The problem of diagnosing autoimmune diseases is currently very acute. Many such pathologies are known, but the peculiarities of their course make it difficult to detect them in a timely manner. Symptoms are often blurred, so the patient visits doctors for a long time in an attempt to identify the root cause of the disturbing condition. Consider what is included in the spectrum of autoimmune diseases, what methods of clarifying the diagnosis are used by modern doctors.
General information
Features of the diagnosis of autoimmune diseases due to the fact that such pathological conditions lead to damage to various internal systems and organs. As part of the identification of the disease, the patient is sent for general tests and examinations. The next stage involves the selection of more accurate methods relevant to a particular case. Without a timely diagnosis of the disease and the selection of a suitabletherapeutic method may cause complications, including severe and irreversible.
Antiphospholipid syndrome
This pathological condition is relatively common. It harms the heart, vascular and nervous systems. Timely diagnosis of an autoimmune disease can prevent severe thrombosis, which in such a pathology can be the most unpredictable localization. Among the consequences of the disease is thrombocytopenia, the inability of a woman to bear a fetus. Unpredictable spontaneous miscarriages and death of the embryo inside the uterus are possible. Cases of lightning-fast formation of the disease are known. With such a disease, active and adequately selected treatment is especially important.
You can suspect such a disease if a vascular pattern appears on the body, the analysis for syphilis gives an affirmative result, foci of rashes appear, the integrity of large articular elements is violated. With an autoimmune disease, ulcers appear, which cannot be healed. More often localized on the legs. The blood flow is disturbed, the fingers of the lower extremities are affected by gangrene. There is a risk of pulmonary thromboembolism. More often the disease is detected in young women. To make a diagnosis, it is necessary to carefully examine the patient's blood counts, check for syphilis in order to prove the falsity of the affirmative analysis.
Kidneys suffer
When planning the diagnosis of autoimmune diseases, it must be remembered that a number of non-specific symptoms can be explained by renalviolations of this type. Kidney damage leads to vasculitis, glomerulopathy, glomerolonephritis, Goodpasture's disease. To clarify the condition, first prescribe general blood and urine tests, if an autoimmune disease is suspected, specialized laboratory studies of the biological fluids of the human body are carried out. Inadequate treatment or its absence is associated with the formation of chronic inflammatory foci and subsequent deterioration of the patient's he alth.
Diseases: what are they?
There is a possibility of Wegner's vasculitis. This is what is called an autoimmune lesion of the vascular walls. Both large and small vessels are affected. You can notice the disease by general weakness, weight loss and loss of appetite. The patient has a fever, there are joint, muscle pain. The development of the situation is determined by the localization of lesions. Usually, the diagnosis is easy due to the specific symptoms. Without adequate therapy, the patient lives no more than six months. Proper treatment can increase life expectancy by up to a decade.
Paraneoplastic encephalitis is an autoimmune pathological condition related to the type of encephalitis. The risk of death is increased, while the disease can easily go into remission. Pathology covers the brain and leads to mental disorders.
Possible polymyositis - in terms of frequency of distribution, it is far from the last line in the list of autoimmune diseases. Diagnosis of the disease, tests to clarify the condition allowdetermine the degree of damage to muscle tissue, skin. A distinctive feature is numerous inflammatory foci. It is more often diagnosed in the fair sex. With polymyositis, the body temperature rises, the sweat glands are activated, and the head hurts. The condition is assessed as uncomfortable, muscle weakness worries.
Diagnostic principles
Suspecting an autoimmune pathology, it is necessary to check the patient's blood. According to the specialists of the laboratory for the diagnosis of autoimmune diseases at Pavlov State Medical University, such a study should show the presence of specific autoantibodies. Additionally, testing is carried out to detect cell sensitization. Sometimes RBT testing is recommended. An alternative is to test for inhibition of leukocyte migration. The study is carried out subject to the detection of an autoantigen.
Checking the patient's condition, you need to clarify the HLA phenotype and check the concentration of compliments C3, C4 - the levels will be below normal. The laboratory specifies the content of gamma globulin. An increase in the indicator above the statistical average makes it possible to suspect an autoimmune disorder. In addition, the immunoregulatory index and specific deposits in the tissues affected by the disease are specified. They are characterized by infiltration of the lymphoid cell type.
