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Flashcards in Rheumatology Deck (16)
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1

AS treatment

Naproxen first and then TNF alpha such as golimumab or etanercept (not infliximab)

2

HLA associations

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

DRB1:08: Grave's

B1502 - steven johnson

HLA DQ2 - 95% of Coeliacs (rest is DQ8)

3

Psoriatic arthropathy treatment

Try two DMARDs first, sulfasalzine then methotrexate, and if not works TNF alpha inhibitor golimumab. Last step ustekinumab

4

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

5

Polymyositis confirmation

muscle biopsy

6

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

7

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)

8

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

9

Antibodies

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

10

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. 

 

11

Tx flare up of Behcet

Prednisolone

and Azathiprine as second line

12

First line in ocal finger OA

Topical NSAIDS

13

14

Lupus complement levels

C3 and C4 reduced, C3d (complement degradation product) raised. This is due to ongoing inflammation which consumes complement!

15

Side effect of xanthine oxidane inhibitors?

Febuxostat / allopurinol: build up of 6-MP can lead to bone marrow suppresion and neutropenia.

16

infliximab in pregnancy

stopped in week 16