Rheumatological and Autoimmune Flashcards
What are the most common autoimmune antibodies seen in vasculitis and how are they screened for, and what following procedure should be done if one is discovered?
Anti- Neutrophil Cytoplasmic Antibodies/ ANCAs
- indirect immunofluorescence
ELSIA testing to establish:
- Proteinase - 3
- Myeloperoxidase
What is the common vasculitis that affects the large vessels, and who is affected? and what are the symptoms
what are some complications?
Giant cell vasculitis:
Females, >50, white
Headache
Jaw pain
Visual disturbance
polymyalgia
complications:
blindness
- amaurosis tagux pattern
Stroke
Out line pathophysiology of giant cell vasculitis:
T cell mediated immune response.
granulomatous inflammation - with giant cell and lymphocyte infiltration.
fibrosis occurs, endothelial damage. thrombogenic.
disease is segmental across the vessel.
What are some diagnostic findings of giant cell?
Increased ESR > CRP
Temporal pain
Pulseless temporal vessels
- *biopsy of temporal artery
- mononuclear infiltration
What is the treatment of giant cell vasculitis?
Prednisolone
- even before confirmation of biopsy
or
IV methylprednisolone if eye problems.
+
Aspirin 75mg for clots
Name the common, ANCA negative small vessel vasculitis, and what are the areas it predominantly affects?
Henock Schonlein disease
skin, GI, kidneys and joints
Who gets Henock Schonlein disease, and what are the typical symptoms:
Children
Males
- palpable purpura rash
- mainly on buttocks
- ecchymosis
- Urticaria rash
- G.I pain
complications:
- polyarthritis
- glomerulonephritis
What is the pathological process behind Henock Schonlein disease?
Previous group A Strep infection.
cross reacts causing type III hypersensitivity reaction with IgG forming against the IgA
Name a ANCA positive vasculitis, and list who gets it and common symptoms:
Granulomatous Angiitis
middle ages men
- sinusitis
- nasopharyngeal ulceration
- haemoptysis
- bilateral lung nodules
- haematuria
**nasopharynx
lungs
kidneys `
What investigations should be done for granulomatous angiitis vasculitis?
Serum c- ANCA levels
biopsy
- necrotic granulomas
high protein to serum creatinine level
What’s the treatment for granulomatous angiitis?
Cyclophosphamide
Steroids
Rituximab
What vasculitis is biggest cause of an MI in children?
Kawasaki Vasculitis
What are the symptoms of Kawasaki vasculitis and how is it treated?
- fever
- conjunctivitis
- strawberry tongue
- erythematous rash on palsm and soles
Treated with:
- aspirin
- IgG immunoglobulins
list the common types of seronegative arthritis:
Ankylosing spondylitis
Reactive arthritis
Psoriatic arthritis
What is associated with HLA DR3?
Systemic Lupus, Grave’s disease, Diabetes Melitus
