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Rheumatology Flashcards

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1
Q

anti Sm

A

SLE

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2
Q

anti SSA/Ro & SSB/La

A

Sjogren syndrome

subacute cutaneous lupus erythematosus

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3
Q

anti dsDNA

A

SLE - prone to nephritis

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4
Q

anti U1RNP

A

mixed connective tissue disease (MCTD)

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5
Q

anti Jo-1, PL-7, PL-12

A

antisynthetase syndrome

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6
Q

anti Mi-2

A

dermatomyositis

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7
Q

anti centromere

A

limited cutaneous systemic sclerosis

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8
Q

anti Scl-70 (anti-topoisomerase)

A

diffuse cutaneous systemic sclerosis

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9
Q

associated complications?

  • anti centromere
  • anti Scl-70
  • anti RNA polymerase
A
  • anti centromere - primary PAH
  • anti Scl-70 = ILD
  • anti RNA polymerase - renal crisis, malignancy
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10
Q

HLA associated with:-

  • RA & SLE
  • SLE, SS, Sjogren’s
A

HLA-DRB1 - RA, SLE

HLA-DQ - SLE, SS, Sjogren’s

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11
Q

Which HLA more common in non-Caucasians with higher risk of lupus nephritis, neuropsych SLE, APLS

A

HLA-DRB11503, HLA-DRB108 in African american, Hispanic

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12
Q

How to distinguish Raynaud’s fr autoimmune CTD vs other causes?

A

Peri-ungal erythema/capillary dilatation & drop-out

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13
Q

The classes of lupus nephritis & respective management

A

Class 1: mesangial immune deposits without hypercellularity
Class 2: mesangial immune deposits with hypercellularity
Class 3: focal proliferative, <50% glomeruli
Class 4: diffuse proliferative, >50% glomeruli, segmental or global
Class 5: membranous
Class 6: advanced sclerosing lesions
Class 1&2 (no intensive tx), 3&4 (intensive tx), 5&6 (tx refractory)

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14
Q

Serology markers in SLE which correlate w disease activity

A

high dsDNA, low C3, C4

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15
Q

Serology marker in SLE which correlates w neonatal heart block

A

anti-Ro

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16
Q

anchor drug in SLE

A

Hydroxychloroquine

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17
Q

risk of Hydroxychloroquine requiring regular checks

A

Retinopathy

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18
Q

1st line choice for lupus nephritis

A

MMF

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19
Q

Haematological manifestations of SLE

A
  • TTP

- Macrophage activation syndrome (assoc in JIA); fever, high ferritin, low plt, low fibri, high tiglyceride, high AST

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20
Q

Cardiac involvement of SLE

A
  • Pericarditis

- Liebman-sachs endocarditis

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21
Q

ANA staining patterns

A
  • Speckled - non-specific
  • peripheral - SLE
  • Homogenous - SLE, RA, drug- induce lupus
  • Centromere - limited scleroderma
  • Nucleolar - diffuse sclerdoerma, SLE
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22
Q

Medications for SLE which are safe in pregnancy

A

hydroxychloroquine, azathioprine, steroids

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23
Q

When to consider systemic immunosuppressive therapy (CYC or MMF) in systemic sclerosis?

A
  • Pts w diffuse skin involvement that is severe & progressive
  • Pts w ILD
  • Pts w myocarditis
  • Pts w severe inflamm myopathy and/or arthritis
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24
Q

