
No not always disease
Need autoantibodies + symptoms to diagnose autoimmune disease
What’s the diagnosis?
1.) High titer of rheumatoid factor + no symtoms
2.) High titer of rheumatoid factor + joint pain
1.) no disease
2.) rheumatoid arthritis (the symptoms need to match the elevated antibody)
What condition does this patient likely have:
25y/o
Afro Caribbean lady
Painful hand joint for 18months
3yr Hhx raynauds
Few days pleuritic chest pain
Disabling fatigue.
Systemic Lupus Erythematosus
What is the typical patient for Systemic Lupus Erythematosus?
Female (9:1)
Afrocaribbean > South Asians > Caucasians
FHx
Environmental factors like UV light and smoking
What are the 2 components to UV light?
What do they do?
UVa (ageing)
UVb (bad)
How can UVb affect someone predisposed to lupus?
Can go through skin causing damage to cells
Can trigger lupus
Patients often go on holiday and trigger lupus due to UV expsoure in those predisposed to it (can get flare ups if have it)
If patients have SLE, what are they recommended to do while on holiday?
Use suncream with high SPF
What is serositis?
Inflammation of serosal membrane
Can be what causes pleuritic chest pain in lupus
What is the system for Hx taking for Autoimmune Rheumatoid Diseases?
Constitutional symptoms (B symptoms affecting whole body)
Then Glove and Sweater approach
What are some constitutional symptoms/B symptoms affecting whole body?
Fever (IL-6)
Fatigue
Weight loss
Night sweats (fever at night)
Poor appetite
What is the glove and sweater approach to history taking?
Imagine putting on gloves ask patient about things to do with their hands
Imagine as your putting on a sweater you have to consider symtpoms for everything that the sweater passes
What are some “Glove” symptoms you should ask patients about for an Autoimmune Rheumatioid disease?
Raynauds (cold fingers and toes, go blue)
Join pains and swelling
Hand rash
Synovitis
What are some “sweater” symptoms you should ask patients about for an Autoimmune Rheumatioid disease related to the arms as you put the sweater on?
Proximal muscle weakness (may struggle to life arms or may not be able to get off toilet or seat due to weak thighs)
Large joint swelling
Nerve involvement
Limb rash
What are some “sweater” symptoms you should ask patients about for an Autoimmune Rheumatioid disease related to the head/face as you put the sweater on?
Alopecia (hair loss, hair on pillow when wake up)
Facial rash
New mouth ulcers
Ulcers in nose
Nose bleeds
What are some “sweater” symptoms you should ask patients about for an Autoimmune Rheumatioid disease related to the trunk as you put the sweater on?
Pleuritic chest pain
Pericardial pain (listen for pleural and pericardial rubs)
Truncal rash / photosensitivty
What is strange about Crp in a pataient with Autoimmune Rheumatoid Disease??
May nto always be raised
What conservative managements are done for Lupus?
Life style modification (stop smoking)
Use of suncream
What types of drugs may be used to treat Systemic Lupus Erythematosus?
DMARDs: Azathioprine , mycophenolate mofetil, hydroxychloroquine
Steroids: Prednisolone, methylprednisolone
Sevre cases: IV cyclophosphamide
What are some issues seen in lupus?
A RASH POINTS Medical Diagnosis
ANA positive
Renal abnormalities
Arthralgia/arthirits
Serositis
Haematological abnormalities
Photosensitivity
Oral ulcers
Immunological abnormalities
Neurological abnormalities
Thrombocytopenia
Scalp chanegs (hair loss)
Malar rash/Discoid rash
What is the likely diagnosis?
25y/o south Asian lady
Painful bilateral hand joints 3months
Inc joint pain and swelling affecting feet
Disabling fatigue
Rheumatoid arthritis
What is the most common autoimmune rheumatic disease?
Rheumatoid arthritis
What is the classic patient for rheumatoid arthritis?
Female (3:1)
Prevelance = 1%
No race predilection
Genetic/environemtnal factors (smoking and poor dental hygiene)
What are the 3 ss of Rheumatoid arthritis?
Stiffness in morning that improves with movemtn
Swelling (persisten of one joint or more)
Squeezing (squeezing the joints in painful inflammatory arthritis)
What investigations should you definitely do ion rheumatoid arthritis?
X-rays or ultrasound at least
What antibodies are most commonly in rheumatoid arthritis?
Rheumatoid factor antibodies
Anti-CCP antibodies
How do you treat Rheumatoid arthritis?
DMARDs + Steroids
What DMARDs are most used for Rheumatoid arthritis?
1st line?
1st line DMARD = Methotrexate, sulfasalazine, hydroxychloroquine
What steroids are usually used in Rheumatoid Arthritis?
Prednisolone
Methylprednisolone
