Rheumatology Flashcards
4 main presentations of lupus
Discoid lupus - scarring, depigmentation, 80% above neck
Subcutaneous lupus (SCLE) - photosensitive, non-scarring rash, cape distribution
Systemic lupus - low risk: malar rash, patchy alopecia
Systemic lupus - high risk: more systemic involvement
Renal and CSN lupus ab
Anti-SM
3 specific SLE Abs
DsDNA
Anti-Sm
SLE - monitor disease activity
Anti-dsDNA - lupus nephritis
C3/C4
ESR
anti-Ro
Subacute cutaenous lupus, neonatal heart block
Anti-U1RNP
MCTD
Anti-dendritic cell biologic
Litifilimab
Anti-BAFF/BlyS (b cell activating/b lymphocyte)
Belimumab
Biologic blocking IFN 1 signalling
Anifrolumab
SLE treatment principals
All patients get hcq
Mild - usually hcq alone
Moderate - Pred, possibly aza or MTX as steroid sparing
Severe = renal and cns
- Induction - Pred and Cyclophosphamide/MMF
- Maintenance - MMF or AZA, biologics
Lupus nephritis Rx
Steroid pulse + MMF/Cyclo
Rescue Ritux
APLS anticoagulation in pregnancy
LMWH and aspirin
Anti-histone
Drug induce lupus
Common drugs causing lupus
Anti-TNF
Minocycline
PPIs
Hydralazine
Rheumatoid - HLA association
HLA-DRB1 04
Ab in < 1% autoimmune disease
Anti dfs70
Felty syndrome triad
RA + neutropenia + splenomegaly
RA - what cytokine causes erosions
TNF
Major cytokines in RA
Erosions - TNF
Inflammation - IL-1, IL-6, IL-17, TNF
Eye manifestations RA
Scleritis, episcleritis (whole or segmental), peripheral ulcerative keratitis
Common neuro finding of RA
CTS
Most common haem finding of RA
Anaemia
Diagnostic criteria for RA
Inflammatory arthritis (usually peripheral) > 3 joints
Positive RF and/or anti-CCP
Elevated ESR/CRP
Duration > 6 weeks
No other CTD
Poor prognostic features for RA
Early erosive XR changes
Extra-articular features
Sustained CRP elevation
CCP positivity
Which DMARD does not slow radiographical progression RA
HCQ
Treatment ladder RA
MTX 1st
Triple therapy 2nd - LFL,SLZ, MTX
Add biologics third
Add JAKi 4th
MTX A/E
Myelosuppression
Nephrotoxicity - need urinary alkalinisation and leucovorin rescue
Hepatotoxicity
A/E HCQ
Retinopathy
Leflunomide A/E
Antidote -
Myelosuppresion
Teratogenic
Antidote - cholestyramine
SZL A/E
Myelosuppression, high risk in G6PD
Sulfur drug - rash
TNFi A/E
reactiviation opportunistic infections
Cardiac failure
Reversible lupus
A/E of JAK inhibitors
Increased Zoster infection
Increased overall cancer risk
Increased CVS risk
IMS okay in pregnancy
PASH TNF
Pred, Aza, SZS, HCQ, TNF
Dose of pred associated with worse outcomes/mortality
Daily dose > 8mg (aim to wean below this as safely possible)