Risk factors leading to ILD in systemic sclerosis

A
  • early diffuse cutaneous
  • anti-Scl70
  • elevated CRP
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25
Areas of skin distribution in limited cutaneous systemic sclerosis
below elbow & knee, face involvement & truncal sparing
26
Pharmacological mx of ILD in SS
- 1st line MMF - CYC - Aza - Nintedanib (multi-targeted tyrosine kinase inhibitor - FGFR, PDGFR, VEGFR)
27
Pharmacological mx of PAH in SS
i) Endothelin receptor antagonist: ambrisentan, bosentan ii) PDE-5 inhibitors: sildenafil, tadalfil iii) Riociguat (stimulate guanylate cyclase -> cGMP) iv) Severe class III/IV PAH: IV epoprostenol (prostacyclin antagonist) v) Consider other prostacyclin analogues: iloprost - Tx iron deficiency – better survival - Consider lung transplantation
28
Risk factors of scleroderma renal crisis
RNA polymerase III Ab, tendon friction rubs
29
Usual trigger of scleroderma renal crisis
Steroid
30
anti HTN agent of choice for scleroderma renal crisis
Captopril
31
anti HTN agent to avoid for scleroderma renal crisis
beta-blocker
32
Non-pharmacological measures to prevent Raynaud's
- keep warm - avoid caffeine - smoking cessation
33
Pharmacological mx of Raynaud's
1st: Nifedipine 2nd: Sildenafil, topical nitrate, alpha blocker, SSRI Severe: IV iloprost
34
Gut involvement in SS
- GORD 90% pts - bloating, small intestinal bacterial overgrowth - Faecal incontinence 30% - overflow diarrhoea
35
Cardiac complications in SS
- Myopericarditis - CAD HTN cardiomyopathy - Arrhythmia (cardiac fibrosis) - Heart failure
36
The 4 types of inflammatory myopathies
Polymyositis(PM) Dermatomyositis (DM) iii) Inclusion body myositis iv) Immune-mediated necrotizing myopathy (IMNM)
37
Which inflammatory myopathy M>F
Inclusion body myositis (IBM) M>F | PM & DM - F:M 2:1
38
Cells involved in the 4 types of inflammatory myopathies
DM: CD4 plasmacytoid dendritic cells IMNM: macrophages PM & IBM: endomysial CD4 T cells, cytotoxic CD8 T cells, myeloid dendritic cells, plasma cells
39
which complication is related to anti MDA5 & anti synthetase ab in DM/PM
ILD - poor prognosis
40
hyperkeratosis “mechanic's hands”, ILD, myositis, polyarthralgia, fever & Raynaud. anti Jo-1 ab.
anti-synthetase syndrome
41
antibodies related to Immune-mediated necrotizing myopathy
Anti -SRP, anti-HMGCR | *necrotising myopathy
42
antibody related to classic DM with mild disease
anti Mi-2
43
antibodies related to severe DM with a/w cancer
anti-TIF1 & anti NXP-2
44
Insidious – prox leg weakness up to 5yrs, asymmetric, distal finger flexor weakness, muscle atropphy, dysphagia (cricopharyngeal muscle 1/3rd to half of pts), CK not useful to monitor disease (usually low), less responsive to immunosuppressive tx
Inclusion body myositis
45
Gene mutations which confer risk of RA
DRB1, STAT4, PADI, PTPN22
46
Cytokines involved in pathogenesis of RA
TNF, IL-1, IL-6 (Macrophage-derived)
47
Predominant cells in RA synovial fluid
neutrophils
48
Hallmark of RA joint in X-ray
juxta-articular osteopaenia & erosion
49
Joint findings in RA
Small joints (sparing of DIP), symmetrical, associated nodules
50
Joint findings in SLE
passively correctible deformity (Jaccoud arthropathy) - minimal erosion in imaging
51
Joint findings in gout
tophi, DIP not spared, punched out erosions in imaging
52
Joint findings in psoriatic arthritis
erosion + new bone = pencil in cup, Nail change, sausage fingers
53
Joint findings in OA
Heberden's nodes (osteophytes), subchondral sclerosis
54
What are the abs involved in RA?
IgM against Fc portion of IgG
55
Non-rheumatic dx with RF +ve
Hep C, Hep B, Viral infection
56
Best predictors of severity of RA
Erosions | anti-CCP (but does not reflect current disease activity thus not used to assess progress)
57
Factors indicating current activity of RA
CRP, ESR, swollen joint count
58
Anchor drug in RA
Methotrexate
59
Mechanism of action of MTX
irreversibly binds to & inhibits dihydrolate reductase
60
Rescue therapy for MTX toxicity
Folinic acid (leucovorin)
61
Mechanism of action of folinic acid
supplies cofactor blocked by MTX, displaces MTX fr intracellular binding sites, restores active folate stores for DNA synthesis
62
Rescue therapy for leflunomide toxicity
Cholestyramine
63
Mechanism of action of leflunomide
Inhibits pyrimidine biosynthesis
64
