A/43

Question 1

2 characteristics of SLE

Answer 1

• multisystem disorder

- remitting/relapsing disease : ondulant

Question 2

What type of autoantibodies can you find in SLE? (3)

Answer 2

• Antinuclear antibodies
• Antibodies to blood cells
• Antibodies to phospholipids

Question 3

What is the anti-smith antibody?

Answer 3

auti-antibody against double strand DNA, found specifically in SLE

Question 4

How do we detect ANA in lupus?

Answer 4

immunofluorescence test - different patterns depending on which region of the cell is affected

Question 5

Limitations of testing for ANA (2)

Answer 5

• low specificity : other autoimmune disorders can also be positive
• 5-15% old healthy people can be positive too

Question 6

Incidence of SLE (3)

Answer 6

• 1/250 people prevalence
• 9:1 female / male ratio
• Disease of the 30s

Question 7

What do the antibodies to phospholipids affect in SLE?

Answer 7

blood clotting : patients more prone to venous thrombus and thrombocytopenia

Question 8

Pathomechanisms of SLE (3)

Answer 8

• Type 3 HS : DNA/antiDNA complexes
• Type 2 HS : antibodies to RBC, platelets
• Antibodies to clotting system

Question 9

Genetic factors of SLE pathogenesis (4)

Answer 9

• familiar accumulation
• HLA-DR2 and HLA-DR3 are the most prone
• Genetic deffect of C1q, C2, C4
• Deffective clearance of immune complexes

Question 10

Most affected systems by SLE (7)

Answer 10

1. Vessels
2. Skin
3. Joints
4. Kidney
5. Heart
6. Serosal membranes
7. CNS

Question 11

Morphology of SLE on the vessels

Answer 11

Acute necrotizing vasculitis of small arteries and arterioles

Question 12

Morphology of SLE on the skin (2)

Answer 12

• Butterfly erythema

- Maculopapular eruption

Question 13

Morphology of SLE on kidney (2)

Answer 13

• Endothelial, mesangial, epithelial proliferation caused by inflammation
• Glomerulonephritis due to IC deposits

Question 14

Morphology of SLE on heart (2)

Answer 14

• Libmen-Sacks endocarditis

- AS

Question 15

Morphology of SLE on CNS (2)

Answer 15

• Cerebral microinfarcts

- Neurologic / psychiatric manifestations

Question 16

SLE therapy

Answer 16

immunosuppression, steroids

Question 17

Incidence of RA (2)

Answer 17

• Peak incidence 40-50 years

- 5:1 female / male ratio

Question 18

What type of auto-antibodies in RA?

Answer 18

anti-citrullinated protein antibodies (ACPA)

Question 19

What is rheuma factor?

Answer 19

IgM/A autoantibodies against Fc receptor of IgG

Question 20

What does rheumatoid arthritis mostly cause? (2)

Answer 20

• Non suppurative, proliferative, symmetric synovitis of small joints
• Destruction of articular surface

Question 21

Factors that affect incidence of RA? (2)

Answer 21

• Genetic factors : HLA-DR4 allele

- Environmental triggers

Question 22

Pathomechanism of RA? (3)

Answer 22

• CD4 is activated by binding MHCII
• CD4 induces macrophages to release cytokines
• Cytokines induce MMP, RANKL, RF production and proliferation of fibroblasts and synovia

Question 23

What do MMPs do?

Answer 23

Destroy tissue

Question 24

What does RANKL do?

Answer 24

Osteoblast proliferation, which leads to bone destruction

Question 25

2 types of joint issues caused by RA

Answer 25

• pannus

- ankylosis

Question 26

What is pannus in RA?

Answer 26

hypertrophy of synovia, inflammatory cells, granulation tissue

Question 27

What is Ankylosis in RA?

Answer 27

Bony bridge on articular surface, fibrous deformity of the joint

Question 28

Other organ effects of RA (3)

Answer 28

• Subcutaneous rheumatoid nodules
• Acute necrotizing vasculitis
• Lung fibrosis

Question 29

What is Reynaud’s phenomenon?

Answer 29

Hyperreactivity to cold due to vascular involvement of RA