RA & SLE tutorial

Question 1

What is RA? What antibodies are seen?

Answer 1

Chronic joint inflammation can result in joint damage. Synovitis.
Autoantibodies: Rheumatoid factor & anti-cyclic citrullinated peptide CCP antibodies

Question 2

What is ankylosing spondylitis? What does it usually include? Autoantibodies?

Answer 2

Chronic spinal inflammation that can result in spinal fusion & deformity. 
Site of inflammation includes enthesis. 
No autoantibodies (seronegative)

Question 3

What are examples of seronegative spondyloarthropathies?

Answer 3

Ankylosing spondylitis, reactive arthritis, psoriatic arthritis, enteropathic synovitis (arthritis associated with GI inflammation)

Question 4

What is SLE what does it cause? What are autoantibodies seen?

Answer 4

Chronic tissue inflammation in presence of antibodies directed against self-antigens. Multi-system inflammation mainly joints, skin & kidneys.
-Autoantibodies: antinuclear antibodies ANA, anti-double stranded DNA antibodies dsDNA, anti-phospholipid antibodies

Question 5

What are connective tissue disorder examples?

Answer 5

SLE, sjorgen’s syndrome, autoimmune inflammatory muscle disease, systemic sclerosis - scleroderma, overlap syndrome

Question 6

What are characteristics of connective tissue disorders? Autoantibodies? What is seen commonly?

Answer 6

• Arthralgia & arthritis typically non-erosive.
• Serum autoantibodies characteristic & may aid diagnosis, correlate with disease activity, may be directly pathogenic.
• Raynauds phenomenon often common in these

Question 7

What is raynauds phenomenon?

Answer 7

• Intermittent vasospasm of digits on exposure to cold. From white to blue to red.
• Vasospasm leads to blanching of digit.
• Cyanosis as static venous blood deoxygenated.
• Reactive hyperaemia.
• Most commonly isolated & benign condition

Question 8

What are anti-phospholipid antibodies associated with?

Answer 8

Also termed anti-cardiolipin antibodies.

-Associated with risk of arterial & venous thrombosis in SLE

Question 9

What are clinical manifestations of SLE?

Answer 9

Wide ranging: malar rash (erythema sparing nasolabial fold), photosensitive rash, mouth ulcers, hair loss, raynaud’s, arthralgia & sometimes arthritis, serositis (pericarditis, pleuritis, less commonly peritonitis), renal disease (glomerulonephritis - lupus nephritis), cerebral disease (cerebral lupus eg. Psychosis)

Question 10

What investigations are done for SLE and what is seen?

Answer 10

• Inflammation: high ESR but CRP usually normal except infection/serositis/arthritis. Can see haemolytic anaemia, lymphopenia, thrombocytopenia.
• Renal: look at proteinuria & albumin .
• Immunological: ANA , anti-dsDNA, anti-phoshpholipid, low C3 & C4 in active disease.
• Treatment can sometimes cause abnormal liver function (transaminitis) or neutropenia due to adverse drug rxn