Precautions of toxicity for TNF blocker
TB risk, demyelination (hx of optic neuritis), lymphoma, melanoma & non-melanoma, CHF (esp stage IV NYHA)
65
What is the tx for latent TB before commencing anti-TNF
Isoniazid for 4-6 weeks
66
Mechanism of action & main risks of tofacitinib vs baracitinib
tofacitinib - JAK 1/3 inhibitor, high infection risk | baracitinib - JAK 1/2 inhibitor, VTE risk
67
Use of Yttrium in RA
radioisotope ->chemical synovectomy
68
Features of Spondylarthritis
1. Onset age <40 2. Insidious onset 3. Improvement w exercise 4. No improvement w rest 5. Nocturnal pain that improves on waking (Responds to NSAIDs)
69
Axial features of spondyloarthropathy
- Inflammatory back pain - Buttock pain - alternating, poorly localised - Restriction in spinal movement
70
Areas affected in enthesitis
Achilles, plantar fascia, chest wall, pelvic brim
71
Extra-articular Involvement of RA
- Acute uveitis - IBD - Osteopenia - Neurological: cauda equina, fracture, A-a subluxation - CVD risk, aortic regurg, conduction disturbance - Chest wall restriction, apical fibrosis - Secondary amyloidosis
72
1st line mx for spondyloarthritis
NSAIDs, exercise, physical tx
73
2nd line tx for axial spondyloarthropathy
TNF blocker, IL-17 blocker | *no role for local steroids & DMARDs for axial SpA
74
5 distinct patterns of psoriatic arthritis
1. Asymmetric oligo/mono 2. Polyarthritis - symmetric 3. Spondylo-arthritis - axial, AS-like 4. DIP with nail disease 5. Arthritis mutilans
75
Main risk factor of GCA
Age >50
76
HLA association with GCA
HLA-DRB1*04
77
Pathophysiology of GCA
Dendritic cell in adventitia activated --> recruit CD4 T cells & macrophages & migrate to media IL-6 (->Th17 effect) & IFN-gamma (macrophage activation -> granuloma)
78
Specific symptom suggesting GCA
jaw claudication
79
Extra-cranial sx of GCA
aortic involvement (aneurysm), subclavian stenosis/occlusion, cough
80
Options of mx in GCA
Glucocorticoids - GCA without visual sx - Pred 40-60mg - GCA with visual sx -> IV methyl pred for 3/7 then Pred Tocilizumab - Anti-IL6
81
Sjogren's risk to which malignancy?
Non-Hodgkin lymphoma
82
Mechanism of action of sulfasalazine
suppress TNF alpha, induces apoptosis of inflamm cells
83
Mechanism of action of hydroxychloroquine
suppress TNFalpha, induces apoptosis of inflamm cells
84
Medication to avoid with MTX
trimethoprim
85
Rheumatic meds which are safe for pregnancy
- glucocorticoids - azathioprine - cyclosporin/tacrolimus - sulfasalazine - anti TNFs - IVIG
86
Which TNF blocker safe to be used throughout pregnancy?
certolizumab
87
When to stop infliximab/adalimumab & Etanercept during pregnancy?
Stop infliximab/adalimumab at 20 weeks | Etanercept at 30-32 weeks during pregnancy
88
Which rheumatic med is NOT recommended for men trying to conceive?
cyclophosphamide *MMF, MTX, LFL, HCQ can be used
89
Inborn errors of metabolism leading to primary urate overproduction
- Accelerated purine synthesis (PRPP synthase enzyme hyperactivity) - Impaired purine salvage (HGPRT1 deficiency) - Lesch-Nyhan syndrome - Hereditary defects of energy metabolism - glucose-6 phosphatase deficiency
90
Food to avoid in hyperuricaemia
- Seafood & red meat (high in purine) - Fructose (alters hepatic metabolism to increase purines) - Alcohol (increases ATP degradation & purine turnover)
91
Most common sites of subcutaneous tophus
``` Fingers -IP joints damaged by osteoarthritis. Wrists Olecranon bursae Ulnar aspect of the forearm Helix of the ear ```
92
Joint aspiration findings for dx of gout
intra-cellular needle-shaped, negatively birefringent crystals.
93
Imaging options for gouty arthritis
- X-ray: Overhanging edge with sclerotic margin - U/sound: double contour sign, hyperechoic aggregates, tophi - Dual energy CT: Erosions, MSU crystal deposition
94
HLA associated with Allopurinol hypersensitivity syndrome
HLA B*5801 (Han Chinese, Thai)
95
Which part of nephron is involved in urinary excretion of uric acid by uricosuric agents
inhibit URAT1 & GLUT9 in prox tubule
96
what's the duration for gout flare prophylaxis?
6 months
97
antibody associated with drug-induced lupus
anti-histone antibodies
98
medications a/w drug-induced lupus
- hydralazine - procainamide - isoniazid - methyldopa - chlorpromazine - quinidine - minocycline

Rheumatology (1 decks)

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