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Flashcards in General rheumatology Deck (29):
1

what is the main risk factor for autoimmune disease?

advancing age is the greatest risk factor for autoimmune disease

2

what are some systemic effects of inflammation?

fever, leukocytosis, septic shock syndrome

3

what are some clinical markers that increase with inflammation?

ESR, CRP, ferritin, WCC, immunoglobulins

4

what are some clinical markers that decrease with inflammation?

albumin and Hb (anaemia of chronic disease)

5

what is an identified environmental trigger for Ra and SLE?

Smoking and Uv light respectively

6

how do we classify vasculitis?

Large (GCA), medium (microscopic polyangitis), small vessel (leukocyteclastic vasculitis)

7

what is the difference between PSC and PBC

PBC affects small bile ducts, PSC affects large bile ducts

8

for small vessel vasculitis- what are the types and what Anca are they associated with?

C-Anca, PR3= wegner's granulomatosis
P-Anca, MAO= MPA and chugg strauss syndrome

9

general clinical features of vasculitis?

Mixed inflammatory, ischaemic picture. Most affect multiple organs

10

which population of patients do we see kawasaki disease?

children

11

name the large cell vasculitis types

GCA and takayasu

12

what does CREST stand for? which disease does it relate to?

Scleroderma
C- Calcinosis
R- Raynaud's phenomenon
E- esophageal involvement
S- sclerodactyly
T- Telangiectasia

13

what are the two types of scleroderma?

diffuse and localised

14

what are some investigations for scleroderma?

• Anti ANA antibodies
• Anti topoisomerase antibodies
• Anti centromere antibodies
• Raised ESR
• Monitor BP and renal function

15

what are two emergency complications of scleroderma?

1. scleroderma renal crisis (AKI and uncontrolled HT)
2. cardiac tamponade

16

what do we mean by mixed connective tissue disease?

Has features of scleroderma, SLE and myositis.

17

describe antiphospholipid syndrome

antibodies to phospholipids leaves the body in a hyper coagulable state- both for arterial and venous clots. Associated with SLE

18

what are 7 features of spondyloarthritides?

1. Seronegativity (RF negative)
2. HLA B27 association
3. Axial arthritis (sacroillitis)
4. Asymmetrical large joint arthritis
5. Inflammation of the site of insertion of tendon or ligament into bone
6. Dactylitis- inflammation of an entire digit
7. Extra-articular manifestations

19

what is the radiographic feature of A.spondylytis?

sacroiliitis on pelvic Xray and syndesmophytes

20

tell me about some features of ankylosing spondylitis?

• Inflammatory back pain
• Both sacro-iliac joints are affected
• Associated with psoriasis, IBD
• Can arise by itself (idiopathic/primary)
• HLA B27
• +ve FMH
• Elevated CRP

In contrast to rheumatoid arthritis, where inflammation and erosion are the only pathological processes present, AS involves inflammation, cartilage erosion, and an additional process, which is subsequent repair (ossification).

Patients complain of morning back stiffness, improved by exercise. Back pain in the middle of the night and alternating buttock pain

21

what are some extraarticular manifestations of Ankylosing spondylitis?

Constitutional
-Low grade fever
-Fatigue
-Weight loss

Eye
-Acute anterior uveitis

CVD
-Ascending aortitis
-Conduction abnormalities
-Valve incompetence
-Cardiomegaly
-Pericarditis
-MI

Pulmonary
-Slowly progressive fibrosis of lung

Neurological
-Compression of spinal cord
-Myelopathy
-Cauda equina syndrome

Renal
-IgA nephropathy
-Amyloidosis

Bone
-Osteoporosis

22

What is the general treatment and management of Ankylosing spondylitis?

1. Disease monitoring
2. Regular exercise + physiotherapy
3. NSAIDs - first line treatment
4. Analgesics (paracetamol)/ codeine phosphate
5. If peripheral involvement= sulfasalazine
6. Anti TNF drugs- infliximab, etanercept, adalimumab, and golimumab
7. Surgery (last resort, may be disabling)

23

how do we confirm diagnosis of amyloidosis? what special stain do we use?

Amyloidosis is confirmed through tissue biopsy
- requires Congo Red stain
- shows up an apple green birefringence under polarised light

24

WHY DO YOU GET OESOPHAGUS INVOLVEMENT WITH SCLERODERMA?

you get oesophagus involvement bc scleroderma causes fibrosis in the lower 2 thirds of the oesophagus

25

what is the major cause of morbidity and mortality of scleroderma (localised)?

pulmonary hypertension

26

tell me about anti-phospholipid syndrome. How do we manage it?

• Autoantibodies to phospholipids
• Increased hypercoagulable state
• Increased clots in arterial and venous system
• Treated with warfarin
Can be classified as either primary or secondary (to SLE)

27

what are the autoantibodies to phospholipids that we check for to ix anti-phospholipid syndrome?

• Lupus anticoagulant
• Anti-cardiolipin
Anti Beta 2 glycoprotein

28

2 forms of scleroderma? how do we differentiate?

diffuse or localised

• Diffuse cutaneous systemic sclerosis: skin thickening on the proximal extremities or the trunk in addition to face and distal extremities.

-Limited cutaneous systemic sclerosis: skin thickening confined to sites distal to the elbows and knees, but can also involve the face.

29

what are some general complications of scleroderma?

dysphagia, pulmonary hypertension, digital ulceration/ischaemia, arthralgia, raynaud's phenomenon