RHEUMATOLOGY Flashcards
(36 cards)
Antibodies associates with Limited Cutaneous Systemic Sclerosis (LCSS)?
Anti-centromere antibodies
Ab associated with Diffuse Cutaneous Systemic Sclerosis (DCSS)?
- Anti-RNA Polymerase
- Anti-DNA Topoisomerase 3 (SCL 70 antibodies)
Osteogenesis imperfecta is associated with what collagen type abnormality?
Collagen type 1 abnormality
Ab associated with heart block in neonatal lupus?
Anti-Ro ab
TTT of Discoid Lupus Erythematosus?
Topical steroids
Hydroxychloroquine (monitor by ophthalmologist: risk of retinopathy)
Echo findings associated with Pseudoxanthoma elasticum?
Mitral valve prolapse (increased risk of MI)
Features of pseudoxanthoma elasticum?
- Yellow papules on neck, antecubital fossa
- Retinal angioid streak
- GI haemorrhage
- Cardiac: mitral valve prolapse, increased risk of ischaemic heart disease
Mode of inheritance of Pseudoxanthoma elasticum?
Autosomal recessive - abnormality in elastic fibres
Pain 4-5 cm distal to the lateral epicondyle, worsens on elbow extension and forearm pronation?
Radial tunnel syndrome - compression of posterior interosseous nerve (a branch of the radial nerve) as it passes through the radial tunnel.
Pain on lateral epicondyle, worsened by resisted wrist extension and gripping?
Lateral epicondylitis (tennis elbow) - pain is more proximal than in radial tunnel syndrome and is due to degeneration of the common extensor tendon origin.
Pain on thumb movement and over the radial styloid process (dorsal compartment of wrist)?
De Quervain’s tenosynovitis - (+ Finkelstein test)
Medial epicondyle pain, worsened by resisted wrist flexion and pronation?
Medial epicondylitis (golfer’s elbow)
Numbness + tingling in the ulnar nerve distribution (little and ring fingers)?
Cubital tunnel syndrome - due to compression of ulnar nerve at the elbow. Symptoms are typically neurological rather than purely painful and occur on the medial side of the elbow
Ab in Sjögren’s syndrome?
- Rheumatoid factor + in nearly 50%
- ANA + in 70%
- Anti-Ro + in 70% of patients with PSS
- Anti-La in 20% of patients with PSS
Diagnosis of Sjögren syndrome?
Antibodies + Schirmer’s test + focyl lymphocyctic infiltration on histology + low C4 and hypergammaglobulinaemia
Management of Sjögren?
Artificial saliva and tears - Pilocarpine to stimulate saliva production
Features of Sjögren syndrome?
- Dry eyes (keratoconjunctivitis sicca), mouth (recurrent parotitis), vagina
- Dry joints: arthralgia and myalgia
- Dry fingers: Raynaud’s syndrome
- Dry kidney: Renal tubular acidosis
- Dry nerves: sensory polyneuropathy
- 40-60 fold risk of LYMPHOID MALIGNANCY
Mose of action of Apremilast?
Phosphodiesterase type 4 inhibitor
MOA of Rituximab?
Anti- CD20 monoclonal antibody
MOA of methotrexate?
Dihydrofolate reductase injibitor: Inhibits the reduction of dihydrofolate to tetrahydrofolate
MOA of TNF-adalimumab, certolizumab pegol, etanercept, golimumab, and infliximab.
Inhibits interaction of TNF-alpha to p75 cell surface TNF receptors
Features of dermatomyositis?
Skin features
- Photosensitivity
- Macular rash over back and shoulder
- Heliotrope rash
-Gottron’s papules
- ‘mechanic’s hands’
- Nail fold capillary dilatation
Other features
Proximal muscle weakness +/- tenderness
Raynaud’s
Respiratory muscle weakness
Interstitial lung disease: e.g. Fibrosing alveolitis or organising pneumonia
Dysphagia, dysphonia
Investigations of dermatomyositis?
80% of patients are ANA positive
30% have Ab to aminoacyl-tRNA synthetases (anti-synthetase antibodies), including:
- Ab against histidine-tRNA ligase (also called Jo-1)
- Ab to signal recognition particle (SRP)
- Anti-Mi-2 antibodies
Pain over the radial side of wrist, worse when gripping objects and adducting the wrist with the thumb tucked in? (Positive Finkelstein’s test)
De Quervain’s synovitis
