SLE, Systemic manifestations and RA Flashcards

(43 cards)

1
Q

what is rheumatoid arthritis

A

Chronic joint inflammation (synovium) can result in joint damage
Associated with autoantibodies (RF and Anti-CCP)

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2
Q

Which autoantibodies are associated with rheumatoid arthritis

A

Rheumatoid factor

Anti-CCP

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3
Q

What is ankylosing spondylitis

A

Chronic spinal inflammation that can result in spinal fusion and deformity
Site of inflammation includes the enthesis

No autoantibodies (‘seronegative’)

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4
Q

What are the consequences with ankylosing spondylitis

A

Spinal fusion

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5
Q

How is spinal fusion evidently seen on a radiograph

A

Bamboo spine

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6
Q

examples of seronegative spondyloarthopathies

A

Ankylosing spondylitis
Reactive arthritis (Reiter’s Syndrome)
Psoriatic arthritis
Arthritis associated with gastrointestinal inflammation (enterohepatic synovitis)

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7
Q

main features of SLE

A

Chronic tissue inflammation in the presence of antibodies directed against self antigens
Multi-site inflammation but particularly the joints, skin and kidney

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8
Q

key autoantibodies in SLE

A

Antinuclear antibodies
Anti-double stranded DNA antibodies
Anti-phospholipid antibodies

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9
Q

arthralgia

A

Pain in joints
Tenderness but not obvious inflammation

Common in connective tissue disorders

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10
Q

What is Raynaud’s phenomenon

A

Intermittent vasospasm of digits on exposure to cold
Typical colour changes – white to blue to red
Vasospasm leads to blanching of digit
Cyanosis as static venous blood deoxygenates
Reactive hyperaemia

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11
Q

main manifestations of SLE

A

Malar rash – butterfly, photosensitive
Mouth ulcers
Hair loss
Raynaud’s phenomenon
Arthralgia and sometimes arthritis
Serositis (pericarditis, pleuritis, less commonly peritonitis)
Renal disease – glomerulonephritis (‘lupus nephritis’)
Cerebral disease – ‘cerebral lupus’ e.g. psychosis

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12
Q

demographic of SLE

A

females 15-45

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13
Q

Which rheumatoid conditions are seronegative

A

OA
Reactive arthritis
Gout
Ankylosing Spondylitis

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14
Q

What type of hypersensitivity is associated with SLE

A

Type 3 hypersensitivity -due to formation of immune complexes

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15
Q

three stages of Raynaud’s

A

1) Vasospasm
2) Cyanosis
3) Reactive hyperaemia

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16
Q

key investigations for SLE

A

ESR
CRP is usually normal
Autoantibodies
Antiphospholipid antibodies

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17
Q

haematological findings SLE

A

Haemolytic anaemia, Lymphopenia, Thrombocytopenia

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18
Q

What is the main clinical risk in a neonate with neonatal lupus syndrome

A

Permanent heart block - conduct ECG

19
Q

renal investigations performed in patients with SLE

A

Measure urine protein: Creatinine ratio
Albumin
eGFR

20
Q

How can we measure disease activity in SLE

A

Immune complexes

Unwell lupus patient has LOW complement C3 and C4 levels and HIGH levels of anti-ds-DNA antibodies

21
Q

aim of SLE treatment

A

aims at remission or low disease activity and prevention of flares

22
Q

What should patients with SLE be assessed for

A

antiphospholipid antibody status

infectious and cardiovascular diseases risk profile

23
Q

What is Sjorgren’s syndrome

A

Autoimmune exocrinopathy
lymphocytic infiltration of especially exocrine glands and sometimes of other organs (extra-glandular involvement)
non-erosive arthritis and raynauds common

24
Q

What is inflammatory muscle disease

A

Proximal muscle weakness due to autoimmune-mediated inflammation either with (dermatomyositis) or without (polymyositis) a rash
associated with malignancy and pulmonary fibrosis

25
skin changes in dermatomyositis
heliotrope rash on eyelids, malar regionm nsao-labial folds red or purple lesions on knuckles - gottrons papules subcutaneous calcinosis mechanics hands - cracking over finger pads
26
Which serum markers are elevated in dermatomyositis
Creatine phosphokinase
27
symptoms of sjorgens
dey eyes dry mouth parotid gland enlargement
28
What is systemic sclerosis
Thickened skin with Raynaud’s phenomenon Dermal fibrosis, cutaneous calcinosis and telangiectasia Skin changes may be limited or diffuse
29
What is overlap syndrome
When features of more than 1 connective tissue disorder are present e.g. SLE and inflammatory muscle disease we can use the term overlap syndrome
30
investigation findings inflammatory muscle disease
elevated CPK abnormal electromyography abnormal muscle biopsy
31
manifestations of diffuse systemic sclerosis
Fibrotic skin proximal to elbows or knees (excluding face and neck) Anti-topoisomerase-I (Anti-Scl-70) antibodies. Pulmonary fibrosis, renal (thrombotic microangiopathy) involvement. Short history of Raynaud’s phenomenon
32
manifestations of limited systemic sclerosis
Fibrotic skin hands, forearms, feet, neck and face Anti-centromere antibodies Pulmonary hypertension Long history of Raynaud’s phenomenon
33
Which antibodies are associated with CREST and limited systemic sclerosis
Anti-centromere antibodies
34
CREST
sub-type of limited systemic sclerosis: | Calcinosis, Raynaud’s phenomenon, Oesophageal dysmotility, Sclerodactyly, Telangiectasia
35
autoantibodies are associated with polymyositis
Anti-tRNA transferase
36
auto-antibody is associated with mixed connective tissue disorder
Anti-U1 RNP antibody
37
auto-antibody is associated with diffuse systemic sclerosis
Anti-Scl-70
38
anti nuclear antibodies
seen in all SLE | not specific for SLE
39
anti double stranded DNA antibodies
specific for SLE | levels indicate disease activity
40
anti phospholipid antibodies
associated with risk of arterial and venous thrombosis in SLE can occur without SLE - primary antiphospholipid antibody syndrome
41
investigations for synovitis
ultrasound - thickening, increased blood flow
42
treatment of rheumatoid arthritis
``` steroids short term for the inflammation DMARDs - methotrexate and hydrochloriquine if DMARDs dont work: anti TNFa, anti IL-6, B cell biologic JaK inhibitors ```
43
clinical signs for checking for psoriatic arthritis
nail signs - pitting, thickening under nail, oncholysis (separation)