Autoimmune connective tissue diseases Flashcards by aderonke adesanoye

What MSK complication can arising from SLE

Osteonecrosis of the femoral head

How well did you know this?

Not at all

Perfectly

What hypersensitivity reaction is involved in SLE

Type 3
- Immune complexes are deposited in tissue as they fail to clear.

How well did you know this?

Not at all

Perfectly

What drugs are associated with lupus

Procainamide

Isoniazid

Hydralazine

How well did you know this?

Not at all

Perfectly

SLE is more prevalent in which populations?

African and Asians

Female> Male (9:1)

How well did you know this?

Not at all

Perfectly

Dermatological features of SLE

Photosensitive malar rash
- Nasolabia sparing

Discoid lesions

Non-scarring alopecia

Reynaud’s phenomenon

Livedo reticularis

How well did you know this?

Not at all

Perfectly

MSK presentation of SLE

Migratory joint pain (non-erosive arthritis)
- Knees, wrist, PIPJ

Myalgia

How well did you know this?

Not at all

Perfectly

The most common heart manifestations of SLE are…

Pericarditis (most common)

Libman Sachs endocarditis ( Nonbacterial thrombotic endocarditis)

How well did you know this?

Not at all

Perfectly

The most common renal manifestation of SLE is…

Proliferative glomerulonephritis

How well did you know this?

Not at all

Perfectly

Neuropsychiatric manifestations of SLE

CVA

Mood disorder
- Depression, anxiety

Psychosis

Transver myelitis

How well did you know this?

Not at all

Perfectly

Neonatal/ congenital lupus can present with what cardiac manifestation?

Complete heart block
- As anti-RO antibodies can cross placenta

How well did you know this?

Not at all

Perfectly

The most specific serology for SLE is…

Anti-double stranded DNA antibodies

Anti-smith antibodies (ENA)

How well did you know this?

Not at all

Perfectly

Antiphospholipid antibodies seen in SLE

Anticardiolipin

Lupus anticoagulant

How well did you know this?

Not at all

Perfectly

The most sensitive serology for SLE is…

Anti-nuclear antibodies (ANA)
- 99% are positive.

How well did you know this?

Not at all

Perfectly

What markers can be used to monitor disease activity of SLE

ESR

C3, C4 levels
- Lower in acute phase as they are used uo

Anti-dsDNA titres

How well did you know this?

Not at all

Perfectly

Pregnant women with SLE have to be given _____ (what and when) to reduce the risk of pre-eclampsia

Low dose aspirin from week 12.

How well did you know this?

Not at all

Perfectly

Respiratory manifestations of SLE

Pleurisy (pleuritic chest pain)

Interstitial fibrosis

How well did you know this?

Not at all

Perfectly

First line treatment for non-organ threatening disease in SLE is…

Hydroxychloroquine

How well did you know this?

Not at all

Perfectly

First line treatment option for organ involvement in SLE is…

Cyclophosphamide

How well did you know this?

Not at all

Perfectly

Complications of sjogren’s syndrome

Eyes
- conjunctivitis
- Corneal ulcers

Oral
- Halitosis
- Dental cavities
- Candida

Vagina
- Vaginitis
- Candidiasis

How well did you know this?

Not at all

Perfectly

Extra-glandular presentation of Sjogren’s [5]

Joint pain/ arthritis

Vasculitis

Neuropathy

Interstitial lung disease

Nephritis

How well did you know this?

Not at all

Perfectly

Causes of secondary Sjogren’s syndrome

Rheumatoid arthritis

SLE

systemic sclerosis

Polymyositis

How well did you know this?

Not at all

Perfectly

Sjogren’s syndrome is associated with a 40-60 fold increase in…

Lymphoid malignancy

How well did you know this?

Not at all

Perfectly

Serological diagnosis of Sjogren’s

ANA antibodies (70% sensitivity)
- Anti-Ro
- Anti-La

Hypergammaglobulinaemia

Low C4

How well did you know this?

Not at all

Perfectly

Histological diagnosis of Sjogren’s syndrome

Salivary lymph gland biopsy
- Shows focal lymphocytic infiltrates

How well did you know this?

