Connective Tissue Disease Part 1 Flashcards

1
Q

What are connective tissue diseases?

A

Conditions associated with spontaneous overactivity of the immune system (not diseases of connective tissue)

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2
Q

What are some features of connective tissue disease?

A

Specific auto-antibodies are present, evolve over months to years sometimes leading to organ failure and death

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3
Q

What are some examples of connective tissue diseases?

A

Systemic Lupus Erythematous (SLE), Sjogren’s syndrome, dermatomyositis/polymyositis, anti-phospholipid syndrome

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4
Q

What is SLE?

A

Systemic autoimmune condition that can affect almost any part of the body

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5
Q

What occurs in lupus?

A

Immune system attacks cells and tissues resulting in inflammation and tissue damage, immune complexes form and precipitate causing further immune response

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6
Q

Who gets SLE?

A

Female to male ratio is 9:1, commonly presents in childbearing years, commoner and more severe in those of Afro-Caribbean, Hispanic American and Asian ethnicity

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7
Q

What does the loss of immune regulation cause?

A

Increased and defective apoptosis

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8
Q

What do necrotic cells release?

A

Nuclear materials, which then act as auto-antigens

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9
Q

How does auto-immunity arise?

A

Results from exposure to nuclear and cellular auto-antigens

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10
Q

What does the stimulation of B and T cells cause?

A

Production of auto-antibodies

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11
Q

Where do the immune complexes of antigens and auto-antibodies that form and circulate deposit in the body?

A

The basement membrane

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12
Q

What does the activation of complement cause?

A

Attracts leucocytes which release cytokines = perpetuates inflammation which causes necrosis and scarring

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13
Q

What score on the EULAR/ACR 2019 classification criteria indicates lupus?

A

Score > 10, ANA must be positive

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14
Q

What are some cutaneous features of SLE?

A

Subacute cutaneous or discoid lupus, acute cutaneous lupus, non-scarring alopecia, Malar rash, oral ulceration

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15
Q

What are the features of arthritis associated with lupus?

A

Synovitis or tenderness of at least 2 joints with > 30mins morning stiffness, jaccouds arthropathy

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16
Q

What are some neurological manifestations of lupus?

A

Delirium, psychosis, seizure, headache, cranial nerve disorder

17
Q

What are the manifestations of serositis associated with SLE?

A

Pleural/pericardial effusions, acute pericarditis

18
Q

What are some haematological and renal features of lupus?

A
Haematological = leucopenia, thrombocytopenia, haemolytic anaemia, lymphadenopathy
Renal = proteinuria > 0.5g in 24hrs, biopsy proven nephritis, red cell casts
19
Q

What are some antibodies associated with SLE?

A

Anti-nuclear antibody (ANA), Anti-double stranded DNA antibody (dsDNA), anti-phospholipid antibodies (APLS),
Anti-Ro antibody, Anti Sm antibody

20
Q

What are some features of anti-nuclear antibody (ANA)?

A

Positive in a titre 1:80 in almost all SLE patients

21
Q

What are some features of anti-double stranded DNA antibody (dsDNA)?

A

Present in 60% of patients, specific for SLE, titre correlates with disease activity, associated with lupus nephritis, most important antibody for diagnosing lupus

22
Q

What are some features of antiphospholipid antibodies (APLS)?

A

Lupus anticoagulant/anti-cardiolipin antibodies/anti-beta2glycoprotein antibodies, associated with venous/arterial thrombosis and recurrent miscarriage, livedo reticularis

23
Q

What are some features of complement in regards to its relationship with SLE?

A

Activation and consumption is related to disease activity, particular association with renal and haematological disease, C3 and C4

24
Q

What are some features of anti-Ro antibody and anti-Sm antibody?

A
Anti-Ro = can be associated with neonatal lupus and congenital heart block
Anti-Sm = highly specific for lupus
25
Q

What is the treatment for lupus in all patients?

A

Sun protection measures, hydroxychloroquine, minimise steroid use, monitor disease activity using SLEDAI score

26
Q

What should be prescribed for patients positive for antiphospholipid antibody?

A

Anticoagulants/antiplatelets