Autoimmune Rheumatic Disorders

Immune system can be - or -. List out the three lines of defense and the cells in each!

Innate or Acquired

1. Skin and mucous membranes

2. Phagocytes (NK, granulocytes, macrophages)

3. Lymphocytes (B and T cells) and Antibodies

NK, B, and T cells all come from - cells

Granulocytes (phils) and Monocytes (macro) come from - cells

Lymphoid

Myeloid

Function and maturation..

• B cell

• T cell

• Make antibodies to attach to antigen (plasma B), mature in bone marrow

• Attack sick cells (killer T) and signal for T and B cell proliferation (helper T), mature in thymus

Both B and T cells have - cells. T also has - cells to limit -/--

Memory, suppressor, cytotoxic/killer T

T cells especially good against -

viral

Biggest factor in immune function (thymus, bm, cell production and response)

Aging

Rheumatic diseases affect the -

Joints

List of rheumatic diseases

OA, gout, RA, spondyloarthropathy, lupus (SLE), fibromyalgia, polymyalgia rheumatica, inflammatory muscle diseases

Autoimmune disorders activate - or - - without reason

T or B cells

List of autoimmune disease

DM1, RA, lupus, GBS, MG, MS, Grave’s, Rheumatic fever, IBD, giant cell arteritis, ankylosing spondylitis, dry eye syndrome, immune hemolytic anemia, antiphospholipid syndrome

3 characteristics of inflammation

calor, rubor, dolor

Gout

• Overview

• S/s and location

• Labs

• Meds

• Related to hyperuricemia (urate crystals in joints), more common in males, increased purine or beer intake/dehydration/meds/injury or surgery/MI or stroke

• Painful, red and hot, tophi/bumps, most often in MTP of great toe/fingers/ankles/knees/elbows

• Serum uric acid levels, WBC

• Uric acid lowering med (xanthine oxidase inhibitor — allopurinol) and NSAID/steroid

Rheumatoid Arthritis

• What it is

• S/s

• systemic effects

• Labs

• Meds

• Inflammation of synovium, edema, WBC infiltration, synovial thickening

• Joint pain and stiffness, inflammation, joint deformity, crepitus, decreased ROM

• Fatigue, rheumatoid nodules, tenosynovitis, anemia, dry eye, lung fibrosis, peripheral nerve entrapment, C spine injury

• Sed rate, crp, rheumatoid factor, ACPA

• DMARD (methotrexate), JAK inhibitors, TNFa, NSAID

Cytokines in acute inflammation

TNF, IL-1

Ankylosing Spondylitis

• What it is

• S/s

• Systemic effects

• Tx

• A stiff back from chronic inflammation (could cause fusion)

• LBP >3mo, insidious onset, better with activity, pain/stiffness ascend over time, limited AROM, flexed posture, enthesitis, synovitis, sacroilitis

• Fatigue, fever, uveitis, weight loss, gut, heart, GU

• ROM, biologic DMARD (TNFa), NSAID, corticosteroids

Psoriatic Arthritis

• Overview

• s/s

• Tx

• Develops from psoriasis, plaques on extensor surfaces, inflammation of synovium and entheses

• Pain, redness, swelling, DIP/ankle/wrist/knee, nails and skin, usually no systemic symptoms

• DMARDs (Methotrexate, TNF), NSAID, Steroids; splinting/AD/stretching/strengthening

On xray/ct…

AS looks like _ and PA looks like _

osteoporosis/erosion, destruction of cartilage/bone and new bone formation

Lupus

• Clinical Features

• Labs

• Tx

• Fatigue, joint pain, myalgia, mouth sores, skin rash, nephropathy, NS involvement, vasculitis

• CBC, ANA

• Hydoxychloroquine (anti-malaria), MTX, biologics, glucocorticoids, NSAID, CAR T cell therapy

What is fibromyalgia?

• Criteria

• Meds

CNS issue resulting in diffuse pain, no joint inflammation, fatigue

• Must be in all 4 quadrants, 11/18 tender pts

• Antidepressants, muscle relaxants, gabapentin