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BPT annoying facts > Rheumatology 3 > Flashcards

Rheumatology 3 Flashcards

1
Q

SLE mutation and associated with familial chilblain lupus ( cutaneous LE)?

A

TREX mutation

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2
Q

Key immunopathogenesis in SLE?

A

Loss of self tolerance to autologous-antigens

  • low C3/4 resulting in inability to phagocytose apoptotic materials ( increase in apoptotic materials)
  • alot of auto-antigens bind with antibodies = immune complexes causing inflammatory cascade

Immune complexes trigger TLR

  • B cells activation and differentiation = BAFF/BLyS - B cell proliferation
  • IFN activation ( hypomethylation of DNA)
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3
Q

UV light and SLE?

A

UV triggers keratinocytes apoptosis = cytokine release - hypomethylation of T cell DNA

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4
Q

Hormones in SLE - what hormones increase and decrease?

A

Estrogen increased in SLE

Androgen/DHEA decrease in SLE

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5
Q

Most common cardiovascular presentation of SLE?

What cardiac valve most affected and pathology?

A

pericarditis

Mitral valve- Regurgitation

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6
Q

Lupus hepatitis have what antibody?

A

Ribosomal P antibody

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7
Q

Mitral valve prolapse in SLE a/w what condition as well?

A

Antiphospholipid syndrome

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8
Q

ANA positive (ANA can be positive in majority of healthy population) what antibody next?

A

Anti-DFS-70 - if positive means unlikely SLE

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9
Q

Hydroxychloroquine use in SLE?

A

improve MMF response

Reduce neonatal lupus risk

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10
Q

Belimumab mechanism of action?

A

Anti BAFF/BLys - causing B cell to commit suicide

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11
Q

Anifrolumab mechanism of action?

A

Inhibit IFNa/b signalling

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12
Q

Antiphospholipids antibodies - what type of anticoagulation?

Asymptomatic?
Prior thrombosis?
Prior thrombosis + obstetrics complication?

A

Asymptomatic - aspirin

Prior thrombosis - Therapeutic LMWH till 6 weeks post-partum

Prior thrombosis + obstetric complication - LMWH (prophylactic) + aspirin

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13
Q

Fluorinated steroids eg and why it exists?

A

Example
Betamethasone

Fluorinated steroids - cross placenta barrier/ penetrate skin better hence more side effects

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14
Q

Role of fluorinated steroids in neonatal lupus?

A

Use fluorinated steroids + IVIG in neonates with 2nd heart block = prevents progression to Complete HB

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15
Q

Which steroids does not cross placenta barrier?

A

Dexamethasone

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16
Q

Role of opioids in fibromyalgia?

A

No role - cause it to be much worse

17
Q

Fibromyalgia - diagnostic points of tenderness?

A

Upper outer quadrants of gluteal region

Bilateral mid point of trapezius muscle

18
Q

CCP - citrullination means what

CCP antibodies a/w what?

A

peptidylarginine to peptidylcitrulline

Severe destructive RA, RA-ILD + CVD

19
Q

3 mucosal sites a/w Rheumatoid arthritis

A

Lungs - Smoking
Oral periodontal disease - PADI
GI tract

20
Q

PADI function in RA?

A

PADI gene from porphyromonas gingivalis - converts arginine to citrulline

21
Q

what is RS3PE syndrome

A

Rheumatoid seronegative symmetric synovitis with pitting edema

  • boxing glove and shoes appearance - tendosynovitis
  • excellent response to steroids
22
Q

Importance of eye manifestations in RA?

A

Rare but very high likelihood of Rheumatoid arthritis - RF/CCP positive
-uveitis/episcleritis/anterior chamber eye perforation

23
Q

Rheumatoid nodules in RA importance?

what are they?

A

Rheumatoid nodules = Poor prognosis

Nodules = terminal vasculitis with central necrosis and surrounding fibroblasts

24
Q

Greatest sensitivity for RA - what imaging?

A

Ultrasound

25
Q

How long to monitor RA radiographic progression?

A

5 years

26
Q

When to start biologics for RA?

A

When tried 2 or more conventional DMARDS for at least 6 months

27
Q

Conventional DMARDS side effects?

  • MTX
  • Sulfalazine
  • Hydrochloroquine
  • Leflunomide
  • Tofacitinib
  • TNF inhibitors?
A

MTX - oral ulcers/ bone marrow toxicity/hepatotoxicity

Sufalazine - agranulocytosis/ azoospermia

HCQ - Retinopathy/blue-grey skin discoloration/photosensitivity

Leflunomide - pneumonitis/peripheral neuropathy

Tofacitinib - Reactivation TB/Herpes Zoster

TNFi - Drug induced lupus/Demyelinating syndrome/Heart failure

28
Q

Biologics DMARDS side effect

TNFi - Infliximab/Adalimumab
Anti-CD20 - Rituximab ( best for seropositive RA)
IL6i - Tocilizumab

A

Rituximab - PML/reactivation of TB

Tocilizumab - Diverticular perforation/reactivation TB

29
Q

Prednisolone role in RA?

A

short-term Bridge till DMARDS efficacy achieved

30
Q

Takayasu arteritis likes to affect which arteries?

Which HLA it is associated most with?

A

Aorta - 1st ( can have occlusion)
Renal arteries - 2nd

HLA B51

31
Q

Clinical features of Takayasu arteritis?

A
  1. Claudication of extremities
  2. Brachial arteries = decrease pulsation
  3. Difference at least 10 mmHg systolic blood pressure between arms
  4. Bruits - abdominal aorta/ subclavian arteries

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