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Flashcards in Massive resvision Deck (38):
1

Poor prognostic indicators for RA

-young age at onset
-male
-HLA DR4 positive
-many active joints
-delayed referral
-high CRP/PV at outset
-RhF/CCP positive
-early radiological erosions
-poorer functional scores at outset
-adverse socioeconomic circumstances
-extraarticular features

2

Anti-CD20
Biologic agent --> B cell depletion

Rituximab

3

Disruption of T cell costimulation

Abatacept

4

IL-1 inhibitor

Anakira

5

IL-6 inhibitor

Tocilizumab

6

Genes in RA

HLA-DR4, HLA-DR1

7

Who is SLE more common in

Women, asian, afro-carribean, hispanic etc
Not african blacks

8

Hormonal factors influencing SLE

incidence increased in those with higher oestrogen exposure - early menarche, on oestrogen containing contraceptives and HRT

9

Environmental factors and SLE

Viruses eg Epstein-Barr Virus
UV light may stimulate skin cells to secrete cytokines stimulating B-cells
Silica dust (found in cleaning powders, cigarette smoke and cement) may increase risk of developing SLE

10

Anti-Blys

Belimumab

11

What do patients with SLE die from?

Infection important cause of death in the early / medium stage of disease
Cardiovascular disease the major the cause of death in the late stages

Complications of SLE in the first few years
Late onset of disease
Male SLE
Lower socioeconomic class

12

Anti-ENA in SLE and

Secondary sjogrens features
Congenital heart block

13

Definition of vasculitis?

Presence of leukocytes/immune complexes in the vessel wall with reactive damage to mural structures

14

How do you assess vasculitis?

BVAS (Birmingham vasculitis score)

15

Takayasu arteritis

Large vessel

16

Giant cell arteritis

Large vessel

17

Kawasaki's

Medium vessel

18

PAN

Medium vessel

19

Isolated CNS vasculitis

Medium vessel

20

Churg-strauss

Small vessel

21

Wegeners

Small vessel

22

Microscopic polyangitis

Small vessel

23

HSP

Small vessel

24

Essential cryoglobulinemia

Small vessel

25

Hypersensitivity vasculitis

Small vessel

26

Spondylolysis

Defect in the pars interarticularis of the vertebra

27

Spondylolisthesis

Forward slippage of one vertebra on another

28

Kyphosis

Centre of gravity anterior to spine
High pre – load
May be “opposite” of scoliosis
Treatment of limited success
Surgical treatment very risky

29

When do you give surgical treatment for kyphosis?

When conservative treatment has failed
Adolescent with > 50% slip
Progressive neurological deficit
Postural deformity

30

Treatment for spondylolisthesis?

Grade 1 or 2: Abnormal neighbouring discs
-Posterolateral stabilisation in situ
Grade 3+ : Combined discogenic + nerve root problem
-one stage combined anterior and posterior stabilisation

31

Epimysium

Surrounds entire muscle

32

Endomysium

Surrounds individual muscle fibres

33

Perimysium

Surrounds bundles of muscle fibre

34

Red fibres

(Type 1, slow twitch); large mitochondria &  myoglobin

35

White fibres

White fibres (Type 2, fast twitch); small mitochondria & large motor end-plates

36

Definitive test for Dermatomyositis?

Muscle biopsy!!

37

CK levels lower than in PM
Muscle biopsy shows inclusion bodies
Responds poorly to therapy

Inclusion body myositis

38

Treatment for polymyositis/dermatomyositis?

Glucocorticoids
Azathioprine
Methotrexate
Ciclosporin
IV immunoglobulin