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THE INVASION OF THE AUTOANTIBODIES

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THE INVASION OF THE AUTOANTIBODIES Powered By Docstoc
					THE INVASION OF THE
  AUTOANTIBODIES
     They’re not just for
  rheumatologists anymore
The first autoantibody
IIF ANA test- the starting point for
  modern autoantibody screening
               Clinical associations with a positive ANA

        1:640           SLE, MCTD
                        Drug induced LE
                        RA (especially with extraarticular sxs)
                        Sjogren’s syndrome
                        Scleroderma, myositis
Titer                   Autoimmune hepatitis and thyroiditis
                        Malignancy (especially lymphoma)
                        SBE, HIV
                        Oral contraceptive use
                        Normal women
        1:40
Not all ANA’s are the same
              homogeneous
peripheral




             nucleolar
speckled
Ribosomal P protein   Constitutive protein in ribosome
     Some autoantibodies are highly specific
          E.G. anti-nDNA antibodies

                                    Anti-DNA ab prevalence (%)

                               Elevated        Greatly elevated

SLE                            66                30
RA                              5                <2
Malignancy                      5                <2
Discoid LE                      5                <2
Autoimmune hepatitis (Type1)    5                <2
Anti-TNF alpha Rx               7                <5
  Anti-Ro (SS-A) antibodies
Present in SLE and Sjogren’s syndrome
Often in association with anit-La abs
Associated with neonatal lupus
Associated with extra-glandular Sjogren’s
       Anti-histone antibody positive (%)


Drug – Induced Lupus syndrome
   Procainamide                              96
   Hydralazine                               90
   Penicillamine PERIPHERAL                  10
   Etanercept                                <5
Drug – Induced ANA without symptoms         <10
    Anti-RNP (SNRP-U1) Abs
Features of several CTD’s MCTD
   SLE- recurrent serositis, non erosive arthritis
   Scleroderma- Raynaud’s, sclerodactly,
    esophageal dysmotility
   Myositis- Elevated CK, proximal weakness
Painful swelling of the hands
RNA Polymerases (Diffuse Scleroderma)
Anti-SRP (Signal recognition protien 5   PM
                        IIF – ANA
           >/= 1:640   1:320/160    1:80   1:40   NEG



       +     100%         98%        94%    82%   5%


EIA-
ANA
       -      0%           2%         6%    18%    95%
Anti-beta2 glycoprotein 1
antibodies
Anti-neutrophil cytoplasmic abs
Anti-neutrophil cytoplasmic abs ANCA
     P-ANCA          C-ANCA
The autoantibody challenge



 For the diseases grouped by specialty
  on the next 6 slides try to identify the
 most closely associated autoantibody
      (see last 2 slides of handout)
CTD DISEASES ASSOCIATED WITH DIAGNOSTIC
            AUTOANTIBODIES

SLE
RHEUMATOID ARTHRITIS
DIFFUSE SCLERODERMA
CREST SYNDROME (LIMITED SCLERODERMA)
DRUG INDUCED LE
DERMATOMYOSITIS
NEONATAL LE
SJOGREN’S SYNDROME
WEGENER’S GRANULOMATOSUS
GOODPASTURE’S DISEASE
GASTROINTESTINAL DISEASES ASSOCIATED WITH
       DIAGNOSTIC AUTOANTIBODIES

AUTOIMMUNE HEPATITIS – TYPE 1
AUTOIMMUNE HEPATITIS – TYPE 2
PRIMARY BILIARY CIRRHOSIS
CELIAC DISEASE
DERMATOLOGIC DISEASES ASSOCIATED WITH
     DIAGNOSTIC AUTOANTIBODIES

PEMPHIGUS VULGARIS
BULLOUS PEMPHIGOID
DERMATITIS HERPETIFORMIS
NEUROMUSCULAR DISEASES ASSOCIATED WITH
      DIAGNOSTIC AUTOANTIBODIES

Myasthenia gravis
Stiff man (person) syndrome – with diabetes
Stiff man (person) syndrome – paraneoplastic
Paraneoplastic sensory neuronopathy
Lambert Eaton syndrome
Progressive cerebellar ataxia – paraneoplastic
Bush-Rumsfeld encephalopathy
CNS SLE
Chronic Inflammatory Demyelinating Polyneuropathy
Cerebral folate deficiency syndrome
   ENDOCRINE DISEASES ASSOCIATED WITH
       DIAGNOSTIC AUTOANTIBODIES

Hashimoto’s thyroiditis
Grave’s disease
Type 1 diabetes mellitus
Addison’s disease
Acquired hypocalciuric hypercalcemia
 HEMATOLOGIC DISEASES ASSOCIATED WITH
      DIAGNOSTIC AUTOANTIBODIES

ITP
HIT
Cold agglutinin disease
Pernicious anemia
   DIAGNOSTIC AUTOANTIBODIES 1

Anti- histone antibodies
                                Anti- Hu antibodies
Anti- desmoglein 1 & 3
antibodies                      Anti- topoisomerase 1
                                antibodies
Anti- tissue transglutaminase
antibodies                      Anti- Sm antibodies
Anti- fillagrin antibodies      Anti- Collagen !V cross-link
                                protein antibodies
Anti- ribosomal P antibodies
                                Anti- TSH receptor antibodies
Anti- CYP 2D6 (LKM)
antibodies                      Anti- centromere antibodies
Anti- glutamic acid             Anti-Mi2 antibodies
decarboxylase antibodies
DIAGNOSTIC AUTOANTIBODIES 2
Anti- calcium receptor antibodies          Anti- thyroidal peroxidase antibodies
Anti- endomysial antibodies                Anti- Islet cell antibodies
Anti-folate receptor antibodies            Anti- RNA polymerase I, II, III
Anti-PR3 antibodies                        antibodies
Anti- acetyl choline receptor antibodies   Anti- 21-α-hydroxylase antibodies
Anti- histidyl RNA transferase             Anti- hemidesmosome antibodies
antibodies                                 Anti-myeloperoxidase antibodies
Anti- glycoprotein IIb/IIIa antibodies     Anti- Ro/La antibodies
Anti- amphiphysin antibodies               Anti- reality antibodies
Anti- parietal cell antibodies             Anti- little i antibodies
Anti- platelet factor 4-heparin compLex    Anti- pyruvate dehydrogenase
antibodies                                 complex antibodies
Anti-voltage gated Ca channel P/Q          Anti- F actin antibodies
type antibodies                            Anti-signal recognition particle
Anti- Purkinje cell antibodies             antibodies
Anti-lactoferrin antibodies                Anti-α fodrin antibodies
                                           Anti-RNP antibodies

				
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posted:3/31/2008
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