Lecture 5- A Clinical Approach to Autoimmunity Flashcards Preview

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Flashcards in Lecture 5- A Clinical Approach to Autoimmunity Deck (19)
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1

Autoimmune Rheumatic Diseases (ARDs)

 

A diverse group of conditions that primarily affect the joints, bones, muscle, and connective tissue

Result from a break in immune tolerance by producing pathogenic antibodies which result in a heterogenous group of diseases which affect multiple systems.

 

The presence of autoantibodies can be used as a guide along with clinical features and aid in the stratification of disease and treatment

2

Importance of autoantibodies (not present in all ARDs)

 

  • Aid to diagnosis
  • Associated with specific clinical features
  • Disease prognosis
  • To stratify therapy e.g. monoclonal antibody therapy

3

diagnose

 

Systemic lupus erythematosus

4

Systemic lupus erythematosus 

 

  • Female to male ratio: 9:1
  • Prevalence:24/100,000
  • Race: Afro-Caribbean > South Asians > Caucasians
  • Genetic factors are important
  • Environmental factors

5

History taking for ARDs

Current symptoms

  • Pain (Socrates/squitas)
  • Stiffness
  • Swelling
  • Pattern of joint involvement

Evolution

  • Acute or chronic?
  • Associated events
  • Response to treatment/Family history

Involvement of other systems

  • Skin, eye, lung
  • Malaise, weight loss, fevers, night sweats?

 

Impact on patient’s lifestyle

6

history taking for Lupus

  • constitutional symptoms
  • glove and sweater approach

7

constitutional symptoms of lupus

  • Fever
  • Fatigue
  • weight loss
  • night sweats
  • poor appetite

8

“Glove and sweater” approach for lupus

 

 

  • Gloves
    • Raynaud’s
    • Joint pain and swelling
    • Hand rash
  • Sweater
    • Proximal muscle weakness >myalgia
    • Hair loss
    • Eye and mouth dryness
    • Nose bleeds
    • Mouth ulcers
    • Pleuritic chest pain
    • Pericardial pain
    • Truncal rash/photosensitivity
    • Limb weakness

9

examination for ARDS (lupus)

10

how to diagnose lupus with acronymn

4/11 criteria items= definite lupus

11

Investigations for ARDs (Lupus)

 

 

  • Routine bloods
    • FBC
    • Urea, electrolytes and creatinine
    • Liver enzymes
    • C-reactive protein
    • Plasma viscosity and ESR
  • Autoantibodies/lupus assoc bloods
    • Antinuclear antibodies (>1:160)
    • Anti-DsDNA antibodies
    • Anti-Sm antibodies
    • Anti Ro and La antibodies
    • Complements
    • Antiphospholipid antibodies

12

treatment of SLE

  • Patient education RE: lifestyle modification, use of sunscreen (at least SPF 50)
  • Start DMARDs : Hydroxychloroquine , Azathioprine, Mycophenolate
  • Use of steroids:  Prednisolone ,methylprednisolone
  • In Severe cases: IV Cyclophosphamide

13

diagnose

Rheumatoid arthritis

14

Rheumatoid arthritis

 

15

History taking for RA

Current symptoms

  • Pain (Socrates/squitas0
  • Stiffness
  • Swelling
  • Pattern of joint involvement

Evolution

  • Acute or chronic?
  • Associated events
  • Response to treatment/Family history

 

Involvement of other systems

  • Skin, eye, lung
  • Malaise, weight loss, fevers, night sweats?

 

Impact on patient's lifestyle

16

examining for RA

17

Investigations for RA

 

 

 

  • Routine tests
    • FBC
    • Urea, electrolytes and creatinine
    • Liver enzymes
    • C-reactive protein
    • Plasma viscosity and ESR
    • X-rays +- ultrasound
  • Autoantibodies
    • +- antinuclear antibodies
    • Rheumatoid factor antibodies
    • Anti-CCP antibodies
    • Anti Ro and La antibodies

18

Treatment of RA

 

  • Start DMARDs early!! : Methotrexate Hydroxychloroquine, Sulfasalazine, Leflunomide
  • Use of steroids: Prednisolone, methylprednisolone
  • Combination therapy is usual.

 

START EARLY

19

classification criteria for RA