The problem of diagnosing autoimmune diseases is currently very acute. There are many such pathologies, but the peculiarities of their course determine the complexity of timely detection. Symptoms are often blurry, 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
Diagnostic features of autoimmune diseases are 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 referred for general tests and examinations. The next step involves the selection of more accurate methods relevant for a particular case. Without a timely determination of the disease and the selection of an appropriate therapeutic method, complications may occur, including severe and not amenable to correction.
Antiphospholipid Syndrome
This pathological condition is relatively common. It harms the heart, vascular and nervous systems. Timely diagnosis of an autoimmune disease helps prevent severe thrombosis, which with such a pathology can be the most unpredictable localization. Among the consequences of the disease are thrombocytopenia, a woman's inability to bear the fetus. Possible unpredictable miscarriages and death of the embryo inside the uterus. There are known cases of fulminant formation of the disease. With such a disease, active and adequately selected treatment is especially important.
Such a disease can be suspected if a vascular pattern appears on the body integument, analysis for syphilis gives an affirmative result, foci of rashes appear, and the integrity of large articular elements is impaired. With autoimmune disease, ulcers appear, which cannot be healed. More often localized on the legs. Blood flow is disturbed, 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 study 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 is necessary to remember that a number of nonspecific symptoms can be explained by renal disorders of this type. Damage to the kidneys leads to vasculitis, glomerulopathy, glomerolonephritis, Goodpasture disease. In order to clarify the condition, general blood and urine tests are prescribed first, and in case of suspected autoimmune disease, specialized laboratory tests of biological fluids of the human body are performed. Inadequate treatment or its absence is associated with the formation of chronic inflammatory foci and the subsequent deterioration of the patient's health.
Diseases: what are they?
Wegner's vasculitis is likely. This is called autoimmune damage to the vascular walls. Both large and small vessels suffer. You can notice the disease by general weakness, weight loss and loss of appetite. The patient is in fever, there are joint, muscle pain. The development of the situation is determined by the localization of the lesions. Diagnosis is usually simple due to specific symptoms. Without adequate therapy, the patient lives no more than six months. Proper treatment allows you to increase life expectancy 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 quickly go into remission. Pathology covers the brain and leads to mental disorders.
Polymyositis is possible - by the frequency of distribution, it occupies far from the last line in the list of autoimmune diseases. Diagnosis of the disease, tests to clarify the condition allow you to determine the degree of damage to muscle tissue, skin. A distinctive feature is the numerous inflammatory foci. More often diagnosed in the fair sex. With polymyositis, body temperature rises, sweat glands become active, and the head hurts. The condition is assessed as uncomfortable, muscle weakness worries.
Diagnostic principles
Suspecting autoimmune pathology, it is necessary to check the patient's blood. As the specialists of the laboratory for diagnosing autoimmune diseases at Pavlov State Medical University named after Pavlov specify, such a study should show the presence of specific autoantibodies. Additionally, testing is carried out to detect sensitization of cells. Testing for RBT is sometimes recommended. An alternative is to check the inhibition of leukocyte migration. The study is subject to the identification of autoantigen.
Checking the patient's condition, it is necessary to clarify the HLA phenotype and check the concentration of compliments C3, C4 - the levels will be below normal. The laboratory clarifies the content of gamma globulin. An increase in excess of the average statistical allows you to suspect an autoimmune disorder. In addition, the immunoregulatory index and specific deposits in tissues affected by the disease are specified. They are characterized by lymphoid cell type infiltration.
For examples: SLE
Among the relatively common autoimmune pathologies, the last place in the ranking belongs to systemic lupus erythematosus (SLE). Diagnosis of an autoimmune disease of the connective tissue is a considerable challenge for modern medicine. Clarification of the state is a sequential work, which necessarily includes several stages. First, the doctor studies the medical history, clarifies the symptoms of the case, identifies all significant signs. You need to sort them chronologically as they appear. Then they direct the patient to laboratory tests in order to confirm the preliminary diagnosis. An individual case history is noted for each specific case. This makes it necessary to select an appropriate 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 be tested when prescribed. If the doctor chooses some studies, all of them need to be passed as quickly as possible. While there is no single special analysis, based on which it would be possible to diagnose SLE. The doctor’s task is to evaluate comprehensively the information obtained from numerous laboratory and instrumental studies.
Case Study: Step by Step
The basic principle for diagnosing an autoimmune disease is an integrated sequential approach. First, the doctor collects an anamnesis of the patient and his family. Then it is necessary to fully examine the patient's body. The needy is sent to a laboratory to study the state of the blood. A general analysis is assigned to identify the concentration of the formed elements. A biochemistry study and a check for the presence of autoantibodies are shown. Currently, with suspicion of SLE, 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 checked 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 laboratory tests listed are repeated to monitor the progress of the condition.
