Autoimmune and Inflammatory Disorders Flashcards
what is the definition of autoimmunity
presence of antibodies directed against normal host antigens
what is the pathogenesis of SLE
- unknown etiology
- chronic, inflammatory autoimmune disorder
- vasculitis, fibrosis and tissue necrosis
what are the complications of SLE
multi organ
what is the epidemiology for SLE
- 90% of young middle aged women
- 2.5 times increased risk of AA
what are the 11 criteria that need to be met for SLE dx
- arthritis
- serositis
- malar rash
- discoid rash
- photosensitivity
- oral ulcers
- renal disease
- neurological disease
- hematological disease
- immunological manifestations
- antinuclear antibodies
what are the autoantibodies associated with SLE
- ANA: 95-100
- antinative DNA: 60
- RF: 20
- Anti-Sm: 10-25
- Anti-Ro: 15-20
- Anti-la: 5-20
what is the management for SLE
- rheumatologists: organ specific approach
- long term prednisone
- immunomodulating agents
what are the oral manifestations for SLE
- SLE like lichenoid lesions
- ulcerations/erosions
- hard palatal mucosa ulcer
- white radiating striae from a central ulcer
what is the pathogenesis of sjogrens syndrome
- chronic, inflammatory, autoimmune disorder
- primary vs secondary SS
- unknwon etiology
- expression of MHC II moelcules in activated salivary gland cells
- inherited susceptibility markers trigger a chronic inflammatory response in genetically susceptible individuals
- ongoing activation of the innate immune system as pro inflammatory cytokines are elevated
what are the complications of sjogrens syndrome
- lymphocytic infiltration
- lacrimal glands causing dry eyes (xerophthalmia)
-salivary glands causing dry mouth (xerostomia)
what is the epidemiology for sjogrens syndrome
- eldery women
- female to male ratio is 9:1
what is the dx for SS
- SS ACR classification criteria must have 2/3:
- positive anti-Ro and/or antiLa (+RF and ANA titer greater than 1:320)
- minor labial salivary gland biopsy exhibiting focal lymphocytic sialadenitis focus score greater than 1 focus
- ocular staining score greater than 3
what is the management of SS
- rituximab
- long term prednisone
- immunomodulating agents
what are the dental considerations for SS
- salivary hypofunction
- stimulated and unstimulated salivary flow measurements
- 44 times increased risk of MALToma
what are the autoantibodies for SS
- ANA: 95
- Antinative DNA:0
- RF: 75
- anti-SM: 0
- anti- Ro: 60-70
- anti-La: 60-70
what is the disease treated with azathioprine and SE
- RA
- stomatitis, nausea, vomiting, hepatotoxicity, pancytopenia, rash, arthralgia
what is the disease treated with corticosteroids and SE
- RA, SLE
- candidiasis, HTN, osteoporosis, cataracts, peptic ulcers, psychosis, delayed wound healing
what is the disease treated with cyclosporineand SE
- SLE, PSS
- stomatitis, cardiotoxicity, myelosuppresion, hepatotoxicity, pulmonary fibrosis, neoplasms, thrombocytopenia
what is the disease treated with hydroxychloroquine and SE
- RA, SLE
- mucosal discoloration, lichenoid reactions, convulsions, retinal and corneal changes, leukopenia, thrombocytopenia, nausea, vomiting
what is the disease treated with methotrexate and SE
-RA and SLE
- GI symptoms, stomatitis, rash, alopecia, infrequent myelosuppresion, hepatotozicity, rare pulmonary toxicity
what is the disease treated with mycophenolate mofetil and SE
- RA, SLE
- hyper or hypotension, peripheral edema, chest pain, tachycardia, headache, insomnia, fever, dizziness, anxiety, rash, nausea, comiting, abdominal pain, diarrhea or consitpation, anorexia, dyspepsia, leukopenia, anemia, thrombocytopenia, leukocytosis, ascites, paresthesia, tremor, weakness, abnormal liver or kidney function, dyspnea, cough, sinusitis, pleural effusion. bacterial, candidal and herpetic infections
what is the disease treated with NSAIDs and SE
- RA
- GI symptoms, including indigestion, ulceration, hemorrhage, small bowel ulceration, stomatitis, renal, neurological, pulmonary, hepatic, hematological, dermatological, displacement of protein bound drugs
what are the immune mediated conditions
- contact stomatitis
- angioedema
- orofacial granulomatosis
- sarcoidosis
- erythema multiforme/stevens johnson syndrome/toxic epidermal necrolysis
- lichen planus
what features are seen in melkerson rosenthal syndrome
