Autoimmune diseases Pt 3

What does RAIU stand for

Radioactive Iodine uptake

What does an enhanced RAIU mean?

hyperthyroiditis

What does a decreased RAIU mean?

Hypothyroiditis

What are the two hypothyroiditis conditions from decreased RAIU

• Hashimoto Thyroiditis

• de Quervains thyroiditis = subacute granulomatious thyroiditis

What is the diagnosis of this: You are seeing a young woman, mother of two children, at the office. She has been having tingling sensations in her left arm and left face over the last week or so. What brings her to the office is that she had pain in her right eye, and blurry vision since last night, and now she cannot see anymore with this eye.

Multiple Sclerosis

What are 6 clinical presentations of MS

• recurrent episodes of neurologic deficits

• wide range of symptoms

• young adults

• relapses are typical

• disease duration frequency 20+ years

• several forms of MS

What is the ratio of people affected by MS regarding gender

women to men : 2:1

What are three forms of MS

• 85% remitting-relapse MS

• Primary progressive MS

• Secondary progressive MS

Where is MS more frequent

North of the equator

What are four characteristics of the pathology of MS?

• multiple foci of demyelination of white matter of CNS

• plaques

• Firm consistency

• Frequent inflammatory infiltrates along lateral ventricles or vessels

What are plaques

Lesions are sharply circumscribed regions of gray discoloration

What percent of patients convert from relapsing-remitting to progressive disease?

60%

What are 6 ways to diagnose MS?

• MRI

• Clinical Picture

• CSF shows OCB

• Decreased activity on visual evoked potentials and somatosensory evoked potentials

• Anti-myelin antibodies (anti-MBP and anti-MOG. antibodies)

• MCDonald criteria for objective diagnosis of MS

What is OCB

Oligoclonal bands of immunoglobulins

What is the McDonald criteria for objective diagnosis of MS

combo of MRI, OCB and abnormal evoked potentials

What are to ways MS is treated

• Immunosuppressive drugs

• Disease modifying therapies (DMTs)

What are some Disease modifying therapies (DMTs)

• Anti-CD20 antibody (Ocrelizumab)

• Interferon beta

• Copaxone (polypeptide mix)

• Tysabri (anti-VLA-4 antibody)

• First Oral drug: Fingomolid (Gilenya)

What is the diagnosis of this patient: Young woman presents to your office with this rash. She also complains about pain in the elbows and knees.

Systemic lupus Erythematosus (SLE)

What are two systemic autoimmune diseases?

• systemic lupus erythematosus (SLE)

• Rheumatoid Arthritis

What are 8 characteristics of the clinical presentation of SLE?

• unspecific symptoms such a fever, malaise, joint pain, muscle pain, fatigue

• Patients frequently first seek medical help for the joint pains

• Butterfly rash of the face

• skin lesions

• Anemia

• Frequent infections

• kidney problems

• neurological problems

What are discoid lupus?

thick, red, scaly patches

What are 3 kidney problems with SLE

• hematuria

• proteinuria

• membranous glomerulonephritis → Can lead to renal failure

What are 2 neurological problems that can happen due to SLE

• seizures

• psychosis

What are 3 types of lupus erythematosus

• Systemic lupus erythematosus

• Discoid lupus erythematosus

• Drug-induced lupus erythematosus

What makes SLE different from other lupus erythematosus

whole body involved → BAD

What makes Discoid lupus erythematosus different from other lupus erythematosus

skin only → Much better prognosis

What makes Drug-induced lupus erythematosus different from other lupus erythematosus

typically induced by procainamide, hydralazine, quinidine. Discontinuing drug cures

How to diagnose SLE (7)

• Antinuclear antibodies (ANA)

• Anti-double stranded DNA antibodies (Anti-dsDNA

• Antiphospholipid antibodies (lupus anticoagulant → thrombosis_

• Low complement levels

• impaired renal function

• Anemia

• SLE Diagnostic criteria

What is the SLE Diagnostic criteria (7)

• Butterfly rash

• photosensitivity

• Arthritis

• ulcers

• proteinuria

• hemolytic anemia

• ANA

What are 4 treatments for SLE

• Corticosteroids

• Immunosuppressants

• belimumab

• Cytotoxic drugs

What is Belimumab

BLys inhibitor, inhibits B cell activation

What do B cells do

activate antibodies

What is an example of a cytotoxic drug

Cyclophosphamide

What is the prognosis of SLE patients in 1950s

most patients died within 5 years

What is the prognosis of SLE patients today

90% patients live more than 10 years

Why is Rheumatoid Arthritis a systemic autoimmune disease

it can involve other tissues beyond the joints

How can rheumatoid arthritis affect the skin

subcutaneous nodules

How can rheumatoid arthritis affect the heart

pericarditis

How can rheumatoid arthritis affect the eye

keratoconjunctivitis sicca

What is keratoconjunctivitis sicca

dry eyes

How can rheumatoid arthritis affect the lungs

fibrotis, pleuritis

How can rheumatoid arthritis affect the kidney

amyloiditis

What is arthritis

polyarthritis involving predominantly inflammation of small joints; ultimately severe deformities

What are 7 specific symptoms of RA

• Morning stiffness over an hour

• Painful swollen joints (hands and feet)

• Subcutaneous nodules

• Later symmetric arthritis

• Positive rheumatoid factor

• Join erosion by radiology

• Anti-cyclic citrullinated peptide antibody (anti-CCP)

What is RF

Rheumatoid factor against Fc portion of IgG antibodies

What are 4 nonspecific symptoms of RA

• Malaise

• Fever

• Muscle aches

• anemia

What are 3 treatments for RA

• anti-inflammatory drugs

• physical therapy

• rarely surgery

What are some anti-inflammatory drugs for treatment of RA

methotrexate, anti-TNF

What is the swan neck deformity

conditions that loosen proximal interphalangeal joint and allow it to hyperextend

What joints are involved in the swan neck deformity

distal and proximal interphalangeal joints (DIP and PIP)