Lab Testing in Rheumatic Diseases

Question 1

Polymyalgia rheumatica and Giant Cell Arteritis can both be monitored using __

Answer 1

ESR (acute phase reactant)

Question 2

Where is CRP synthesized and what can increase it? Greater than __mg/l is considered inflammatory?

Answer 2

• synthesized in liver and can be increased by proinflammatory cytokines
• greater than 8mg/l is inflammatory

Question 3

What Acute Phase Reactant increases with age and is higher in F>M

Answer 3

ESR

Question 4

Does ESR or CRP rise/fall more rapidly?

Answer 4

CRP

Question 5

What is produced by B cells in synovial joints in rheumatoid arthritis patients? This autoantibody targets ____.

Answer 5

Rheumatoid Factor. Tagets Fc portion of IgG

Question 6

RF is present in ___% of RA pts.

RF is present in ___% of “nodular” RA pts.

Answer 6

70-80%

100%

Question 7

Cutoff valve for positive RF in:

• ELISA
• latex fixation

Answer 7

• ELISA: RF > 45IU/ml

- latex fixation: RF > 1:80

Question 8

What two tests have 99.5% specificity for RA?

Answer 8

Anti CCP and positive RF

Question 9

homogenous pattern ANA - caused by?

Answer 9

drug induced lupus

Question 10

postive ANA can occur in what four types of pts?

Answer 10

normal (20-30%), RA, CTD (connective tissue disease?), malignancy

Question 11

Rim pattern ANA indicates…

Answer 11

anti DS DNA

Question 12

Speckled anti SSA/B ANA indicates…

Answer 12

Sjögren syndrome

Question 13

Anticentromere antibody indicates…

Answer 13

scleroderma

Question 14

Criteria for SLE

Answer 14

SOAP MD BRAIN

• Serositis (inflammation in synovial fluid)
• Oral ulcers
• Arthritis
• Photosensitivity

-Malar rash, Discoid rash

• Blood - all low (anemia, thrombo/leukopenia)
• Renal
• ANA
• Immunologic (DS DNA)
• Neurologic

Question 15

***Define hematologic manifestations of SLE

Answer 15

– Hemolytic anemia with reticulocytosis OR

• lymphopenia less than 1500
• leukopenia less than 4,000
• thrombocytopenia less than 100,000

Question 16

Antistreptolysin O antibody (ASO titer) and anti DNAase B titers indicate evidence of preceding ___ infection.

Answer 16

evidence of preceding group A streptococcal infection

Acute Rheumatic Fever; polyarticular

Question 17

strep often affects what parts of the body?

Answer 17

large joints (asymmetric)
Post-strep Reactive Arthritis effects SMALL joints SYMMETRICALLY

Question 18

These tests indicate ___:

CBC indicating hemolytic anemia, leukopenia and false positive RPR (reactive plasma reagin - syphilis)

Answer 18

SLE

Question 19

These tests indicate ___:

Positive anti‐CCP, elevated ESR and elevated rheumatoid factor level

Answer 19

Rheumatoid arthritis

Question 20

alcohol promotes increased ___ production and decreased excretion

Answer 20

urate

Question 21

attacks MTP, has tophi

Answer 21

gout

Question 22

tx of acute gout (3)

Answer 22

NSAIDs, colchicene, steroids

Question 23

tx of chronic gout (2)

Answer 23

XO inhibitors, Probencid (increased renal excretion)

Question 24

What imaging study of rheumatic disease has:
– Poor visualization of soft tissue
– (RA) symmetrical involvement of MCP, periarticular
osteopenia, EROSIONS in late disease

Answer 24

radiography - digital radiographs have high spatial resolution

– Plane radiographs may not detect early arthritic disease

Question 25

What imaging study of rheumatic disease: – Aid in injecting/aspirating joint – No radiation – sensitive for SOFT TISSUE abnormalities (SYNOVITIS, TENDONITIS, BURSITIS) and erosions

Answer 25

Ultrasonography

Question 26

What imaging study of rheumatic disease: – is useful for soft tissue abnormalities; good for spine, SI, synovitis, tenosynovitis, erosions – Gadolinium contrast taken up in inflamed synovium (thickened pannus) IV gadolinium can cause nephrogenic systemic fibrosis (NSF) in patient with kidney disease

Answer 26

MRI **GADOLINIUM TOXICITY - use CT if you can

Question 27

What imaging study of rheumatic disease is best forBONY ABNORMALITIES (trabecular, cortical bone), erosions, fractures, degenerative or inflammatory arthritis

Answer 27

CT

Question 28

``` Number of Joints Involved •Mono ‐ •Oligo ‐ •Pauci ‐ •Poly ‐ ```

Answer 28

* Mono ‐ arthritis * Oligo ‐ 3 or more * Pauci ‐ 5 or more * Poly ‐ more than 6

Question 29

**What rheumatic disease affects MCPs and PIPs?

Answer 29

Rheumatoid arthritis

Question 30

**What rheumatic disease affects knees, DIP, cervical and lumbar?

Answer 30

Osteoarthritis

Question 31

Three types of swelling.

Answer 31

bony, effusion, soft tissue

Question 32

define types of effusion swelling

Answer 32

synovial fluid (infl/non-inflam), pus, blood

Question 33

swan neck: looks like ___ indicates ___

Answer 33

hyperextension of PIP | advanced RA deformity

Question 34

boutonniere: looks like ___ indicates ___

Answer 34

hyperF of PIP | advanced RA deformity

Question 35

name 5 arthritic syndromes

Answer 35

``` Syndromes •Arthritis ‐ Dermatitis •Arthritis ‐ Bowel •Arthritis ‐ Pulmonary •Arthritis ‐ Endocrine •Arthritis ‐ Ophthalmologic ```

Question 36

name causes of inflammatory bowel disease and Reactive arthritis that can cause arthritis

Answer 36

* Inflammatory Bowel Disease - Ulcerative Colitis, Crohn’s Diseasem Behcet’s * Reactive Arthritis - Bowel Infection

Question 37

**4 bowel infections that can cause reactive arthritis

Answer 37

Salmonella, shigella, campylobacter, Yersinia (N. gono/Chlamydia)

Question 38

Name two endocrine disorders that can result in respective arthrtities

Answer 38

1. Thyroid - carpal/tarasal tunnel syndrome | 2. Diabetes - charcot's and cheiroarthropathy (thiickened hand/skin that mimics scleroderma)

Question 39

cytoid bodies and vasculitis result in...

Answer 39

retinopathy (arthritis-ophthalmologic)

Question 40

dactylitis indicates

Answer 40

reactive arthritis

Question 41

Sjogrens, SLE, and healthy, >60 years old - all can have false positive ___?

Answer 41

RF

Question 42

Anti-CCP has greater specificity or sensitivity than RF?

Answer 42

specificity

Question 43

Joint aspiration: 200-2,000 = ?; 2000-50,000 = ?; 50,000+ = ?

Answer 43

``` 200-2,000 = noninflammatory 2000-50,000 = inflammatory (cloudy) 50,000+ = septic (cloudy, opaque) ```

Question 44

causes of drug induced lupus

Answer 44

phenytoin, hydralazine