Rheumatoid Arthritis & SLE Flashcards
Common in connective tissues disorders
Raynaud’s phenomenon
Raynaud’s phenomenon
Intermittent vasospasm of digits on exposure to cold
Typical colour changes - white to blue to red
-vasospasms lead to blanching of digit
-cyanosis as static venous blood deoxygenates
-reactive hyperaemia
Most commonly isolated and benign condition
Autoantibodies of RA
Rheumatoid factor
Anti-cyclic citrullinated peptide antibody
Autoantibodies of SLE
Antinuclear antibodies
Anti-double stranded DNA antibodies
Anti-phospholipid antibodies
Autoantibodies of osteoarthritis
None
Autoantibodies of reactive arthritis
None
Autoantibodies of gout
None
Autoantibodies of ankylosing spondylitis
None
ANA significance
Seen in all SLE cases
Not specific for SLE
Anti-dsDNA significance
Specific for SLE
Serum level of antibody correlates with disease activity
Anti-Ro antibodies significance
Secondary Sjögren’s syndrome
Neonatal lupus syndrome
Anti-La antibodies significance
Secondary Sjögren’s syndrome
Neonatal lupus syndrome
Sjogren’s syndrome
Autoimmune exocrinopathy
Exocrine gland pathology results in
-dry eyes
-dry mouth
-parotid gland enlargement
Inflammatory muscle disease
Proximal muscle weakness due to autoimmune mediated inflammation either with or without a rash
Skin changes in dermatomyositis
-lilac coloured rash
-red or purple flat or raised lesion on knuckles
-subcutaneous calcinosis
-mechanic’s hands
Elevated CPK, abnormal EMG, abnormal muscle biopsy
Associated with malignancy and pulmonary fibrosis
Sjogren’s syndrome autoantibody
No unique antibodies
Mixed connective tissue disease autoantibody
Anti-U1-RNP antibodies
SLE clinical manifestation
Malar rash - erythema that spares nasolabial fold
Photosensitive rash
Mouth ulcers
Hair loss
Raynaud’s phenomenon
SLE pathogenesis
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
Tissue damage by antibody effector mechanisms e.g. complement activation and Fc receptor engagement
Autoantibodies of systemic vasculitis
Antinuclear cytoplasmic antibodies
Anti phospholipid antibodies significance
Risk of arterial and venous thrombosis in SLE
May occur in absence of SLE
Anti-Sm antibodies
Specific for SLE
Serum level of antibody does NOT correlate with disease activity
Anti-ribosomal P antibodies
Cerebral lupus
SLE investigations
Inflammation - high ESR but normal C-reactive protein
Clotting - antiphospholipid antibodies
SLE management
Aims at remission or low disease activity and prevention of flares
Hydroxychloroquine is recommended
Maintenance glucocorticoid should be minimised and when possible withdrawn
In persistently active or severe disease we use cyclophosphamide and B cell targeted therapies
Assessed for infectious and cardiovascular disease
Pregnancy planning
