Autoimmune Disorders PDF

Autoimmune Disorders The Basics What Are Autoimmune Disorders? How Do We Diagnose Autoimmune Disorders? Laboratory Tests Test Primary Disease Association Other Disease Associations Rheumatoid Factor (RF) Rheumatoid Arthritis (RA) Sjogren’s Sy...

Autoimmune Disorders The Basics What Are Autoimmune Disorders? How Do We Diagnose Autoimmune Disorders? Laboratory Tests Test Primary Disease Association Other Disease Associations Rheumatoid Factor (RF) Rheumatoid Arthritis (RA) Sjogren’s Syndrome, Lupus, Connective Tissue Disorders, TB, Syphilis, Hematologic malignancies Anti-citrullinated protein Rheumatoid Arthritis (RA) Sjogren’s Syndrome, Psoriatic antibodies (ACPAs or anti-CCPs) arthritis, Leukemia Antinuclear antibodies (ANAs) Lupus Scleroderma, Sjogren’s Syndrome, Connective Tissue Disorders, TB, Syphilis, Cancer, Grave’s Disease, IBD, Myositis Anti-double stranded DNA Lupus None antibodies (anti-dsDNA) Anti-neutrophil cytoplasmic Wegner’s granulomatosis and All other autoimmune diseases antibody (ANCA) other vasculitides ESR/CRP GCA All autoimmune conditions HLA-B27 Ankylosing Spondylitis Many other autoimmune conditions If ANA is positive, order these tests… Test Disease Association Anti-SSA/SSB antibodies Sjogren’s Syndrome and Lupus Anti-Smith Antibodies Lupus Anti-ribonuclearprotein (RNP) antibodies Lupus and connective tissue disorders Anti-Scl antibodies Scleroderma Anti-Jo antibodies Inflammatory myositis How Are Autoimmune Disorders Generally Treated? Hydroxychloroquine Retinopathy Testing Guidelines Frequency Baseline examination within 1 year of drug initiation Annual screening beginning after 5 years of drug use, in the absence of maculopathy and major risk factors More frequent screening in the presence of major risk factors Primary Testing Automated visual fields: 10-2 White Light or 24- 2 for Asian patients OCT of the macula (Mac Cube & 21 Line Raster) Dilated fundus exam Adjunctive Testing Multifocal ERG Fundus autofluorescence Ineffective Testing Fluorescein angiography (FA) Full-field ERG EOG Amsler grid Color vision testing Non-Infectious Uveitis and Autoimmune Disorders Autoimmune Diseases Giant Cell Arteritis (GCA) GCA Signs and Symptoms  GCA Diagnosis oral steroids - elevate these values but must have other symptoms with it like scalp tenderness GCA Diagnostic Criteria Age at onset greater than 50 years old A new headache Temporal artery abnormalities Tenderness to palpation or decreased pulsation ESR of ≥50 mm/hr by Westergren method > 100 mm/hr usually indicative of GCA Abnormal TAB Showing vasculitis characterized by a predominance of mononuclear cell infiltration or granulomatous inflammation usually with multinucleated giant cells Arteritic Anterior Ischemic Optic Neuropathy (AAION) woke up one morning and cant seee - sudden event AAION Signs VF - PERIPHERAL IS AFFECTED AAION and GCA Management prognosis in affected eye is not good but treatment id to prevent fellow eyes to not be affected - months to years tapering Oral or IV Steroids Between 40-80 mg QD of 1 gram IV for three days Continued treatment until lab values and symptoms are normal Taper over the course of months to years Temporal artery biopsy within two weeks of starting treatment Close monitoring of ESR/CRP Biologics or DMARD’s for those contraindicated from long term steroid use Treat any complications arising from treatment Close monitoring with primary care, rheumatology, and/or neuro-ophthalmology Systemic Lupus Erythematosus (SLE) Lupus Diagnostic Criteria Lupus Diagnostic Criteria Other Systemic Lupus Complications Lupus Management Ocular Effects of Lupus Lupus Retinopathy more cws than heme Rheumatoid Arthritis (RA) RA Diagnostic Criteria Systemic Complications of RA Ocular Effects of RA Sjogren’s Syndrome (SS) SS Signs SS Symptoms SS Diagnostic Criteria Need 4 points total to make a 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) Patients may also have anemia, leukopenia, and lymphopenia when performing a CBC SS Management Spondyloarthropathies What Are Spondyloarthropathies (SpA)? Ankylosing Spondylitis Reactive Arthritis Psoriatic Arthritis Signs and Symptoms of All SpAs Key Clinical Findings for SpA Disease Usual Differentiating Clinical Features Key Lab/Imaging Findings Ankylosing spondylitis Family history, symmetric disease HLA-B27-positive Psoriatic arthritis Personal history of psoriasis or family Asymmetric changes in history of psoriatic arthritis the sacroiliac joints Reactive arthritis History of recent infection, need to rule Unilateral sacroiliac joint out active infection disease IBD-associated arthritis History of IBD Asymmetric changes in the sacroiliac joints Undifferentiated None specific other than low back pain Variable spondyloarthropathy and stiffness, does not fit any other category SpA Management Ocular Effects of SpA’s Clinical Pearls