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Questions and Answers
What is the specific HLA association with Rheumatoid Arthritis?
What is the specific HLA association with Rheumatoid Arthritis?
What is the specificity of Anti-CCP antibodies in Rheumatoid Arthritis?
What is the specificity of Anti-CCP antibodies in Rheumatoid Arthritis?
What is the percentage of Rheumatoid Arthritis patients who have Rheumatoid Factor?
What is the percentage of Rheumatoid Arthritis patients who have Rheumatoid Factor?
What is the gender ratio of Rheumatoid Arthritis in the population?
What is the gender ratio of Rheumatoid Arthritis in the population?
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What is the percentage of the population that has Rheumatoid Arthritis?
What is the percentage of the population that has Rheumatoid Arthritis?
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How many out of the 7 criteria for Rheumatoid Arthritis must a person have to be classified as a Rheumatoid Arthritis patient?
How many out of the 7 criteria for Rheumatoid Arthritis must a person have to be classified as a Rheumatoid Arthritis patient?
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What is the minimum number of joints that must be affected to classify a patient with rheumatoid arthritis?
What is the minimum number of joints that must be affected to classify a patient with rheumatoid arthritis?
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Which of the following is NOT a sign of rheumatoid arthritis?
Which of the following is NOT a sign of rheumatoid arthritis?
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What is the name of the deformity of the thumb in rheumatoid arthritis?
What is the name of the deformity of the thumb in rheumatoid arthritis?
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What is the primary pathology of rheumatoid arthritis?
What is the primary pathology of rheumatoid arthritis?
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What is the complication of rheumatoid arthritis that affects the eyes?
What is the complication of rheumatoid arthritis that affects the eyes?
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What is the name of the treatment for rheumatoid arthritis that is an immunosuppressive therapy?
What is the name of the treatment for rheumatoid arthritis that is an immunosuppressive therapy?
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What is the relevance of rheumatoid arthritis to dentistry?
What is the relevance of rheumatoid arthritis to dentistry?
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What is the primary symptom of Sjogren's syndrome?
What is the primary symptom of Sjogren's syndrome?
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What is the ratio of male to female patients with Sjogren's syndrome?
What is the ratio of male to female patients with Sjogren's syndrome?
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What is the investigation used to diagnose Sjogren's syndrome?
What is the investigation used to diagnose Sjogren's syndrome?
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What is the normal amount of paper wetting in 5 minutes in a Sjogren's syndrome diagnosis?
What is the normal amount of paper wetting in 5 minutes in a Sjogren's syndrome diagnosis?
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What is the primary method of diagnosing Sjogren's syndrome?
What is the primary method of diagnosing Sjogren's syndrome?
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What is a common complication of Sjogren's syndrome in dentistry?
What is a common complication of Sjogren's syndrome in dentistry?
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What is the male to female ratio of systemic lupus erythematosus?
What is the male to female ratio of systemic lupus erythematosus?
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What is the peak onset age for systemic lupus erythematosus?
What is the peak onset age for systemic lupus erythematosus?
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What is the pathology of systemic lupus erythematosus?
What is the pathology of systemic lupus erythematosus?
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What is the aetiology of systemic lupus erythematosus?
What is the aetiology of systemic lupus erythematosus?
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What is a clinical feature of lupus erythematosus?
What is a clinical feature of lupus erythematosus?
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What is an investigation used for lupus erythematosus?
What is an investigation used for lupus erythematosus?
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What is a treatment for lupus erythematosus?
What is a treatment for lupus erythematosus?
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What is the association between autoimmune disorders and?
What is the association between autoimmune disorders and?
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Which autoantibody is 95% specific for Rheumatoid Arthritis?
Which autoantibody is 95% specific for Rheumatoid Arthritis?
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What binds to Fc receptors on IgG in the body?
What binds to Fc receptors on IgG in the body?
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What is the clinical feature of Rheumatoid Arthritis?
What is the clinical feature of Rheumatoid Arthritis?
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What is the percentage of the population that has Sclerodema?
What is the percentage of the population that has Sclerodema?
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How many criteria out of 7 must a person have to be classified as a Rheumatoid Arthritis patient?
How many criteria out of 7 must a person have to be classified as a Rheumatoid Arthritis patient?
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What is the primary method of diagnosing Sjogren's syndrome?
What is the primary method of diagnosing Sjogren's syndrome?
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What is the relevance of Sjogren's syndrome to dentistry?
What is the relevance of Sjogren's syndrome to dentistry?
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What is the peak onset age for systemic lupus erythematosus?
What is the peak onset age for systemic lupus erythematosus?
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What is the pathology of systemic lupus erythematosus?
What is the pathology of systemic lupus erythematosus?
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What is the aetiology of systemic lupus erythematosus?
