Naproxen first and then TNF alpha such as golimumab or etanercept (not infliximab)
B27 - psoriasis, AS, IBD and reactive arthritis
B51 - Behcet
B52 - Takayasu arteritis (high ESR and big vessels affected first)
DR2 - anti-GBM disease (Goodpasture's), MS, SLE, narcolepsy
DR4 - rheumatoid arthritis
B1502 - steven johnson
HLA DQ2 - 95% of Coeliacs (rest is DQ8)
Psoriatic arthropathy treatment
Try two DMARDs first, sulfasalzine then methotrexate, and if not works TNF alpha inhibitor golimumab. Last step ustekinumab
List of anitbody drugs
Canakinumab - IL-1 inibitor - used in gout flare up
Abciximab - CD41 (integrin alpha-IIb) - platelet aggregation inhibitor
Adalimumab - TNF-α - rheumatoid arthritis, Crohn's disease, plaque psoriasis, psoriatic arthritis, ankylosing spondylitis, juvenile idiopathic arthritis, hemolytic disease of the newborn
Alemtuzumab - CD52 - multiple sclerosis
Alirocumab / Evolocumab - PCSK9 - hypercholesterolemia
Bevacizumab - VEGF-A - metastatic cancer, retinopathy of prematurity
Denosumab - RANKL - osteoporosis, bone metastases etc.
Eculizumab - C5 - paroxysmal nocturnal hemoglobinuria, atypical hemolytic uremic syndrome
Golimumab - TNF-α - rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis
Infliximab - TNF-α - rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, psoriasis, Crohn's disease, ulcerative colitis
Palivizumab - F protein of respiratory syncytial virus - respiratory syncytial virus (prevention)
Pembrolizumab - PD-1 - melanoma and other cancers
Rituximab - CD20 - lymphomas, leukemias, some autoimmune disorders
Secukinumab - IL 17A - uveitis, rheumatoid arthritis psoriasis
Trastuzumab - HER2/neu (IgG1 antibody)- breast cancer
Tocilizumab - IL-6 receptor - rheumatoid arthritis
Ustekinumab - IL-12, IL-23 - multiple sclerosis, psoriasis, psoriatic arthritis
What is palindromic rheumatism and how do you treat it?
Recurrent, self-resolving inflammatory attacks in and around the joints, consists of arthritis or periarticular soft tissue inflammation. The course is often acute onset, with sudden and rapidly developing attacks or flares Tx hydroxychloroquine is first line
Rheumatoid arthritis presentation and initial Ix
small joint polyarthritis with sparing of distal interphalangeal joints. Ultrasound of affected joints, Anti-CCP, rheumatoid factor and x-ray of hands good initial Ix. Start t with methotrexate. Then consider biologicals such as anti-cd20 (rituximab), anti il-6 (tocilizumab), anti tnf alpha (golimumab/adalimumab)
Rheumatoid arthritis and foot drop - why?
common peroneal nerve palsy due to nerve entrapment both post severe knee deformity and knee replacement MRI required to look at degree of entrapment
anti-PR3 -> can be seen in GPA (wegener's)
cANCA -> GPA (Wegener;s)
pANCA -> eosinophilicGPA
anti-Jo1 -> polymyositis 30% and 60% IPF
AMA -> PBC
Anti-SM -> chronic AI hepatitits
anti-Ro -> neonatal heartblock and Sjogren's
anti-LKM1 -> AI hepatitis type 2
anti-Scl70 -> systemic sclerosis
anti-centromere -> limited cutaneous scleroderma
Difference limited and diffuse cutaneous scleroderma
Limited - anti centromere
Diffuse - anti-RP3
Anti-topisomerase more in diffuse
Anti-fibrillarin and and anti-U11 RNP in both found with pulmonary fibrosis, cardiac myositis etc.
Tx flare up of Behcet
and Azathiprine as second line
First line in ocal finger OA
Lupus complement levels
C3 and C4 reduced, C3d (complement degradation product) raised. This is due to ongoing inflammation which consumes complement!
Side effect of xanthine oxidane inhibitors?
Febuxostat / allopurinol: build up of 6-MP can lead to bone marrow suppresion and neutropenia.
infliximab in pregnancy
stopped in week 16