Autoimmune connective tissue disease

Question 1

Name some common symptoms of SLE

Answer 1

Malar rash Joint pains Photosensitivity Reynaud’s Mouth ulcers Alopecia Dry/gritty eyes Dry mouth Vagnial dryness Dry skin

Question 2

How should a severe flare of SLE be treated?

Answer 2

IV cyclophosphamide + high-dose prednisolone

Question 3

What are the 3 best tests for monitoring activity of SLE?

Answer 3

Anti-dsDNA antibodies Complement C3 and C4 consumption ESR

Question 4

How do we treat the cutaneous symptoms of SLE?

Answer 4

Topical steroid. Use sunblock to prevent rashes. Sun exposure can also trigger acute systemic flares

Question 5

What are the signs of lupus nephritis?

Answer 5

High blood pressure, foamy urine, and oedema (usually legs, feet and ankles)

Question 6

What is polymyositis?

Answer 6

Progressive symmetrical proximal weakness and auto-immune mediated myositis. (Chronic inflammation of the muscles).

Question 7

What is dermatomyositis?

Answer 7

Progressive symmetrical proximal weakness and auto-immune mediated myositis. Also involves the skin- may see macular rash, helitrope rash, nailfold erthema, Gottron’s papules.

Question 8

What kind of rash is this and what condition is it associated with?

Answer 8

Discoid rash.

SLE.

Question 9

What kind of rash is this and what condition is it associated with?

Answer 9

Heliotrope rash.

Dermatomyositis.

Question 10

What kind of rash is this and what condition is it associated with?

Answer 10

Malar rash.
SLE.

Question 11

What are the causes of erythema nodosum?

Answer 11

Sarcoidosis, drugs (sulphonamides, the Pill, Dapsone), streptococcal infection.

Rarer= Crohn’s/UC, BGC vaccination, Mycobacteria

Question 12

What are the main symptoms of fibromyalgia?

Answer 12

Pain in at least 11 trigger points in the body,

Sleep deprivation,

Menorrhagia,

Low mood,

Fatigue,

Poor concentration

Question 13

How do we treat fibromyalgia?

Answer 13

Physiotherapy

CBT

Patient education

Painkillers- tricyclic antidepressants (e.g. amitryptiline), neuropathic painkillers (e.g. pregabalin, gabapentin).

If these fail may use SNRIs.

Question 14

What are the symptoms of limited cutaneous sclerosis (CREST syndrome)?

Answer 14

Calcinosis

Raynaud’s

Esophageal and gut dysmotility

Sclerodactyly

Telangiectasia

Question 15

What are the symptoms of antiphospholipid syndrome (CLOT)?

Answer 15

Coagulation defects

Livedo reticularis

Obstretric (recurrent miscarriages)

Thrombocytopenia

Question 16

How do we treat large-vessel vasculitis (e.g. giant cell arteritis)?

Answer 16

Steroids (prednisolone)

With adjuncts of aspirin and bone protection.

Question 17

How do we treat medium/small vessel arteritis?

Answer 17

Steroids and IV cyclophosphamide (15mg/kg)

Question 18

In what condition might you see cherry red spots in the retina?

Answer 18

Giant cell arteritis (due to central retinal artery occlusion)

Question 19

What is Kawasaki’s disease?

Answer 19

An autoimmune acute systemic vasculitis affecting children under 5.

Question 20

Key symptoms of Kawasaki’s disease?

Answer 20

1) Bilateral conjunctivitis

2) Dry lips, stawberry tongue
3) Acute cervical lympahdenopath

4) skin rash
5) swelling of hands and feet

Question 21

What is a classical symptom of churg-strauss syndrome (could mention in an SBA?)

Answer 21

Asthma