Rheumatoid arthritis
The basic principle for diagnosing an autoimmune disease is the study of clinical manifestations. The doctor’s task is to choose the appropriate laboratory tests and direct the patient for examination using x-ray radiation, which allows to assess 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 a laboratory where blood is taken for general research and analysis for biochemistry. The next step will be an X-ray examination to determine the level of damage to the tissue forming the joints.
It is necessary to check the blood in order to determine the appearance of inflammatory markers. These include fibrinogen, a C-reactive protein. With rheumatoid arthritis in the blood, a specific inflammatory marker is observed, which in medicine has been called rheumatoid. Be sure to examine the biological fluid for its presence. As additional research activities, tests are prescribed to determine the functionality of the 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 a blood test does not diagnose an autoimmune disease. 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, a symmetric disease and the formation of specific nodules. Plasma rheumatoid factor is evaluated. An x-ray should show a change in the tissues of the joints.
To diagnose rheumatoid arthritis, it is necessary to determine at least four of the seven signs indicated. The duration of presence is assessed: some signs are considered relevant only if they are recorded for six weeks or more.
Autoimmune Pancreatitis
Diagnosis of this disease is developed on the basis of its belonging to inflammatory pathologies. The peculiarity of the disease is an attack from the immune system of the pancreas. The inflammatory focus is formed inside the organ, due to which the generated enzymes cannot penetrate the intestinal tract. They are stored in iron and lead to the destruction of its structure. In addition to the pancreas, other organs suffer - kidneys, glands responsible for the generation of saliva, lymph nodes, and hepatic ducts for bile. The disease is one of the chronic and is diagnosed relatively rarely. The danger is higher for men over fifty years of age, but there are cases of detection in children, women of different age groups.
Clarification of the disease is difficult due to poor knowledge and nonspecific symptoms. The work is divided into several consecutive steps. First, the doctor responsible for the diagnosis and treatment of autoimmune disease examines the needy for help and clarifies what are the health complaints. It is necessary to collect a medical history, to fully form an anamnesis of the case. The doctor examines the client, feels, taps in the abdomen, checks the weight. Next, the patient is sent to a laboratory for blood testing. Information on the content of immunoglobulin IHG4 is considered especially significant. Additionally 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. An ultrasound examination of the abdominal cavity and MRI will be prescribed. An alternative is CT. Such events provide accurate information about the structure and dimensions of organs. To assess the condition of the biliary tract, an x-ray is needed. A pancreatic biopsy is indicated.
Autoimmune thyroiditis
The term denotes an autoimmune lesion of the thyroid gland. The disease proceeds in the form of a chronicle, belongs to the category of inflammatory. Chronic lymphocytic infiltration progresses, glandular tissue destruction processes are observed, primary hypothyroidism is formed. The disease was first described by Japanese doctor Hashimoto. The work was published in 1912. Risk group - women over forty years of age. The disease is due to genetic factors, the influence of the outside world. Prolonged intake of iodine excess, radiation, exposure to interferon, nicotine can provoke the disease.
The doctor involved in the diagnosis of autoimmune thyroid disease should interview the patient and clarify the medical history, refer the needy to specialized studies. Among the diagnostic criteria is an increase in the concentration of thyroid antibodies in the blood. The most informative indicators will be the content of antibodies to thyroperoxidase, information on such particles to thyroglobulin is somewhat less useful. Usually echogenicity of glandular tissue decreases, its volume increases or decreases (depends on the form of the disease). A patient with an autoimmune disease suffers from primary hypothyroidism. If at least one of the listed criteria for AIT is not observed, the diagnosis is formulated as probable, but not set absolutely accurately.
Clarification: what will help?
In order to choose the right treatment for an autoimmune disease, a thyroid tissue puncture biopsy is included in the diagnosis, which distinguishes the disease from nodular goiter. If the disease is established in a woman planning a bearing a child, it is necessary to study the functionality of the thyroid gland. For this, blood is analyzed for the content of T4, TSH before conception. The analysis is repeated every trimester.
If an autoimmune disease is suspected in the laboratory, blood is tested for various forms of anemia. Biochemistry is done in order to identify abnormalities. With the pathology under consideration, they are similar to those characteristic of hypothyroidism: the content of total cholesterol increases, the creatinine level increases moderately, the content of triglycerides, aspartate transaminase increases.
Details and indicators
Laboratory diagnosis of an autoimmune disease involves checking hormonal levels. There are several scenarios for the development of pathology. TSH can be higher than normal at a standard concentration of T4, an increase in TSH with a decrease in the amount of T4 is possible, as well as a decrease in TSH against the background of a normal T4 content. If an AIT study shows a picture similar to the disease in question, but the thyroid hormone functionality is normal, the diagnosis is considered to be refuted.
