Flashcards in General rheumatology Deck (29):
what is the main risk factor for autoimmune disease?
advancing age is the greatest risk factor for autoimmune disease
what are some systemic effects of inflammation?
fever, leukocytosis, septic shock syndrome
what are some clinical markers that increase with inflammation?
ESR, CRP, ferritin, WCC, immunoglobulins
what are some clinical markers that decrease with inflammation?
albumin and Hb (anaemia of chronic disease)
what is an identified environmental trigger for Ra and SLE?
Smoking and Uv light respectively
how do we classify vasculitis?
Large (GCA), medium (microscopic polyangitis), small vessel (leukocyteclastic vasculitis)
what is the difference between PSC and PBC
PBC affects small bile ducts, PSC affects large bile ducts
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
general clinical features of vasculitis?
Mixed inflammatory, ischaemic picture. Most affect multiple organs
which population of patients do we see kawasaki disease?
name the large cell vasculitis types
GCA and takayasu
what does CREST stand for? which disease does it relate to?
R- Raynaud's phenomenon
E- esophageal involvement
what are the two types of scleroderma?
diffuse and localised
what are some investigations for scleroderma?
• Anti ANA antibodies
• Anti topoisomerase antibodies
• Anti centromere antibodies
• Raised ESR
• Monitor BP and renal function
what are two emergency complications of scleroderma?
1. scleroderma renal crisis (AKI and uncontrolled HT)
2. cardiac tamponade
what do we mean by mixed connective tissue disease?
Has features of scleroderma, SLE and myositis.
describe antiphospholipid syndrome
antibodies to phospholipids leaves the body in a hyper coagulable state- both for arterial and venous clots. Associated with SLE
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
what is the radiographic feature of A.spondylytis?
sacroiliitis on pelvic Xray and syndesmophytes
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
what are some extraarticular manifestations of Ankylosing spondylitis?
-Low grade fever
-Acute anterior uveitis
-Slowly progressive fibrosis of lung
-Compression of spinal cord
-Cauda equina syndrome
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)
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
WHY DO YOU GET OESOPHAGUS INVOLVEMENT WITH SCLERODERMA?
you get oesophagus involvement bc scleroderma causes fibrosis in the lower 2 thirds of the oesophagus
what is the major cause of morbidity and mortality of scleroderma (localised)?
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)
what are the autoantibodies to phospholipids that we check for to ix anti-phospholipid syndrome?
• Lupus anticoagulant
Anti Beta 2 glycoprotein
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.