Not at all

Perfectly

Which two ENA antibodies are associated with Sjogren's syndrome

Anti-Ro (SSA) Anti-La (SSB)

Schirmer's test ________ is suggestive of insufficient tear production, as seen in Sjogren's syndrome

<10mm

Management of Sjogren's syndrome

Artifical saliva and tears Hydroxychloroquine

Features of CREST syndrome

C- Calcinosis R- Raynaud's phenomenon E- Esophageal dysmotility S- Sclerodactyly T- Telangectasia

Types of systemic sclerosis

Limited cutaneous Diffuse cutaneous

Limited cutaneous sclerosis affects (distal/proximal) region and has a _______ progression

Affects distal regions and has slow progression

What type of systemic sclerosis presents with CREST syndrome

Limited cutaneous sclerosis

Diffuse cutaneous sclerosis affects (distal/proximal) region and has a _______ progression

Affects the proximal region and shows a rapid progression

What type of systemic sclerosis has a high risk of renal crisis

Diffuse systemic sclerosis

Serology diagnosis for diffuse cutaneous sclerosis

ANA antibodies Anti-scl 70 Anti-RNA polymerase III antibodies

Serology diagnosis for limited cutaneous sclerosis

ANA antibodies Anti-centromere antibodies

Elevated ___________ is strongly predictive of a _______ in diffuse cutaneous sclerosis

Anti-RNA polymerase III antibodies, strongly predictive of a renal crisis.

Raynaud's phenomenon can be managed using...

CCB- Nifedipine

ILD in systemic sclerosis can be managed using...

High dose corticosteroid + cyclophosphamide

Scleroderma renal crisis can be managed using...

ACE inhibitor

Types of idiopathic inflammatory myositis

Inclusion body myositis Dermatomyositis Polymyositis

Inclusion body myositis presents with...

Asymmetrical proximal limb weakness + exercise intolerance Diminished deep tendon reflexes Dysphagia

Inclusion body myositis presents with _________ muscle weakness, whereas polymyositis presents with _______ muscle weakness

IBM= asymmetrical proximal weakness Polymyositis= symmetrical proximal weakness.

Polymyositis features

Symmetrical muscle weakness Bulbar and intercostal muscle weakness

Dermatomyositis features

Dermatological - Photosensitive, V-shaped rash (anterior chest) - Heliotrope rash on eyelids Systemic - Fever, arthalgia, weight loss Cardiac - Arrhythmias, DCM Gottron's papules

Gottron's papules are associated with ______

Dermatomyositis

In myositis, an electromyography would show...

Polyphasic action potentions

Myositis will show elevated muscle enzymes, which include...

Creatinine kinase ALT LDH

In myositis, serological investigations show elevated...

Anti-nuclear antibodies Anti-synthase antibodies

Definite diagnosis of myositis involves...

Muscle biopsy and history

Patients diagnosis with myositis have an increased risk of _______ so must be screened

Malignancies

Patients with myositis have an increase risk of which malignancies

- Breast - Lung - Ovary

_______ is used for the initial pharmacological management of myositis

Corticosteroids (prednisolone)

Drug causes of erythema nodosum

Penicillin COCP Phenytoin Sulphonamides

Treatment of erythema nodosum

NSAIDs

Investigations for sarcoidosis

Rule out TB - Mantoux tuberculin test Bloods - Bone profile= raised calcium and vit D - Raised serum ACE - LFTs- abnormal if liver affected Serology - Raised interleukin-2 receptor ECG Imaging - Chest X-ray - CT Respiratory function test Lymph node biopsy and histology - Non-caseating granuloma with epitheliod cells.

CXR in sarcoidosis will show...

Bilateral hilar lymphadenopathy

What group of people are most commonly affected by sarcoidosis?

Age 20-40 Afro-caribbean Women

First-line management of sarcoidosis

Oral corticosteroids

Second line management in sarcoidosis

DMARDs - Methotrexate - Azathioprine - Leflunomide - Mycophenolate

What are the features of Lofgren's syndrome

Seen in sarcoidosis: - Erythema nodosum - Bilateral hilar lymphadenopathy - Polyarthralgia

What are the features of Heerfordt's syndrome

Seen in sarcoidosis: - Submandibular/ parotid gland inflammation - Uveitis - CN7 palsy

Autoimmune connective tissue diseases Flashcards

(61 cards)