It is necessary to check the blood composition to determine the presence of antibodies to thyroid tissue. Typically, the content of such elements increases to thyroperoxidase, thyroglobulin. If both indicators are above normal, the likelihood of an autoimmune disease is particularly high. If there is none, the analysis indicates a high risk of its development.
Differential diagnosis
As indicated above, only on the basis of symptoms, autoimmune diseases are not diagnosed, since for most pathologies of this type the picture is blurry, similar to many other health disorders. Autoimmune thyroiditis is no exception. Differentiation of cases is carried out, taking into account the peculiarities of goiter, the functionality of the thyroid gland. In particular, hashi toxicosis should be distinguished from toxic goiter. The autoimmune nature of the disorder is indicated by AIT in the nearest relatives, as well as subclinical hyperthyroidism. In favor of the disease in question, short-term thyrotoxicosis (up to six months), as well as a moderate symptomatology of the case, speaks. A rather specific picture of ultrasound. Euthyroidism is achievable in a short time with the appointment of thyreostatics to the patient. In addition, the titer of antibodies to TSH receptors does not increase.
The euthyroid phase is similar to endemic goiter. The pseudo-node form has a number of similarities with nodular goiter and organ oncology. To clarify the condition, puncture of the gland is necessary. Diagnosis of an autoimmune disease in the laboratory should show lymphocyte infiltration. This phenomenon is characteristic of AIT, it is widespread, limited. In autoimmune disease, large oxyphilic cells are detected.
Autoimmune hepatitis
Diagnosing autoimmune liver disease is also quite complicated. - . . , . . , . , : . .
The first step necessary for the selection of treatment for the diagnosis of autoimmune liver disease is to analyze the history. It is necessary to identify how long the first complaints appeared, how long the person is worried about the severity, pain on the right under the ribs. Clarify the presence of fever and yellowing of the skin, mucous membranes, biological fluids. An anamnesis of life is analyzed, they clarify whether there have been chronic diseases before, whether the inflammation in the abdominal cavity has been transferred, and sepsis of such a 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 had developed earlier, whether there was a need to interact with poisonous compounds. After a detailed survey, examine the patient, paying attention to the color of the skin, mucous membranes. They check the temperature, palpate the stomach - the patient usually feels pain. Tapping allows you to determine hepatomegaly.
Continuation of the study
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 any, to check the concentration of formed elements. Hepatitis is indicated by an increase in the content of leukocytes, characteristic of the presence of a focus of inflammation in the body.
A biochemical study is performed. The results give an idea of the liver function, pancreatic performance and the concentration of vital trace elements in the circulatory system. As part of the diagnosis of an autoimmune disease, analyzes provide an assessment of the PHA index. This parameter reflects hepatic fibrosis. If such a process proceeds, the prothrombin index is below normal, gamma-glutamyltranspeptidase is observed in increased concentration, and the first type of class “A” alipoprotein is detected in a slightly smaller amount than is characteristic of a healthy person. When conducting a blood test for the PHA index as part of the diagnosis of an autoimmune disease, it is taken into account that the indicated type of alipoprotein is a whey protein responsible for the movement of beneficial cholesterol fractions. The current system involves evaluating the index on a twelve-point scale. A high probability of cirrhosis is indicated by values above nine. If, during the diagnosis of an autoimmune disease in the laboratory, the PHA is less than two, the risks of cirrhosis are rated as zero.
More details
The coagulogram allows you to assess the state of the blood. With cirrhosis, indicators decrease. An immunological study in 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 to autoimmune hepatitis indicates the growth of antinuclear, microsomal types, as well as antibodies to various elements of the liver and smooth muscle cells.
When diagnosing an autoimmune disease in a laboratory, the hepatitis virus in the blood can be detected.
Additionally, if you suspect a disease, you need to check for infection with parasites. To do this, examine feces.
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 lack of specific symptoms found in all patients with celiac disease. Known symptoms in different individuals are expressed to varying degrees. It is noted that the risk of an incorrect diagnosis in such a disease is especially high. There are no unified algorithms for laboratory research and instrumental study of the patient's condition. Many approaches are complicated, inaccessible, which creates additional obstacles in the diagnosis. The 69th proposed criteria for celiac disease. At first it was proposed to do three consecutive biopsies. In the 90th, the requirements were revised.
Diagnosis involves the study of villous atrophy and the study of the patient's condition to determine crypt hyperplasia. If such phenomena are detected, they are accompanied by epithelial dystrophy upon receipt of gluten with food, while remission is achievable with its exclusion, the diagnosis is considered confirmed.
The first step in diagnosis is to identify abnormalities in the digestive tract. Symptoms are problems with stool, although this is not present in all patients. The predominant percentage suffers from atrophic duodenitis. To correctly diagnose, you need to get a biopsy. Histological analysis is a key method for making an accurate diagnosis.