Autoimmune thyroid disease
This is the most common autoimmune condition. The department measures the full thyroid axis with the antibodies that identify Hashimoto’s thyroiditis and Graves’ disease and predict where the gland is heading. Ultrasound is used to examine the thyroid and monitor the subclinical disease so that treatment begins when it is needed and not before. Thyroid eye disease is recognised early. The optic nerve and retina are imaged by optical coherence tomography on the Optos MonacoPro, with visual fields on the Zeiss Humphrey analyser where there is any question of pressure on the nerve, so that the sight-threatening form of the disease is detected before vision is affected.
Psoriasis and psoriatic disease
Psoriasis is a systemic condition that shows on the skin, and the department treats it as such. Plaque, guttate, inverse and pustular forms, and involvement of the scalp and nails, are treated with topical and systemic therapy and phototherapy as the extent warrants. The joints are assessed for psoriatic arthritis, which affects a third of patients and is preventable in its damage if found early. The cardiovascular and metabolic risk that accompanies the condition is measured and treated with cardiovascular specialists.
Alopecia and hair loss
Autoimmune hair loss is time-sensitive: in its scarring forms, the follicle is destroyed permanently if treatment is delayed, and in its non-scarring forms early treatment shortens the course. The department distinguishes alopecia areata in its patchy, total and universal presentations from frontal fibrosing alopecia, lichen planopilaris and discoid lupus of the scalp, and both from hormonal and androgenetic loss, with scalp biopsy where the diagnosis is unclear. Treatment, including intralesional and systemic options, begins at the diagnosis, and is provided with the dermatology department.
Associated condition screening
Where one autoimmune condition is found, others are screened because they cluster and each is easier to treat before it presents. The department screens for coeliac disease, type 1 and latent autoimmune diabetes, Addison’s disease, pernicious anaemia and B12 deficiency, autoimmune liver disease and vitiligo, and refers to rheumatology specialists where the picture indicates a connective tissue disease.
Antibody assessment and monitoring
Autoimmune disease begins with antibodies, and the antibodies usually appear years before the disease does. Measuring them therefore gives the earliest warning the immune system offers. The department tests for the antibodies specific to each organ the three conditions can involve — the thyroid, the skin, the gut, the adrenals, the liver, the stomach — together with a broader screening panel and the inflammatory markers that show whether the immune system is currently active. Where antibodies are present but there is no disease yet, the department monitors you so that if the condition does develop it is recognised at its start, when treatment is simplest.