What is the aetiology of systemic lupus erythematosus?
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What is the clinical feature of lupus erythematosus?
What is the clinical feature of lupus erythematosus?
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What is the investigation used for lupus erythematosus?
What is the investigation used for lupus erythematosus?
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What is the treatment for lupus erythematosus?
What is the treatment for lupus erythematosus?
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What is the relevance of lupus erythematosus to dentistry?
What is the relevance of lupus erythematosus to dentistry?
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What is the prognosis of systemic lupus erythematosus?
What is the prognosis of systemic lupus erythematosus?
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What is the primary pathology of rheumatoid arthritis?
What is the primary pathology of rheumatoid arthritis?
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What is a common complication of Sjogren's syndrome in dentistry?
What is a common complication of Sjogren's syndrome in dentistry?
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What is the relevance of rheumatoid arthritis to dentistry?
What is the relevance of rheumatoid arthritis to dentistry?
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What are the 2 pathologies of rheumatoid arthritis?
What are the 2 pathologies of rheumatoid arthritis?
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What are the 2 types of Sjogren's syndrome?
What are the 2 types of Sjogren's syndrome?
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What is the male to female ratio of Sjogren's syndrome?
What is the male to female ratio of Sjogren's syndrome?
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What is the primary symptom of Sjogren's syndrome?
What is the primary symptom of Sjogren's syndrome?
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What is the investigation used to diagnose Sjogren's syndrome?
What is the investigation used to diagnose Sjogren's syndrome?
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What is the complication of rheumatoid arthritis that affects the eyes?
What is the complication of rheumatoid arthritis that affects the eyes?
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What is the treatment for rheumatoid arthritis that is an immunosuppressive therapy?
What is the treatment for rheumatoid arthritis that is an immunosuppressive therapy?
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Study Notes
Autoimmune Disorders
- Four examples of autoimmune disorders:
- Rheumatoid Arthritis (RA)
- Sjogren's Syndrome (SS)
- Systemic Lupus Erythematosus (SLE)
- Scleroderma
Rheumatoid Arthritis (RA)
- Associated with MHC, specifically HLA-DR4 (70%)
- Auto-antibodies: Rheumatoid Factor (RF) and Anti-Citrullinated Protein Antibodies (Anti-CCP)
- RF binds to Fc receptors on IgG
- 80% of RA patients have RF
- 1% of the population has RA, with a female to male ratio of 2.5:1
- Three clinical features:
- Symmetrical inflammatory polyarthritis
- Progressive joint damage and deformity
- Systemic disease
- Seven criteria for RA diagnosis:
- Morning stiffness
- Symmetrical arthritis
- >3 joints affected
- Hands arthritis
- Subcutaneous nodules
- Rheumatoid Factor (RF)
- Radiographic changes (Must have at least 3 out of 7 criteria)
- Three symptoms:
- Pain, swelling, and morning stiffness
- Malaise
- Non-articular symptoms
- Five signs:
- Swelling
- Warmth
- Tenderness
- Limited movement
- Deformity
- Five occurrences with the hands of an RA patient:
- Boutonnière deformity (thumb)
- Ulnar drift (fingers point away from thumb)
- Z-shaped thumb
- Swan neck deformity of hands
- Subluxed MCP joints
- Two pathologies:
- Chronic inflammatory reaction of the synovium resulting in 'pannus' (granulation tissue)
- Subcutaneous nodes in skin, pleura, pericardium, and lung
- Seven complications:
- Rheumatoid nodules
- Tendon rupture
- Anemia
- Vasculitis of blood vessels in skin
- Nerve entrapment due to damage of wrist (e.g., median nerve)
- Atlanto-axial subluxation of the neck or TMJ
- Eye complications due to Sjogren's and episcleritis
- Four treatments:
- Analgesia (e.g., NSAIDs)
- DMARDs (immunosuppressive therapy)
- TNF monoclonal antibodies (e.g., infliximab, etanercept)
- Anti-B cell monoclonal antibodies (e.g., rituximab)
- Dental relevance:
- Hand deformity affects oral hygiene
- Carpal tunnel syndrome (tingling and numbness in hands)
- Atlanto-axial subluxation during GA (difficulty moving neck)
- TMJ dysfunction (hard to open mouth)
- Sjogren's syndrome (elevated levels of caries due to alteration of protein profile and change in composition of saliva)
- Anemia (lack of red blood cells due to lack of B12; tongue may hurt and ulcers are common)
- Complications of systemic treatment (e.g., glucocorticoids used on immunocompromised patients may not work, so healing time is increased as immunosuppressed patients have an increased risk of infection and bruising)
Sjogren's Syndrome (SS)
- Chronic immune system disorder
- Two types:
- Primary: dryness of eyes, mouth, and vagina
- Secondary: secondary to RA, PSS, and SLE
- Male to female ratio: 1:9
- Two peaks of onset: mid-30s and postmenopausal (45-60)
- Pathology: autoimmune sialadenitis (inflammation of lacrimal and salivary glands)
- Four symptoms:
- Sicca symptoms (dryness of mouth, eyes, skin, and vagina)
- Excessive fatigue, arthralgia (joint pain), and myalgia (muscle pain)
- Swollen salivary glands and lachrymal glands
- Increased risk of lymphoma or maltoma (B cell lymphoma Mucosal Associated Lymphoid Tissue)
- Three investigations:
- Schirmer test
- Ultrasound of salivary glands
- Labial gland biopsy
- Dental relevance:
- Dry mouth (dental caries, loss of teeth, candida infections)
- Salivary gland enlargement
- Complications of systemic treatment
- Treatment: keep mouth hydrated (Xylitol Chewing Gum for stimulation of Salivary Glands & Flow)
Systemic Lupus Erythematosus (SLE)
- Male to female ratio: 1:9
- Peak onset: 20-40 years
- Autoimmune multi-system disease
- Characterized by arthralgia and skin rashes
- Pathology: widespread vasculitis of capillaries, arterioles, and venules
- Aetiology:
- Genetic
- Complement deficiency
- Triggers:
- UV light
- Infection
- Drugs (e.g., slow acetylators and hydralazine)
- Four immunological mechanisms:
- Polyclonal B cell activation
- Production of anti-nuclear antibodies (ANA)
- Impaired T cell function
- Failure to remove immune complexes
- Five clinical features:
- Photosensitivity rash
- Vasculitis with gangrene (loss of blood flow at the tips of fingers)
- Cerebral micro-infarcts (memory problems and headaches)
- Lupus nephritis (affects kidney, causing blood in urine, elevated blood pressure, and edema of the feet)
- Anti-phospholipid syndrome (increased tendency to clotting with venous thrombosis, arterial thrombosis, recurrent fetal loss, thrombocytopenia, and livedo reticularis)
- Five variants:
- Discoid lupus (DLE)
- Subacute cutaneous (SCLE)
- Systemic lupus erythematosus
- Anti-phospholipid syndrome
- Drug-induced lupus
- Seven investigations:
- ESR raised
- Normal CRP
- RF increased
- ANA increased
- Anemia (normochromic normocytic, haemolytic)
- Neutropenia, thrombocytopenia
- Reduced complement
- Three treatments:
- Antimalarials
- Prednisolone
- Immunosuppressive agents
- Prognosis: 95% survive for a maximum of 5 years
- Dental relevance:
- Oral ulceration
- Immunosuppression and candidiasis
- Dry mouth
- Often mistaken for lichen planus in the oral cavity
Scleroderma (Systemic Sclerosis)
- Three types:
- Systemic fibrosis (diffuse systemic sclerosis)
- CREST syndrome (Calinosis, Raynaud's, oesophageal involvement, sclerodactyly, telangiectasia)
- Morphoea (localized to skin)
- Male to female ratio: 1:3
- Peak onset: unknown
Autoimmune Disorders
- Four examples of autoimmune disorders:
- Rheumatoid Arthritis (RA)
- Sjogren's Syndrome (SS)
- Systemic Lupus Erythematosus (SLE)
- Scleroderma
Rheumatoid Arthritis (RA)
- Associated with MHC, specifically HLA-DR4 (70%)
- Auto-antibodies: Rheumatoid Factor (RF) and Anti-Citrullinated Protein Antibodies (Anti-CCP)
- RF binds to Fc receptors on IgG
- 80% of RA patients have RF
- 1% of the population has RA, with a female to male ratio of 2.5:1
- Three clinical features:
- Symmetrical inflammatory polyarthritis
- Progressive joint damage and deformity
- Systemic disease
- Seven criteria for RA diagnosis:
- Morning stiffness
- Symmetrical arthritis
- >3 joints affected
- Hands arthritis
- Subcutaneous nodules
- Rheumatoid Factor (RF)
- Radiographic changes (Must have at least 3 out of 7 criteria)
- Three symptoms:
- Pain, swelling, and morning stiffness
- Malaise
- Non-articular symptoms
- Five signs:
- Swelling
- Warmth
- Tenderness
- Limited movement
- Deformity
- Five occurrences with the hands of an RA patient:
