MSK Autoimmune Diseases Flashcards
What can mimic MSK autoimmune disease presentation?
Drugs- cocaine, mocycline, PTU Infection- HIV, endocarditis, hepatitis, TB Malignancy- lymphoma Cardiac myxoma, Cholesterol emboli, Scurvy
Risk factors for systemic lupus erythematous
Female,
15-50,
Afro-caribbean
Systems affected by SLE?
Face, Nervous system, General, Skin, Heart, Chest, Muscles, Blood, Joints
What are the classification criteria for SLE?
Any 4 of:
Malar rash,
Discoid rash,
Photosensitivity,
Oral ulcers,
Arthritis,
Serositis,
Renal (signif proteinuria or cellular casts in urine),
Neurological (unexplained seizures or psychosis),
Haematological (low WCC, platelets, lymphocytes, haemolytic anaemia),
Immunological (anti ds-DNA, cardiolupin, lupus anticoagulant),
ANA
Skin manifestations of SLE
Butterfly rash on face, Photosensitivity, Vasculitis, Purpura, Urticaria, Alopecia
Nervous system manifestations of SLE?
Fits, Hemiplegia, Ataxia, Peripheral neuropathy, Cranial Nerve lesions
Chest and heart manifestations of SLE?
Pericarditis, Endocarditis, Aortic valve lesions, Pleurisy, Pleural effusion, Fibrosis
Joint and muscle presentation of SLE?
Myopathy,
Aseptic necrosis of hip,
Arthritis in small joints
Blood presentation of SLE?
Anaemia,
Leukopenia,
Thrombocytopenia,
Raynaund’s phenomeno
What is Scleroderma?
Immune system attacking connective tissue under the skin and around internal organs and blood vessels
What are the 2 classes of scleroderma?
Localised or systemic
What is the presentation of localised scleroderma?
Morphea
What are the 2 classes of systemic scleroderma?
Limited and diffuse
Presentation of limited scleroderma (CREST)
Calcinosis, Raynaund’s phenomenon, Esophageal dysmotility, Sclerodactomy, Talangectasia
Presentation of diffuse scleroderma?
Fixed flexion
Complications of limited scleroderma?
Pulmonary hypertension
Complications of diffuse scleroderma?
Pulmonary fibrosis,
Renal crisis,
Small bowel bacterial overgrowth
What is Sjogren’s syndrome?
Autoimmune against exocrine glands
Main 2 symptoms of Sjogren’s syndrome?
Dry mouth,
Dry eyes
GI presentation of Sjogren’s syndrome?
Dry mouth,
Parotid gland enlargement,
Dysphagia,
Abnormal oesophageal motility
CNS and PNS presentation of Sjögren’s syndrome?
Fits,
Hemiplegia,
Ataxia,
Cranial nerve lesions
Sensory neuropathy,
Mononeuritis multiplex
Respiratory presentation of Sjögren’s syndrome?
Interstitial lung disease
Kidney presentation of Sjögren’s syndrome?
Renal ubular acidosis
Skin and joint presentation of Sjögren’s syndrome?
Palpable purpura,
Raynauds Syndrome,
Arthralgia
Complications of Sjögren’s syndrome?
Lymphoma, Neuropathy, Purpura, Interstitial lung disease, Renal tubular acidosis
Systemic presentation of Sjögren’s syndrome?
Fatigue,
Fever,
Myalgia,
Arthralgia
What is auto-immune myositis?
Autoimmune condition causing inflammation and weakness in muscles
Incidence of auto-immune myositis?
6/million
Presentation of auto-immune myositis?
Polymyositis,
Dermatomyositis,
Gottrons papules (on hands),
Heliotrope rash (ocular, purple oedema)
Complications of auto-immune myositis?
Cancer,
Interstitial lung disease,
Respiratory muscle weakness
Giant cell arthritis classification criteria?
3 of the following.... age of onset >50, New headache, Temporal artery tenderness/ reduced pulsation, ESR >49, Abnormal temporal biopsy
ANCA associated vasculitis types?
Granulomatosis with polyangiitis,
Microscopic polyangiitis,
Eosiniphilic granulomatosis with polyangiitis
What is granulomatosis with polyangiitis?
Necrotising granulomatous inflammation
Which ANCA associated vasculitis involves the upper and lower respiratory tracts?
Granulomatosis with polyangiitis,
Eosinophilic granulomatosis with polyangiitis
Describe microscopic polyangiitis
Necrotising vasculitis,
Few/ no immune deposits,
Affects small vessels
In what ANCA associated vasculitis does pulmonary capillaritis occur?
Microscopic polyangiitis
Describe Eosinophilic granulomatosis with polyangiitis
Eosinophil rich and necrotising granulomatous inflammation often involving the respiratory tract
Which ANCA associated vasculitis is associated with asthma and eosinophilia?
Eosinophilic granulomatosis with polyangiitis
Specific ANA profiles for SLE?
DsDNA,
Ro,
Sm
Specific ANA profiles for scleroderma?
Scl-70,
Centromere
Specific ANA profiles for polymyositis?
Jo-1
Specific ANA profiles for Sjögren’s syndrome?
Ro,
La
Lupus nephritis class 1
Minimal mesangial
Lupus nephritis class 2
Mesangial proliferative
Lupus nephritis class 3
Focal
Lupus nephritis class 4
Diffuse
Lupus nephritis class 5
Membranous
Lupus nephritis class 6
Advanced sclerosing
Multi-system autoimmune diseases mild organ threat treatment?
Hydroxychloroquine
Multi-system autoimmune diseases moderate organ threat treatment?
Azathioprine,
Methotrexate,
Mycophenolate
Multi-system autoimmune diseases severe organ threat treatment?
Cyclophosphamide,
Rituximab
