Podcast
Questions and Answers
Which laboratory test is primarily associated with Rheumatoid Arthritis?
Which laboratory test is primarily associated with Rheumatoid Arthritis?
Which of the following diseases is NOT directly linked to the presence of Antinuclear antibodies (ANAs)?
Which of the following diseases is NOT directly linked to the presence of Antinuclear antibodies (ANAs)?
What is the primary disease associated with the Anti-neutrophil cytoplasmic antibody (ANCA) test?
What is the primary disease associated with the Anti-neutrophil cytoplasmic antibody (ANCA) test?
The presence of HLA-B27 is especially associated with which condition?
The presence of HLA-B27 is especially associated with which condition?
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Which test should be ordered if a patient's Antinuclear antibodies (ANAs) come back positive?
Which test should be ordered if a patient's Antinuclear antibodies (ANAs) come back positive?
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Which laboratory test is associated with identifying inflammatory conditions in general?
Which laboratory test is associated with identifying inflammatory conditions in general?
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Which association is CORRECT regarding the Anti-citrullinated protein antibodies?
Which association is CORRECT regarding the Anti-citrullinated protein antibodies?
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Which of the following diseases is less likely to show a positive result with the Anti-double stranded DNA antibodies test?
Which of the following diseases is less likely to show a positive result with the Anti-double stranded DNA antibodies test?
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What is the initial screening frequency for hydroxychloroquine retinopathy testing after initiating the drug?
What is the initial screening frequency for hydroxychloroquine retinopathy testing after initiating the drug?
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Which of the following is considered ineffective testing for hydroxychloroquine retinopathy?
Which of the following is considered ineffective testing for hydroxychloroquine retinopathy?
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In the diagnosis of Giant Cell Arteritis (GCA), which of the following criteria requires a patient to be over a specific age?
In the diagnosis of Giant Cell Arteritis (GCA), which of the following criteria requires a patient to be over a specific age?
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What is the recommended treatment regimen for managing Arteritic Anterior Ischemic Optic Neuropathy (AAION)?
What is the recommended treatment regimen for managing Arteritic Anterior Ischemic Optic Neuropathy (AAION)?
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Which of the following is NOT an ocular effect of Systemic Lupus Erythematosus (SLE)?
Which of the following is NOT an ocular effect of Systemic Lupus Erythematosus (SLE)?
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What is required to make a diagnosis of Sjogren’s Syndrome (SS) based on the criteria mentioned?
What is required to make a diagnosis of Sjogren’s Syndrome (SS) based on the criteria mentioned?
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Which laboratory finding is highly indicative of Giant Cell Arteritis (GCA)?
Which laboratory finding is highly indicative of Giant Cell Arteritis (GCA)?
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What is a common sign of Arteritic Anterior Ischemic Optic Neuropathy (AAION)?
What is a common sign of Arteritic Anterior Ischemic Optic Neuropathy (AAION)?
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Which of the following treatments is recommended for long-term management of SLE-related ocular effects?
Which of the following treatments is recommended for long-term management of SLE-related ocular effects?
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Which of the following signs indicates the presence of Sjogren’s Syndrome?
Which of the following signs indicates the presence of Sjogren’s Syndrome?
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Study Notes
Autoimmune Disorders
- Autoimmune disorders occur when the body's immune system attacks its own tissues.
- These disorders can affect any part of the body, leading to a wide range of symptoms.
- Diagnosis is usually made based on a combination of clinical symptoms, laboratory tests, and imaging studies.
Laboratory Tests
- Rheumatoid factor (RF) is a blood test that detects antibodies that attack the body's own tissues.
- Rheumatoid arthritis (RA) is the primary association with RF, but it can also be found in other autoimmune diseases.
- Anti-citrullinated protein antibodies (ACPAs) are another blood test that detects antibodies that target citrullinated proteins found in joints.
- ACPAs are highly specific for RA.
- Antinuclear antibodies (ANAs) are antibodies that target the nucleus of cells, which is found in many autoimmune disorders, including lupus.
If ANA is Positive, Order these Tests
- Anti-SSA/SSB antibodies are associated with Sjögren's syndrome and lupus.
- Anti-Smith antibodies are highly specific for lupus.
- Anti-ribonuclearprotein (RNP) antibodies are associated with lupus and other connective tissue disorders.
- Anti-Scl antibodies are found in scleroderma.
- Anti-Jo antibodies indicate inflammatory myositis.
Hydroxychloroquine Retinopathy Testing Guidelines
- Baseline examination should be performed within one year of starting hydroxychloroquine.
- Annual screening should be done after five years of use if there are no signs of maculopathy and major risk factors.
- More frequent screening is necessary in the presence of major risk factors.
- Primary testing includes automated visual fields, OCT of the macula, and a dilated fundus exam.
- Adjunctive testing may include multifocal ERG and fundus autofluorescence.
- Fluorescein angiography, full-field ERG, EOG, Amsler grid, and color vision testing are ineffective in detecting hydroxychloroquine retinopathy.
Giant Cell Arteritis (GCA)
- GCA is a large vessel vasculitis that primarily affects the head and neck.
- Most commonly affects the temporal artery.
- Can cause vision loss if not treated properly.
GCA Signs and Symptoms
- New headache
- Scalp tenderness
- Jaw claudication
- Visual disturbances
- Temporal artery tenderness
GCA Diagnosis
- Age of onset greater than 50 years old.
- New headache.
- Tenderness to palpation of temporal artery or decreased pulsation.
- ESR of ≥50 mm/hr by Westergren method.
- Most commonly, ESR is greater than 100 mm/hr
- Abnormal temporal artery biopsy (TAB) showing vasculitis with a predominance of mononuclear cell infiltration or granulomatous inflammation.