On examples: SLE
Among the relatively common autoimmune pathologies, systemic lupus erythematosus (SLE) is not the last in the ranking. Diagnosis of an autoimmune diseaseconnective tissue is a significant challenge for modern medicine. Refinement of the state is a sequential work, necessarily including several stages. First, the doctor studies the medical history, clarifies the symptoms of the case, determines all significant signs. You need to sort them chronologically as they appear. Then the patient is sent for laboratory tests in order to confirm the preliminary diagnosis. The individuality of the medical history for each specific case is noted. This obliges to select a suitable therapeutic course also individually.
Specialists of the laboratory for the diagnosis of autoimmune diseases of St. Petersburg State Medical University have repeatedly paid attention to the problems of working with patients suffering from SLE. Only an experienced rheumatologist with a high qualification level can correctly formulate a diagnosis. The patient's task is to cooperate with the doctor as responsibly as possible, to be observed by one professional, to take tests when it is prescribed. If the doctor chooses some studies, all of them must be completed as quickly as possible. So far, there is no single special analysis, according to the results of which it would be possible to diagnose SLE. The task of the doctor is to comprehensively evaluate the information obtained from numerous laboratory and instrumental studies.
Case study step by step
The basic principle of diagnosing an autoimmune disease is a comprehensive, consistent approach. First, the doctor collects an anamnesis of the patient and his family. Then it is necessary to fully examine the body of the patient. The needy is sent to the laboratory to study the conditionblood. A general analysis is prescribed to identify the concentration of formed elements. A study on biochemistry and a check for the presence of autoantibodies is shown. Currently, when SLE is suspected, the main methods are practiced: checking anti-RO, anti-LA, RNP. Clarify the presence of antibodies in DNA formed by two helices, and the presence of antinuclear antibodies.
The next diagnostic step is the Wasserman reaction. Blood is tested for syphilis. If the result is positive, but additional tests show the absence of this disease, it is considered false and indicates SLE. In some cases, a biopsy of the skin, kidneys is prescribed. As the case is observed, the listed laboratory tests are repeated to monitor the progress of the condition.
Rheumatoid arthritis
The main principle of diagnosing an autoimmune disease is the study of clinical manifestations. The task of the doctor is to select the appropriate laboratory tests and refer the patient for examination using X-rays, which allows assessing the condition of the joints. To make a diagnosis, work with the patient begins with a general examination of the body. Then the person is sent to the laboratory, where they take blood for a general study and analysis for biochemistry. The next step will be an X-ray examination to determine the level of damage to the tissues that form the joints.
You need to check your blood to see if there are any inflammatory markers. These include fibrinogen, C-reactive protein. With rheumatoid arthritis in the bloodthere is a specific inflammatory marker, which in medicine is called rheumatoid. Be sure to examine the biological fluid for its presence. As additional research activities, tests are prescribed to determine the functionality of internal organs. Immunological examination is allowed. From time to time, the patient will have to take tests again so that the doctor can monitor the progress of the case.
About manifestations
Only by a blood test, the diagnosis of an autoimmune disease is not made. It is necessary to clarify the clinical picture. Pathology is detected if the patient notes stiffness in the morning, if three or more joints are affected by arthritis. The criteria for the disease include arthritis localized in the joints of the hands, symmetrical disease, and the formation of specific nodules. Assess the presence of rheumatoid factor in plasma. The x-ray should show changes in the tissues of the joints.
To diagnose rheumatoid arthritis, you must identify at least four of the seven signs indicated. Assess the duration of presence: some signs are considered relevant only if they are recorded for six weeks or more.
Autoimmune pancreatitis
Diagnosis of this disease is developed based on its belonging to inflammatory pathologies. A feature of the disease is an attack from the immune system of the human pancreas. An inflammatory focus is formed inside the organ, due to which the generated enzymes cannot penetrate the intestinal tract. They store in the gland andlead to the destruction of its structure. In addition to the pancreas, other organs suffer - the kidneys, glands responsible for generating saliva, lymph nodes, hepatic ducts for bile. The disease belongs to the number of chronic and is diagnosed relatively rarely. The danger is higher for men over the age of fifty, but there are cases of detection in children, women of different age groups.
