Rheumatology Flashcards by Isuru Gamage

4 main presentations of lupus

Discoid lupus - scarring, depigmentation, 80% above neck

Subcutaneous lupus (SCLE) - photosensitive, non-scarring rash, cape distribution

Systemic lupus - low risk: malar rash, patchy alopecia

Systemic lupus - high risk: more systemic involvement

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Renal and CSN lupus ab

Anti-SM

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3 specific SLE Abs

DsDNA

Anti-Sm

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SLE - monitor disease activity

Anti-dsDNA - lupus nephritis
C3/C4
ESR

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anti-Ro

Subacute cutaenous lupus, neonatal heart block

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Anti-U1RNP

MCTD

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Anti-dendritic cell biologic

Litifilimab

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Anti-BAFF/BlyS (b cell activating/b lymphocyte)

Belimumab

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Biologic blocking IFN 1 signalling

Anifrolumab

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SLE treatment principals

All patients get hcq

Mild - usually hcq alone
Moderate - Pred, possibly aza or MTX as steroid sparing

Severe = renal and cns
- Induction - Pred and Cyclophosphamide/MMF
- Maintenance - MMF or AZA, biologics

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Lupus nephritis Rx

Steroid pulse + MMF/Cyclo
Rescue Ritux

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APLS anticoagulation in pregnancy

LMWH and aspirin

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Anti-histone

Drug induce lupus

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Common drugs causing lupus

Anti-TNF
Minocycline
PPIs
Hydralazine

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Rheumatoid - HLA association

HLA-DRB1 04

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Ab in < 1% autoimmune disease

Anti dfs70

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Felty syndrome triad

RA + neutropenia + splenomegaly

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RA - what cytokine causes erosions

TNF

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Major cytokines in RA

Erosions - TNF
Inflammation - IL-1, IL-6, IL-17, TNF

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Eye manifestations RA

Scleritis, episcleritis (whole or segmental), peripheral ulcerative keratitis

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Common neuro finding of RA

CTS

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Most common haem finding of RA

Anaemia

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Diagnostic criteria for RA

Inflammatory arthritis (usually peripheral) > 3 joints
Positive RF and/or anti-CCP
Elevated ESR/CRP
Duration > 6 weeks
No other CTD

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Poor prognostic features for RA

Early erosive XR changes
Extra-articular features
Sustained CRP elevation
CCP positivity

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Which DMARD does not slow radiographical progression RA

HCQ

Treatment ladder RA

MTX 1st Triple therapy 2nd - LFL,SLZ, MTX Add biologics third Add JAKi 4th

MTX A/E

Myelosuppression Nephrotoxicity - need urinary alkalinisation and leucovorin rescue Hepatotoxicity

A/E HCQ

Retinopathy

Leflunomide A/E Antidote -

Myelosuppresion Teratogenic Antidote - cholestyramine

SZL A/E

Myelosuppression, high risk in G6PD Sulfur drug - rash

TNFi A/E

reactiviation opportunistic infections Cardiac failure Reversible lupus

A/E of JAK inhibitors

Increased Zoster infection Increased overall cancer risk Increased CVS risk

IMS okay in pregnancy

PASH TNF Pred, Aza, SZS, HCQ, TNF

Dose of pred associated with worse outcomes/mortality

Daily dose > 8mg (aim to wean below this as safely possible)

Most common eye sign of RA

Keratoconjunctivitis sicca

Eye signs of ra in order of severity

Keratoconjunctivitis sicca -dry, gritty eyes Episcleritis - red sclera Scleritis - painful red sclera (can be scleromalacia perforans or peripehral ulcerative keratitis, needs opthal

PR3

GPA

MPO

EGPA 65% MPA 80%

ANCA vasculitis associated with RPGN

MPA

ANCA vasculitis associated with trachela stenosis

GPA

Management of ANCA vasculitis

GC + Cyclophosphamide Ritux as salvage

Urticaria > 72 hours

Antic1q Ab Urticarial vasculitis

Investigation of PAN

Biopsy - segmental necrotising vasculitis medium vessels CT angiographa

Features of Behcet's

Oral ulcers 2 of - genital ulcers - SKin lesions - Pathergy - skin sensitivity to trauma - Ocular inflammation

Visual symptoms and GCA Rx

Methylpred

Complications of GCA

Vision loss Aortic dissection

Anti-topoisomerase - other name?

Anti-Scl70

RNA polymerase III?

Diffuse SSc - Renal - malignancy

Anti-centromere

Limited SSc - Pulm HTN

SSc renal crisis Rx

ACEi

SSc ILD Rx

Cyclophosphamide New evidence for nintedanib

Resorption of terminal tuft

Acro-osteolysis = SSc (diffuse)

Leading cause of death SSc

ILD

Probenecid - CI

Nephrolithiasis

Non gout drugs with: -ULT - Urate elevating properites

Losartan - lowers urate Aspirin - increases urate

Anti-Jo

Anti-synthetase syndrome

Anti Pl 7 Anti Pl 12

Anti synthetase syndrome

Anti Mi

Dermaomyositis

MDA-5

MDA-5 associated ILD

Cancer associated Abs

Anti TIF1 Anti NXP2

Anti Pm-Scl

Scleroderma overalp myositis

Anti-Ku

Scleroderma overlap myositis

Ro60 vs Ro52

Ro60 - Subacute lupus, Sjogren's Ro52 - scleroderma overlap

Spontaneous activity in EMG - Signs - Significance

Fibrilliation, positive waves, complex repetitive discharges Significance - chronic partial/full nerve lesions

Motor unit recruitment on EM - Amplitude - Early recruitment?

Amplitude - Low - primary muscle disease - High - chronic partial dennervation with re-innervation Early recruitment = primary muscle disease

MND EMG findings

Spontaneous activity with chronic partial dennervation all 4 limbs

Characteristic pathology of Sjogren's

Lymphocyte infiltration of exocrine glands

Muscle biopsy - necrosis but no inflammation

Necrotising myopathy - Immune/statin etc.

Managemene of FMF

1st - colchicine 2nd line - Anakinra IL-1 inhibition

Have U1RNP and Anti-Sm/Anti-dsDNA

Lupus - lupus trumps MCTD

What is RF? Found in

Antibody against Fc portion of IgG. Found in Sjogren's, MCTD, cryoglobuinaemia

ANCA positive but with mismatch of pattern to antibody - cause?

Cocaine/levamisole

Main lifestyle RF for RA

Smoking

A/E of tocilizumab

LFT Cholesterolaemia

Staining pattern for ANA positive, dsDNA psotive but ENA negative

Homogenous (nucleus stains one colour)

Most prevalent CNS complication lupus

Cognitive dysfunction = "brain fog"

Difference between Jaccoud's and RA

Jaccound (in SLE) shows no erosive arthritis RA will show erosive arthritis

Faber test for hip pathology

Flexion, external rotation and abduction 90% sensitive and specific

Most common cause of coronary artery aneurysm

Kawasaki disease

Negative birefringence Needle shaped

Uric acid/gout

Positive birefringence Rhomboid

CPPD (Ca)

Central necrosis surrounded by palisading macrophages

Rheumatoid nodule

Cause of gout from increased uric acid synthesis. - which enyme deficiency?

Hypoxanthine-guanine phosphoribosyl transferase (HGPRTase)

Necrotising myopathy antibodies

Srp Hmg coa reductase

Ab most associated with myocarditis in myositis

SRP

IgG antiC1nA

Inclusion body myositis

Rheumatology Flashcards

(86 cards)