- lip swelling
-fissured tongue - facial paralysis
what is the probability of chrons disease
over 22% of children diagnosed with OFG will have CD in 10 years and 8% are already dx
what sites are affects in chrons disease
- mostly swelling of lips
- 57% had swelling and 27% has cobblestoning on buccal mucosa
what is the gingival involvement with chrons disease
it ranges from segmental or diffuse erythema to edematous hyperplastic gingiva +/- pain
28% of patients with angular chelitis ____ had a staph aureus infection
61%
what are the characteristic of 35 OFG patients
- median age 24 years
- cobblestoning 49%
- fissuring 37%
- aphthous like ulceration 15%
- deeper linear type ulcers 12%
what are he percentages of food sensitivity
- benzoic acid (36%)
- food additives (33%)
- perfumes and flavourings (28%)
- cinnamaldehyde (27%)
- cinnamon (17%)
- benzoates (17%)
- chocolate (11%)
what is the treatment for food sensitivities
- topical/intralesional/systemic corticosteroids
- delayed release of triamcinolone
- various response
- adjuvant therapies: clofazimine, sulfasalazine, hydroxychloroquine, methotrexate, danazol, dapsone, TNF- alpha ant, metronidazole
what is sarcoidosis
- multisystem disease involves the lungs, eyes, and skin
- chest radiographic changes during a routine screening exam
- systemic symptoms: fatigue, night sweats, and weight loss
what is the pathogenesis of sarcoidosis
- development and accumulation of granulomas (compact, centrally organized collections of macrophages and eptiheliod cells encircled by lymphocytes)
- granulomas generally form to confine pathogens, restrict inflammation and protect surrounding tissue
- macrophages with chronic cytokine stimulation, differentiate into epitheliod cells, gain secretory and bactericidal capability, lose some phagocytic capacity and fuse to form multinucleated giant cells
describe lofgren’s syndrom
- acute presentation
- arthritis, erythema nodosum, and bilateral hilar adenopathy
- erythema nodosum is observed predominantly in women
- marked ankle periarticular inflammation or arthritis without erythema nodosum is more common in men
what is the oral presentation of lofgren’s syndrome
- plaque or nodular lesion
- tongue and lip
what is the dx for sarcoidosis
- chest radiographic evidence withc linical features and noncaseating granulomas on biopsy
- biopsy indicated for all patients with possible sarcoidosis except those with lofgrens syndrome
what are the clinical characteristics of sarcoidosis
- fatigue
- loss of ventricular function and sudden death
- cardiac and neurologic sarcoidosis
- chest radiographic patterns
what is the tx for sarcoidosis
- oral prednisone (20-40mg/day) international expert panel
- evaluate the response after 1-3 months
- if there has been a response the prednisone dose should be tapered to 5-15 mg per day with treatment planned for an additional 9-12 months
- lack of response after 3 months suggests the presence of irreversible fibrotic disease or an inadequate dose of prednisone
what is the transplantation with sarcoidosis
about 3% of lung transplantations and less than 1% of heart and liver transplantations are on pts with sarcoidosis
what is the prognosis for sarcoidosis
-2/3 of patients with sarcoidosis generally have a remission within a decade after dx
- a recurrence after 1 or more years of remission is uncommon
- less than 5% of pts die from sarcoidosis
- death as a result of pulmonary fibrosis with respiratory failure or of cardiac or neurologic involvement
describe erythema multiforme
- acute hypersensitivity reaction to various antigens
- characterized clinically by target lesions distributed symmetrically on extremities and trunk
- usually self limiting but may be recurrent
- many different classes exist
what is the epidemiology for erythema multiforme
- prevalence less than 1%
- young adults 20-40 years old
- 1:1.5 M:F ratio
- reported recurrence rate of 37%
-oral involvement as high as 70%
what is the clinical presentation for erythema multiforme
- vesiculobullous condition that may affect skin or mucous membranes
- symmetric involvement of extremities and trunk
- characteristic lesion: target lesion
- multiform clinical features: characteristic target lesions, macules, vesicles, papules