Clarification of the disease is difficult due to the lack of knowledge and non-specific symptoms. The work is divided into several successive steps. First, the doctor responsible for diagnosing and treating an autoimmune disease examines the person in need of help and clarifies what the he alth complaints are. It is necessary to collect a medical history, to completely form an anamnesis of the case. The doctor examines the client, feels, taps in the abdomen, checks the weight. The patient is then sent to a laboratory for blood testing. Information on the content of IgG4 immunoglobulin is considered especially significant. Additionally, they study urine, feces. The next step is to work with an endocrinologist, a gastroenterologist. Highly specialized doctors will examine the patient and determine what examinations are needed in a particular case. Abdominal ultrasound and MRI will be ordered. The alternative is CT. Such events provide accurate information about the structure and dimensions of organs. An x-ray is needed to assess the condition of the biliary tract. Pancreas biopsy indicated.
Autoimmune thyroiditis
The term refers to an autoimmune lesion of the thyroid gland. The disease proceeds in the form of a chronicle, belongs to the categoryinflammatory. Lymph infiltration progresses chronically, processes of destruction of the glandular tissue are observed, and primary hypothyroidism is formed. The disease was first described by the Japanese doctor Hashimoto. The work was published in 1912. The risk group is women over the age of forty. The disease is explained by genetic factors, the influence of the outside world. The disease can be provoked by prolonged intake of excess iodine, radiation, exposure to interferon, nicotine.
A doctor who diagnoses an autoimmune thyroid disease should interview the patient and clarify the medical history, send the person in need for specialized studies. Among the diagnostic criteria is an increase in the concentration of thyroid antibodies in the blood. The most informative will be indicators of the content of antibodies to thyroperoxidase, information on such particles to thyroglobulin is somewhat less useful. The echogenicity of the glandular tissue usually decreases, its volume increases or decreases (depending on the form of the disease). A patient with an autoimmune disease suffers from primary hypothyroidism. If at least one of the listed AIT criteria is not observed, the diagnosis is formulated as probable, but not absolutely accurate.
Clarification: what will help?
In order to choose the right treatment for an autoimmune disease, a puncture biopsy of the thyroid tissue is included in the diagnosis, which makes it possible to distinguish the disease in question from nodular goiter. If the disease is established in a woman planning to bear a child, it is necessary to study the functionality of the thyroid gland. To do this, analyze the blood for the content of T4, TSH up toconception. The analysis is repeated every trimester.
When an autoimmune disease is suspected, blood is tested in the laboratory for various forms of anemia. Biochemistry is done in order to identify deviations from the norm. With the pathology under consideration, they are similar to those characteristic of hypothyroidism: the content of total cholesterol increases, the creatinine level moderately increases, the content of triglycerides, aspartate transaminase increases.
Details and figures
Laboratory diagnosis of an autoimmune disease involves checking the hormonal levels. There are several scenarios for the development of pathology. TSH may be higher than normal with a standard concentration of T4, it is possible to increase TSH with a decrease in the amount of T4, as well as a decrease in TSH against the background of a normal T4 content. If the AIT study shows a picture similar to the disease in question, but the hormonal functionality of the thyroid gland is normal, the diagnosis is considered refuted.
It is necessary to check the composition of the blood to determine the presence of antibodies to thyroid tissues. Usually the content of such elements to thyroperoxidase, thyroglobulin increases. If both indicators are higher than normal, the likelihood of an autoimmune disease is especially high. If it doesn't exist yet, test results indicate a high risk of developing it.
Differential Diagnosis
As mentioned above, autoimmune diseases are not diagnosed only on the basis of symptoms, since for most pathologies of this type the picture is blurry, has similarities with manyother he alth disorders. Autoimmune thyroiditis is no exception. Differentiation of cases is carried out, taking into account the characteristics of the goiter, the functionality of the thyroid gland. In particular, hashi-toxicosis must be able to distinguish from toxic goiter. The autoimmune nature of the disorder is indicated by AIT in the closest relatives, as well as subclinical hyperthyroidism. Short-term thyrotoxicosis (up to six months), as well as the moderateness of the symptoms of the case, speaks in favor of the disease under consideration. The ultrasound picture is quite specific. Euthyroidism is achievable in a short time when thyreostatics are prescribed to the patient. In addition, the titer of antibodies to TSH receptors does not increase.
The euthyroid stage is similar to endemic goiter. The pseudonodular form has a number of similarities with nodular goiter and oncology of the organ. To clarify the condition, a puncture of the gland is necessary. Laboratory diagnosis of an autoimmune disease should show lymphocyte infiltration. This phenomenon is characteristic of AIT, it is common, limited. In autoimmune disease, large oxyphilic cells are detected.
