3b.) A Clinical Approach to Autoimmunity Flashcards
State some commone autoimmune rheumatic diseases (ARDs)
- Rheumatoid arthritis
- SLE
- Sjogren’s syndrome
- Systemic sclerosis
What do rheumatologists do?
Diagnose and treat musculoskeletal disease and systemic autoimmune conditions commonly referred to as rheumatic diseases
Why is detecting the presence of autoantibodies useful in clincial practise when dealing with autoimmune rheumatic conditions?
Disease can be present in the absence of autoantibodies- this is important to note. However, antibodies:
- Can aid diagnosis
- Are associated with specific clinical features
- Can be indicative of disease prognosis
- Help us to stratify therapy
Answer the following case study
Answer= D (SLE)
- A: generally over 50
- Fibromyalgia: a diagnosis of exclusion so need to explore others first
- Vit D deficiency: wouldn’t have pleuritic chest pain
- E: this means putting it on. Highly unlikely to be answer
Which races is SLE most common in?
Afro-carribean > South asian > Caucasian
Why may someone who has recently been on holiday have a flare of their SLE?
UV light not good for SLE
If a young afro carribean lady comes in with history of months of joint pain what must you think as one of your differentials?
SLE!!
State some key questions/information you must obtain when taking a history for an autoimmune rheumatic disease
Describe the glove and sweater approach you can use when taking a history for an autoimmune rheumatic disease
- Ask about consitutional symptoms e.g. fever, fatigue, weight loss, nights sweats, poor appetite (need to rule out cancer)
- Glove & sweater approach (imagine taking jumper off: start at hands then work up arms, then jump comes over head, then down face and down trunk)
In which region of body are joint pains & swelling common in autoimmune rheumatic diseases?
Hands & feet
If someone answers ‘yes’ to ‘do you have a dry mouth’; what question can you ask to determine if they have a true dry mouth?
Do you have to have a drink after every mouthful of food
If someone answers ‘yes’ to ‘do you have dry eyes’; what question can you ask to determine if it’s true dry eyes?
Does it feel like you have sand in your eyes
Describe Raynauds phenonenom
- Small blood vessels in extremeties e.g. finegers & toes are oversensitive to slightest changes in temperature, cold or even stress
- Causes vasospasm of small arteries
- Fingers go white FIRST, then blue then red as blood flow returns (note this is the 3 phase Raynauds).
* In 2 phase Raynauds white then blue? CHECK, single phase permanently blue
State some things you should look out for when examining for autoimmune rheumatic diseases
CRP can be normal in SLE; true or false?
TRUE
*Important point for all diseases,normal blood test doens’t mean no diease if patient has symptoms and findings on examination
State the lupus mneumonic
Answer the following case study
E.) Rheumatoid arthritis
What 3 symptoms/signs are we referring to when we talk about the S factor for Rheumatoid arthritis?
