Autoimmunity and vasculitis

Question 1

what investigations are done for CTD/inflammatory joint diseases?

Answer 1

• ANA
• Rhf
• Anti CCP
• Anti cardiolipi
• Lupus anticoagulant
• immunoglobulins
• SPE
• C3/C4

Question 2

Why is electrophoresis helpful when serum immunoglobulins are raised?

Answer 2

It helps tell if it’s a polyclonal increase or an increase due to a monoclonal immunoglobulin

Question 3

If serum immunoglobulins are high electrophoresis can show if this is due to a monoclonal immunofixation how is this?

Answer 3

Will show immunofixation

Question 4

what conditions cause a polyclonal increase in serum immunoglobulins?

Answer 4

Connective tissue diseases
rheumatoid arthritis
chronic infective and inflammatory conditions
chronic liver disease

Question 5

what conditions cause an increase in monoclonal immunoglobulins?

Answer 5

Multiple myeloma

waldenstroms macroglobulinaemia

Question 6

How is complement C3/4 measured?

Answer 6

nephelometry

Question 7

what does low C3 and low C4 suggest?

Answer 7

A complement consumption seen in immune complex diseases

- infection, SLE, septicaemia, active renal disease

Question 8

what does low C4 and normal C3 suggest?

Answer 8

c1 esterase inhibitor deficiency

c4 nut alleles

Question 9

what does a positive ANA test suggest?

Answer 9

connective tissue diseases such as SLE, mixed connective tissue disease, sjogrens syndrome, systemic sclerosis

Question 10

what drugs can increase the chance of a positive ANA?

Answer 10

hydralazine, isoniazid, procainamide

Question 11

what further testing is done on a positive ANA result?

Answer 11

Tested further for antibodies to specific nuclear antigens which includes dsDNA and ENA

Question 12

What are two methods for testing for dsDNA antibodies?

Answer 12

1. ELISA

2. crithdia test

Question 13

what antigen is recognised in c-ANCA?

Answer 13

proteinase 3

Question 14

what antigen is recognised in p-ANCA?

Answer 14

mpo

Question 15

What antibodies are associated with coeliacs?

Answer 15

IgA Ttg antibodies

IgA endomysial antibodies

Question 16

what diseases is anti gastric parietal cell antibodies seen wth?

Answer 16

Atrophic gastritis

pernicious anaemia

Question 17

what dsieases is anti intrinsic factor antibodies seen with?

Answer 17

pernicious anaemia

Question 18

what antibodies are seen with primary biliary cirrhosis?

Answer 18

anti mitochondrial antibodies

anti PDH2 antibodies

Question 19

what antibody is associated with goodpasture syndrome?

Answer 19

anti glomerular basement membrane antibodies

Question 20

what antibodies are associated with sjogrens syndrome?

Answer 20

Anti SSA and Anti SSb

Question 21

what are three ways of detecting autoantibodies in blood samples?

Answer 21

1. indirect immunofluorescence
2. ELISA
3. immunoblotting

Question 22

what happens in ELISA?

Answer 22

Antigens are coated on to the wells

The serum is placed into the well allowing any antibody in the serum to bind to the antigens in the well

Question 23

what takes place in immunoblotting?

Answer 23

Antigens are coated onto a membrane and antibody in the patients serum detected by enzyme linked anti human Ig

Question 24

what is anti CCP highly specific for?

Answer 24

Rheumatoid arthritis

Question 25

what are examples of large cell vasculitis?

Answer 25

giant cell arteritis | takayasu arteritis

Question 26

what are examples of medium sized vessel vasculitis?

Answer 26

Polyarteritis nodosa | Kawasaki disease

Question 27

what are examples of ANCA associated vasculitis?

Answer 27

Granulomatosis with polyaniitis Microscopic polyangiitis Eosinophilic granulomatosis with polyangiitis

Question 28

what are symptoms of sjogrens disease?

Answer 28

Dry eyes Dry moth Dry skin

Question 29

who is most likely to get SLE?

Answer 29

Between the age of 20-40 female | African/carribean origin

Question 30

what are the causes of SLE?

Answer 30

- HLA gene link - UV light can act as a trigger - EBV acts as a trigger

Question 31

what are the immunological consequences of SLE?

Answer 31

- development of autoantibodies circulating or depositing - complement activation and neutrophil infiltration causing inflammation - abnormal cytokine production with high levels of IL10 and interferon alpha

Question 32

what are the clinical features of SLE?

Answer 32

Heart: pericarditis/endocarditis - abdominal pain - renal disease - anaemia - arthritis - raynauds - effusion - butterfly face rash - photosensitivity - fever

Question 33

what is schirmers test?

Answer 33

Test of tear production contributing to diagnosing sjogrens syndrome. Place a strip of paper under the eyelid and measure moistness