Autoimmune hepatitis
Diagnosis of autoimmune liver disease is also quite difficult. With hepatitis of this form, liver tissues are destroyed due to the activity of the immune system of the human body. This disease is characterized by rapid development and an increased risk of cirrhosis in the near future. With it, the tissues die en masse, transform into fibrous ones. The symptoms are similar to the previously mentioned SLE. The diagnosis is made by ruling out other liver diseases and testing the blood for the presence of the hepatitis virus. Compared to autoimmunetype and other chronic varieties of hepatitis, it should be noted: there is no need to wait six months for a diagnosis. For other chronic liver diseases, an important criterion is the observation of a case within six months.
The first step necessary for the selection of treatment for the diagnosis of autoimmune liver disease is an analysis of the anamnesis. It is necessary to identify how long ago the first complaints appeared, how long a person is worried about heaviness, pain on the right under the ribs. Clarify the presence of fever and yellowing of the skin, mucous membranes, biological fluids. They analyze the history of life, clarify whether there were previously chronic diseases, whether inflammation in the abdominal cavity was transferred, sepsis of such localization. It is necessary to clarify the presence of hereditary pathologies, bad habits. They ask whether there were periods of prolonged use of drugs, whether a tumor developed earlier, whether there was a need to interact with toxic compounds. After a detailed survey, the patient is examined, paying attention to the color of the skin, mucous membranes. They check the temperature, palpate the abdomen - the patient usually feels pain. Tapping can identify hepatomegaly.
Research continues
Hepatitis of the nature under consideration, among others, is not the last in terms of occurrence, in comparison with other pathologies from the list of autoimmune diseases. Diagnosis of the disease involves a laboratory examination. The first and basic method is general blood screening. It is necessary to determine anemia, if there is one, checkconcentration of formed elements. Hepatitis is indicated by an increase in the content of leukocytes, which is characteristic of the presence of a focus of inflammation in the body.
Conduct a biochemical study. The results give an idea of the liver function, pancreas performance and the concentration of vital trace elements in the circulatory system. As part of the diagnosis of an autoimmune disease, tests are given to assess the PHA index. This parameter reflects hepatic fibrosis. If such a process proceeds, the prothrombin index is below normal, gamma-glutamyl transpeptidase is observed in an increased concentration, and the first type of class “A” alipoprotein is detected in a slightly smaller amount than is typical for a he althy person. When conducting a blood test for the PGA index as part of the diagnosis of an autoimmune disease, it is taken into account that the alipoprotein of this type is a whey protein responsible for the movement of useful cholesterol fractions. The current system involves assessing the index on a twelve-point scale. A high probability of cirrhosis is indicated by values above nine. If PHA is less than two at the time of laboratory diagnosis of an autoimmune disease, the risks of cirrhosis are assessed as zero.
Read More
Coagulogram allows you to assess the condition of the blood. With cirrhosis, the indicators decrease. An immunological study as part of the laboratory diagnosis of an autoimmune disease shows an increase in the concentration of gamma globulin, an increase in the content of type G immunoglobulins.
When assessing the concentration of antibodies for autoimmune hepatitis indicates an increaseantinuclear, microsomal types, as well as antibodies to various elements of the liver and smooth muscle cells.
A laboratory test for an autoimmune disease can detect the hepatitis virus in the blood.
Additionally, if you suspect a disease, you need to check for parasites. To do this, examine the cal.
Celiac disease
For this pathology, in comparison with other autoimmune diseases present in the list, the diagnosis of the disease is especially difficult. This is due to the absence of specific symptoms found in all patients with celiac disease. Known symptoms are expressed in different degrees in different individuals. It is noted that the risk of misdiagnosis in such a disease is particularly high. There are no unified algorithms for laboratory studies and instrumental study of the patient's condition. Many approaches are complicated, difficult to access, which creates additional obstacles in the diagnosis. The 69th proposed criteria for celiac disease. First, it is suggested to do three consecutive biopsies. In the 90th, the requirements were revised.
Diagnosis involves the study of atrophy of the villi and the study of the state of the patient's body to determine the hyperplasia of the crypts. If such phenomena are detected, they are accompanied by epithelial dystrophy when gluten is taken with food, while remission is achievable if it is excluded, the diagnosis is considered confirmed.
The first step in diagnosis is to identify disorders in the digestive tract. Problems with stools are considered a symptom, although this is not present in everyone.sick. The predominant percentage suffers from atrophic duodenitis. To make a correct diagnosis, a biopsy is needed. Histological analysis is a key method for making an accurate diagnosis.
