Autoimmune Diseases

Represent a diverse family of conditions characterized by an immune-mediated response against self
Over 100 distinct autoimmune diseases have been described
Common pathogenetic mechanism: breakdown of immune tolerance, leading to autoreactive T lymphocytes and/or autoantibodies triggering autoimmunity

Autoimmune disorder that damages exocrine glands, including salivary and lacrimal glands
Characterized by dry mouth and dry eyes, with lymphoid infiltrates and serum autoantibodies
Two clinical forms:
- Primary Sjögren syndrome (SS-1): dry eyes and dry mouth, without connective tissue disease
- Secondary Sjögren syndrome (SS-2): dry eyes and dry mouth, with other autoimmune diseases, such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), or mixed connective tissue disease

Autoimmune disease with unpredictable relapsing-remitting course
Presents with variable clinical features, including:
- Mild joint and skin disease
- Multiorgan life-threatening renal, hematologic, and CNS involvement
Etiology and pathogenesis: genetic predisposition, environmental, and hormonal factors
Epidemiology:
- Females are affected 1.2-15 times more than males
- Peak ages of prevalence: 45-69 for females, 40-89 for males
Clinical features:
- Nonspecific signs and symptoms: fatigue, headache, arthralgias, lymph node enlargement, fever, weight loss
- Renal disease: affects approximately 40-70% of patients, major cause of morbidity and mortality
- Musculoskeletal system: arthritis, arthralgias, myalgias
- Cardiovascular manifestations: vasculitis, pericardial effusions
- Nervous system: anxiety, mood disorders, psychosis, seizures, headaches, myelin
- Pulmonary, gastrointestinal, and ocular manifestations
Mucocutaneous manifestations:
- Facial eruption (butterfly rash)
- Discoid lesions, photosensitivity
Oral manifestations:
- Nonspecific ulcerations, erythematous or discoid lesions on palatal mucosa, buccal mucosa, and gingiva
- Lupus cheilitis (vermilion border of the lower lip)

Umbrella term for diverse group of disorders with excessive cutaneous fibrosis
Subclassified into:
- Localized scleroderma (LSc): limited to skin involvement
- Systemic sclerosis (SSc): affects multiple organs in addition to skin
Epidemiology:
- Women are more commonly involved than men
- Racial predisposition for Caucasian populations
Pathogenesis:
- Interplay between early immunologic events and vascular changes, resulting in activated fibroblasts
Clinical features:
- Raynaud's phenomenon
- Musculoskeletal involvement: arthralgias, morning stiffness
- Gastrointestinal manifestations: dysmotility, gastroesophageal reflux
- Pulmonary complications
Cutaneous manifestations:
- Skin thickening, puffy appearance of extremities, prone to ulceration and deformities
- Telangiectasias
Oral manifestations:
- Rigid lips, microstomia, difficulty in speech and swallowing
- Tongue hardening, telangiectasias
- Temporomandibular disorders, mandibular resorption, periodontal disease, xerostomia, susceptibility to local infections

Susceptibility to infections:
- Odontogenic infections, infectious endocarditis, CNS infections, distal skeletal infections
- Leukopenia, herpes zoster, HPV infection, oral candidiasis
Risk of bleeding:
- Coagulation impairment due to thrombocytopenia, myelotoxic drugs, anticoagulants, or antiplatelet regimens
Adrenal suppression:
- Corticosteroids, risk of adrenal suppression during dental procedures
Cardiovascular disease:
- Assess general condition, communicate with physician, antianxiety techniques, pain control
Hyposalivation and xerostomia:
- Salivary gland involvement, fibrotic changes, medications causing hyposalivation
Dental and periodontal disease:
- Periodontal disease prevalence, customized toothbrushes, oral mucosal involvement as adverse effect of medications

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