Flashcards in Clinical conditions 2 Deck (9)
Describe the pathophysiology of SLE.
i. Inefficient removal of apoptotic bodies by phagocytosis... nuclear self-Ag (DNA and histones) are transferred to lymphoid tissue and taken up by APCs...
ii. activation of TH cells and B cells... production of anti-dsDNA, anti-SM and anti-phospholipid Abs...
iii. form circulating ICs or deposit into tissues...
iv. activation of complement and neutrophil influx... inflammation and tissue damage.
Suggest signs and symptoms of SLE.
- malar rash
- small joint arthritis
- weight loss
- anaemia (can be Coombs +ve)
- aortic valve lesions
Nervous system (60%):
- CN lesions
- demyelinating syndromes
Which features might be seen in the blood test of a person with SLE?
1. presence of anti-nuclear Abs, e.g. anti-dsDNA, anto-SM, anti-phospholipid Abs
2. decreased Hb, WBC and platelets
3. decreased C2, C3 and C4W
Describe 3 points for the management of SLE.
1. P education: lifestyle modification, e.g. use of sunscreen
2. Anti-inflammatory drugs, e.g. prednisolone
3. DMARDs, e.g. azathioprine or mAbs, e.g. rituximab
Describe the pathophysiology of RA.
i. T3 & T4HS involving production of rheumatoid factor Ab against Fc portion of IgG, +/- anti-citrullinated peptide Ab...
ii. deposition of IC into joint synovial membrane... activation of complement and inflammation...
iii. lymphocyte recruitment... B and TH cells activate macrophages... TNFa production... joint destruction and production of further cytokines, e.g. IL-6
Suggest signs and symptoms of RA.
- pain, stiffness and swelling of small joints that is worse in the morning and better with activity
- interstitial lung disease
- weight loss
- dry eyes and mouth
- rheumatoid bursitis/nodules
- tendon sheath swelling and carpal tunnel syndrome
Which features might be seen in the blood test of a person with RA?
1. presence of rheumatoid factor and/or ACPA
2. increased CRP
3. often anaemia
Describe 5 X-ray features typical of RA.
1. loss of joint space
2. swelling of soft tissues
3. marginal erosions
4. juxta-articular osteoporosis (later generalised)
5. subluxation and gross deformity (late/severe disease)