- Boutonnière deformity (thumb)
- Ulnar drift (fingers point away from thumb)
- Z-shaped thumb
- Swan neck deformity of hands
- Subluxed MCP joints
- Two pathologies:
- Chronic inflammatory reaction of the synovium resulting in 'pannus' (granulation tissue)
- Subcutaneous nodes in skin, pleura, pericardium, and lung
- Seven complications:
- Rheumatoid nodules
- Tendon rupture
- Anemia
- Vasculitis of blood vessels in skin
- Nerve entrapment due to damage of wrist (e.g., median nerve)
- Atlanto-axial subluxation of the neck or TMJ
- Eye complications due to Sjogren's and episcleritis
- Four treatments:
- Analgesia (e.g., NSAIDs)
- DMARDs (immunosuppressive therapy)
- TNF monoclonal antibodies (e.g., infliximab, etanercept)
- Anti-B cell monoclonal antibodies (e.g., rituximab)
- Dental relevance:
- Hand deformity affects oral hygiene
- Carpal tunnel syndrome (tingling and numbness in hands)
- Atlanto-axial subluxation during GA (difficulty moving neck)
- TMJ dysfunction (hard to open mouth)
- Sjogren's syndrome (elevated levels of caries due to alteration of protein profile and change in composition of saliva)
- Anemia (lack of red blood cells due to lack of B12; tongue may hurt and ulcers are common)
- Complications of systemic treatment (e.g., glucocorticoids used on immunocompromised patients may not work, so healing time is increased as immunosuppressed patients have an increased risk of infection and bruising)
Sjogren's Syndrome (SS)
- Chronic immune system disorder
- Two types:
- Primary: dryness of eyes, mouth, and vagina
- Secondary: secondary to RA, PSS, and SLE
- Male to female ratio: 1:9
- Two peaks of onset: mid-30s and postmenopausal (45-60)
- Pathology: autoimmune sialadenitis (inflammation of lacrimal and salivary glands)
- Four symptoms:
- Sicca symptoms (dryness of mouth, eyes, skin, and vagina)
- Excessive fatigue, arthralgia (joint pain), and myalgia (muscle pain)
- Swollen salivary glands and lachrymal glands
- Increased risk of lymphoma or maltoma (B cell lymphoma Mucosal Associated Lymphoid Tissue)
- Three investigations:
- Schirmer test
- Ultrasound of salivary glands
- Labial gland biopsy
- Dental relevance:
- Dry mouth (dental caries, loss of teeth, candida infections)
- Salivary gland enlargement
- Complications of systemic treatment
- Treatment: keep mouth hydrated (Xylitol Chewing Gum for stimulation of Salivary Glands & Flow)
Systemic Lupus Erythematosus (SLE)
- Male to female ratio: 1:9
- Peak onset: 20-40 years
- Autoimmune multi-system disease
- Characterized by arthralgia and skin rashes
- Pathology: widespread vasculitis of capillaries, arterioles, and venules
- Aetiology:
- Genetic
- Complement deficiency
- Triggers:
- UV light
- Infection
- Drugs (e.g., slow acetylators and hydralazine)
- Four immunological mechanisms:
- Polyclonal B cell activation
- Production of anti-nuclear antibodies (ANA)
- Impaired T cell function
- Failure to remove immune complexes
- Five clinical features:
- Photosensitivity rash
- Vasculitis with gangrene (loss of blood flow at the tips of fingers)
- Cerebral micro-infarcts (memory problems and headaches)
- Lupus nephritis (affects kidney, causing blood in urine, elevated blood pressure, and edema of the feet)
- Anti-phospholipid syndrome (increased tendency to clotting with venous thrombosis, arterial thrombosis, recurrent fetal loss, thrombocytopenia, and livedo reticularis)
- Five variants:
- Discoid lupus (DLE)
- Subacute cutaneous (SCLE)
- Systemic lupus erythematosus
- Anti-phospholipid syndrome
- Drug-induced lupus
- Seven investigations:
- ESR raised
- Normal CRP
- RF increased
- ANA increased
- Anemia (normochromic normocytic, haemolytic)
- Neutropenia, thrombocytopenia
- Reduced complement
- Three treatments:
- Antimalarials
- Prednisolone
- Immunosuppressive agents
- Prognosis: 95% survive for a maximum of 5 years
- Dental relevance:
- Oral ulceration
- Immunosuppression and candidiasis
- Dry mouth
- Often mistaken for lichen planus in the oral cavity
Scleroderma (Systemic Sclerosis)
- Three types:
- Systemic fibrosis (diffuse systemic sclerosis)
- CREST syndrome (Calinosis, Raynaud's, oesophageal involvement, sclerodactyly, telangiectasia)
- Morphoea (localized to skin)
- Male to female ratio: 1:3
- Peak onset: unknown
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Description
Quiz about autoimmune disorders, including Rheumatoid Arthritis, Sjogren's Syndrome, and Systemic Lupus Erythematous, and their association with MHC. Covers etiopathogenesis and auto-antibodies.
