Laboratory Investigations for Diagnosis of Autoimmune and Inflammatory Periocular Disease: Part II

Abstract

In cases of limited orbital or sino-orbital disease, serologic testing may be negative in a significant number of patients. Specifically, the clinician should be wary of ruling out limited orbital sarcoid or sinoorbital granulomatosis with polyangiitis based on serologic testing alone. Part I of this review has covered serologic testing for thyroid eye disease, IgG4-related disease, and myasthenia gravis. In part II, the authors discuss serologic testing for sarcoidosis, vasculitis, Sjögren syndrome (SS), and giant cell arteritis (GCA).

CT and MR imaging of orbital inflammation

“…Isolated orbital granulomatous involvement, in the absence of systemic disease, should not be called orbital sarcoidosis, as it may represent an idiopathic granulomatous orbital inflammation, probably a different entity, affecting especially men in the fourth decade and in 50% of cases affecting the lacrimal gland [ 26 , 29 ]. Serum angiotensin-converting enzyme (ACE) is increased in 60 to 90% of patients with active disease and reflects its severity [ 1 , 30 ]. Oral steroids are the mainstay of treatment.…”

“…9 a, b). Serologic testing includes measuring serum TSH, T3, T4, TSH-r antibody, thyrotropin-binding inhibitory immunoglobulin, and thyroid-stimulating immunoglobulin [ 32 ]. Natural history of the disease depicts an active phase followed by an inactive phase.…”

“…Bone remodeling is possible [ 37 ]. Increased IgG4 levels in serum will help in making the diagnosis [ 40 ], but serum IgG4 can be normal in up to 40% of patients with biopsy-proven disease [ 32 , 38 ]. The definitive diagnosis is histopathologic typically with abundant IgG4-positive plasma cells and fibrosis [ 38 , 41 ].…”

“…A positive antineutrophil cytoplasmic antibodies (ANCA) is a marker of disease activity. It is present in more than 90% of patients with active systemic disease but only in 32% of patients with a limited form of the disease [ 1 , 7 , 30 ]. Therapy is based on immunosuppressive agents such as cyclophosphamide and corticosteroids [ 7 ].…”

Myasthenia Gravis; Frequency of Different Clinical Features in Patients Presenting to a Tertiary Care Hospital, Karachi

“…The anti AChR antibodies negative patients are called serum negative myasthenia and in the presence of antibodies to muscle specific Kinase (MuSK) receptors are mainstay of diagnosis. 1,9,10 MG is treated by cholinesterase inhibitors, corticosteroids, immune suppressants like azathioprine, and cyclophosphamide which has steroid sparing agent effect as well, Plasmapheresis, transfusion of immunoglobulin and in selected of thymectomy. [11][12][13] That is why this study has been conducted to determine the most common clinical manifestation of patients diagnosed with Myasthenia gravis.…”