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Flashcards in Clinical conditions 2 Deck (9)
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1

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.

2

Suggest signs and symptoms of SLE.

Skin (85%):
- malar rash
- photosensitivity
- urticaria
- purpura

Joints (90%):
- small joint arthritis

General:
- fever
- fatigue
- weight loss
- depression

Blood (75%):
- anaemia (can be Coombs +ve)
- thrombocytopenia
- leucopenia

Heart (25%):
- pericarditis
- endocarditis
- aortic valve lesions

Nervous system (60%):
- seizures
- CN lesions
- demyelinating syndromes

3

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

4

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

5

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

6

Suggest signs and symptoms of RA.

Joints:
- pain, stiffness and swelling of small joints that is worse in the morning and better with activity

Lungs:
- nodules
- interstitial lung disease

Heart:
- pericarditis

General:
- dever
- fatigue
- weight loss

Other:
- dry eyes and mouth
- rheumatoid bursitis/nodules
- splenomegaly
- tendon sheath swelling and carpal tunnel syndrome

7

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

8

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)

9

Name 4 drugs that could be used in the management of RA.

1. Corticosteroids, e.g. prednisolone
2. Methotrexate (1st line)
3. Anti-TNFa mAbs, e.g. inflixmab, etanercept
4. Rituximab (anti-CD20 on B cells causing B cells apoptosis)