Arteritic Anterior Ischemic Optic Neuropathy (AAION)
- Characterized by sudden vision loss in one or both eyes.
- Often occurs in individuals with GCA.
AAION Signs
- Visual field defects with central scotoma (blind spot in the center of the field of vision).
AAION and GCA Management
- High-dose oral or intravenous steroids are the main treatment.
- Close monitoring of ESR, CRP, and clinical symptoms is essential.
- Temporal artery biopsy.
- Biologics or DMARDs are used in cases of contraindication to long-term steroid therapy.
- Complications associated with treatment should be addressed promptly.
Lupus
- Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect many organs and systems in the body.
- The immune system attacks its own cells and tissues, causing inflammation and damage to various organs, including the kidneys, lungs, blood vessels, joints and skin.
SLE Diagnostic Criteria
- Symptoms include fatigue, joint pain, fever, rash, and mouth sores.
- Diagnostic criteria based on a combination of clinical and laboratory findings.
- At least four of the following criteria must be met, with at least one clinical and one immunologic criterion:
- Malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, renal disorder, neurologic disorder, hematologic disorder, immunologic disorder, antinuclear antibody (ANA).
- ANA is present in most patients with SLE.
- Patients should be screened for cardiovascular risks due to the increased risk of heart attack and stroke.
Other SLE Complications
- Anemia, nephritis, pericarditis, and pleuritis.
Lupus Management
- No cure for SLE.
- Treatment goals are to control symptoms, prevent complications, and improve quality of life.
- Medications used include NSAIDs, corticosteroids, antimalarials, immunosuppressants, and biologics.
Ocular Effects of Lupus
- Keratoconjunctivitis sicca (dry eyes).
- Uveitis (inflammation of the uvea, the middle layer of the eye).
- Conjunctival vascular disease (abnormalities in the blood vessels of the conjunctiva).
- Maculopathy (damage to the macula, the central part of the retina that allows for sharp, central vision).
Lupus Retinopathy
- Can develop in both systemic lupus erythematosus (SLE) and drug-induced lupus.
- Characterized by retinal hemorrhages, exudates, and cotton wool spots.
Rheumatoid Arthritis (RA)
- A chronic autoimmune disease that primarily affects the joints.
- The immune system attacks the lining of the joints, causing inflammation, pain, stiffness, and swelling.
- RA progresses over time and can lead to irreversible joint damage.
RA Diagnostic Criteria
- Based on a combination of clinical, laboratory, and radiological findings.
- Requires at least 4 out of 10 criteria: morning stiffness, swollen joints, pain in at least 3 joints, involvement of hand joints, bilateral involvement of joints, rheumatoid nodules, serum rheumatoid factor positivity, radiographic changes, erosions or joint space narrowing on hand x-ray, presence of anti-CCP antibodies.
- A diagnosis of RA is made when there is clear evidence of joint inflammation and exclusion of other causes.
Systemic Complications of RA
- Can affect other organs, such as the heart, lungs, and blood vessels.
- Increased risk of cardiovascular disease, pneumonitis, and vasculitis.
Ocular Effects of RA
- Keratoconjunctivitis sicca (dry eyes).
- Episcleritis (inflammation of the episclera, the outermost layer of the sclera).
- Scleritis (inflammation of the sclera).
- Uveitis (inflammation of the uvea, the middle layer of the eye).
Sjögren’s Syndrome (SS)
- A chronic autoimmune disease that primarily affects the exocrine glands, such as the salivary and lacrimal glands.
- The immune system attacks these glands, causing dryness of the mouth (xerostomia) and eyes (keratoconjunctivitis sicca).
- Can also cause dryness of other parts of the body, such as the skin and vagina.
SS Signs
- Dry eyes
- Dry mouth
- Oral ulcers
- Joint pain
- Fatigue
- Raynaud's phenomenon (abnormalities in blood flow to the hands and feet).
SS Symptoms
- Dryness in the mouth, eyes, and other mucosal surfaces
- Difficulty chewing, swallowing, and speaking due to dry mouth
- Increased sensitivity to light
- Swollen glands
SS Diagnostic Criteria
- Need to meet at least 4 points for diagnosis
- Anti-Ro/SSA Positive (3 points).
- Lip biopsy with Focus > 1 foci/4mm^2 (3 points).
- Ocular Staining Score ≥ 5 (1 point)
- Schirmer’s Test (without anesthetic) ≤ 5mm/5min (1 point)
- Unstimulated Salivary Flow Rate ≤ 0.1 mL/min (1 point)
SS Management
- No cure for SS.
- Treatment focuses on relieving symptoms and managing complications.
- Artificial tears and saliva substitutes.
- Medications to reduce inflammation and improve salivary flow.
Spondyloarthropathies (SpA)
- A group of inflammatory diseases that affect the spine and other joints.
- Includes ankylosing spondylitis, psoriatic arthritis, reactive arthritis, and inflammatory bowel disease-associated arthritis.
- Can cause pain, stiffness, and inflammation in the spine, hips, shoulders, knees, and other joints.
- Can also affect the eyes, skin, and intestines.
- Diagnosis is based on clinical signs and symptoms, as well as radiographic and laboratory findings.
- Treatment focuses on reducing inflammation, pain, and stiffness.
- Medication, physical therapy, and lifestyle modifications are often used to manage these conditions.
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Description
This quiz explores autoimmune disorders and the laboratory tests used for diagnosis. It highlights the roles of various antibodies, including rheumatoid factor and anti-citrullinated protein antibodies, in identifying these conditions. Test your knowledge on the significance of these tests in autoimmune diseases.
