Rheumatoid Arthritis and SLE Flashcards
Describe lupus in an overview
Chronic tissue inflammation in the presence of antibodies directed against self antigens
What 3 types of autoantibodies is lupus associated with?
Antinuclear antibodies
Anti-double stranded DNA antibodies
Anti-phospholipid antibodies
Describe RA in an overview
Chronic joint inflammation that can result in joint damage
What is the sight of inflammation in RA?
Synovium
What 2 types of autoantibodies is RA associated with?
Rheumatoid factor
Anti-cyclic citrullinated peptide (CCP) antibodies
How often does RA cause joint damage?
Rarely, usually it is not erosive and doesn’t cause joint damage but often tenderness is visible on presentation
Describe ankylosing spondylitis in an overview
Chronic spinal inflammation that can result in spinal fusion and deformity
What is the sight of inflammation in ankylosing spondylitis?
Enthesis
Out of SLE, ankylosing spondylitis and rheumatoid arthritis which have autoantibodies?
SLE and rheumatoid arthritis
What phenomenon is common in LE, ankylosing spondylitis and rheumatoid arthritis? Describe it
Reynaud’s phenomenon, there is intermittent vasospasm of digits on exposure to cold, typical colour changes are white to blue to red
Vasospasm leads to blanching of digit
What is the common demographic for SLE?
Women between 15-45 yrs old
What are clinical manifestations of SLE?
Malar rash
Photosensitive rash
Mouth ulcers
Hair loss
Raynaud’s phenomenon
Arthralgia and sometimes arthritis
Serositis (pericarditis, pleuritis, less commonly peritonitis)
Renal disease – glomerulonephritis (‘lupus nephritis’)
Cerebral disease – ‘cerebral lupus’ e.g. psychosis
What is the pathogenesis of SLE thought to be?
Apoptosis leads to translocation of nuclear antigens to membrane surface
Impaired clearance of apoptotic cells results in enhanced presentation of nuclear antigens to immune cells
B cell autoimmunity
What do anti phospholipid antibodies increase risk of in SLE?
Arterial and venous thrombosis
What does level of anti-dsDNA correlate with in lupus?
Disease activity
What will show after haematology investigations in SLE?
Haemolytic anaemia, Lymphopenia, Thrombocytopenia
What is it important to measure in SLE in relation to renal function?
Urine protein (protein:creatinine ratio and albumin)
What is it important to remember in treated SLE patients?
Changes may reflect adverse reactions to medication
What will anti ds-DNA antibody, C4 and C3 levels be in someone with SLE?
Anti ds-DNA levels will be high
C3 and C4 levels will be low
What is recommended for all patients with SLE?
Hydroxychloroquine
What is given if SLE presents acutely?
Glucocorticoids
When are glucocorticoids given in SLE?
When the patient presents acutely to stop the flare up but they cannot be used long term for maintenance
What do SLE patients need to be assessed for?
Antiphospholipid antibody status as they may be at risk of coagulations and in that case need to be given anticoagulants
Infectious disease risk profile
Cardiovascular disease risk profile
What is Sjorgen’s syndrome?
Autoimmune damage to the endocrine glands
What are glandular manifestations of Sjorgen’s syndrome?
Dry eyes
Dry mouth
Parotid gland enlargement
What are non glandular manifestations of Sjorgen’s syndrome?
Non erosive arthritis
Raynaud’s syndrome
Describe inflammatory muscle disease in an overview
Proximal muscle weakness due to autoimmune-mediated inflammation
What are the 2 types of inflammatory muscle disease and how are they differentiated?
With rash= dermatomyotisis
Without rash= polymyositis
What skin changes occur in dermatomyotisis?
Lilac-coloured rash on eyelids, malar region and naso-labial folds
Red or purple flat or raised lesions on knuckles (Gottron’s papules)
Subcutaneous calcinosis
Mechanic’s hands (fissuring and cracking of skin over finger pads)
What is abnormal in muscle biopsy in those with polymyolitis?
There are a high no of CD8 T cells
What is abnormal in muscle biopsy in those with dermatomyositis?
There are a high no of CD4 T cells and B cells
What is scleroderma?
Thickened skin with Raynaud’s phenomenon
What are the 2 categories of skin changes in scleroderma?
Diffuse and limited
What is overlap syndrome?
When features of more than 1 connective tissue disorder are present
What is undifferentiated connective tissue disease?
When incomplete features of a connective tissue disease are present
What auto antibody is present in diffuse systemic sclerosis?
Anti-Scl-70 antobody
What auto antibody is present in limited systemic sclerosis?
Anti-centromere antibodies
What auto antibody is present in dermato/polymyositis?
Anti-tRNA transferase antibodies
What auto antibody is present in mixed connective tissue disease?
Anti-U1-RNP antibodies
