Multisystem Diseases

Question 1

What are the Abs found in the following diseases:

1. Graves Disease (2)
2. Hashimoto Thyroiditis (2)
3. T1DM (4)
4. Goodpastures disease (1)
5. Pernicious anaemia (1)
6. Primary biliary cirrhosis (1)
7. Myasthenia Gravis (2)
8. Dermato- / Polymyositis (3)
9. Vasculitis (3)
10. RA (4)
11. MCTD (1)
12. Scleroderma (3)
13. SLE (2)
14. Addisons Disease (1)
15. Coeliac’s disease (3)

Answer 1

1. Graves Disease - Trab / Anti-TPO
2. Hashimoto Thyroiditis - Tg Ab / Anti-TPO
3. T1DM - anti-GAD Ab / anti-IA2 / anti-ICA / anti-ZNT8
4. Goodpastures disease - anti-GBM Ab
5. Pernicious anaemia - anti-parietal cell
6. Primary biliary cirrhosis - AMA
7. Myasthenia Gravis - ACHr Ab / Anti-MUSK
8. Dermatomyositis / Polymyositis - Jo 1 Ab (more PM with lung) / Anti-Mi-2 (more DM) / Anti-Ro-52 (more DM with lung)
9. Vasculitis - ANCA , PR2, MPO
10. RA - anti-CCP Ab / RF / Anti-Sa / RA33 Ab
11. MCTD – Anti-U1RNP
12. Scleroderma – Anti-Scl 70 (Diffuse) / Anti-centromere (limited) / Anti-RNAP III
13. SLE – dsDNA, Anti-Sm
14. Addisons Disease - 21-OH Ab
15. Coeliac’s disease - EMA / Anti-TTG / Anti-gliadin

Question 2

Patient with longstanding chronic inflammatory illness is suspected of amyloidosis.

In absence of a culprit site to biopsy which 3 sites of biopsy would yield relatively high sensitivity for diagnosing AA amyloidosis?

Answer 2

Highest to lowest sensitivity:

1. subcutaneous fat tissue (93%-100%)
2. salivary gland (83-100%)
3. rectal mucosa biopsy (75-85%)

Question 3

Patient develops digital ischaemia from known APLS.

What 2 treatments might be considered?

Answer 3

1. Aspirin 100mg daily

2. Aggressive anticoagulation (LMWH then warfarin to INR > 3)