BPT Rheumatology Flashcards
Anti-ribosomal P antibody association
Present in minority of patients with SLE, but highly specific
Anti-fillagrin antibody associations
Another name for anti-CCP - rheumatoid arthritis, 90% specificity, 70% sensitivity
Predictors of erosive disease in rheumatoid arthritis
- Erosions at baseline
- Sustained raised inflammatory markers
- High number of swollen, tender joints
- High titre RF and anti-CCP
Novel therapeutics: abatacept
CTLA4 linked to IgG, interrupts CD28 and B7 costimulation, preventing T-cell activation by APCs.
Used in RA in MTX-resistant disease, reducing clinical and radiographic progression.
Novel therapeutics: tocilizumab
IL-6 receptor antagonist, reduces acute inflammation and cytokine release, osteoclastic activity.
Used in RA
Side effects: reversible cytopaenias, dyslipidaemia, abnormal LFTs
Novel therapeutics: tofacitinib
Oral JAK1/3 inhibitor, blocks DNA signalling via STAT impeding cytokine release.
Novel agent being used in MTX-resistant RA
Side effects: neutropenia, abnormal LFTs
Novel therapeutics: anakinra
IL-1 receptor antagonist
Limited use in RA - modest effect only
Cannot be combined with TNF inhibitors due to risk of serious infections.
Rheumatoid factor
Positive in 70-90% of RA, also in up to 95% Sjogren’s, 40-100% cryoglobulinaemia, 15-35% SLE, 20-75% HBV/HCV.
Indicates a worse prognosis in RA, more severe joint disease, higher risk of rheumatoid nodules, vasculitis.
Anti-CCP
90% specificity for RA, 70% sensitivity.
Predictive of RA in asymptomatic patients or in early, undifferentiated arthritis.
Marker of severe erosive disease, but not useful for monitoring disease activity.
Rheumatoid arthritis in pregnancy
- Disease tends to improve during pregnancy
- Contraindicated: MTX, leflunomide (requires cholestyramide washout)
- “Safer”: azathioprine, hydroxychloroquine, sulfasalazine, steroids
anti-U1 RNP (ribonucleoprotein)
Mixed connective tissue disease
Typically only other raised marker is RF and C3/C4 are reduced
Anti-Ro, anti-La
Associated with Sjogren’s syndrome - longer disease duration, more severe lymphocytic infiltrate, extraglandular manifestations.
Anti-Ro positivity in pregnancy associated with risk of congenital complete heart block.
Anti-Jo
Polymyositis (anti-synethetase syndrome)
- Myositis and/or ILD and/or chronic articular involvement
- Mechanic’s hands, Raynaud’s
Anti-histone antibody
Present in >95% drug-induced lupus and 50-70% SLE
Anti-Smith (anti-Sm) antibody
Present in 20% of SLE but the most specific autoantibody. Does not correlate with disease activity.
Markers of disease activity in SLE
Anti-dsDNA; C3/C4 levels ESR less specific
Definition of catastrophic antiphospholipid syndrome
- APLS
- 3+ organ / tissue thromboses within a week
- Occurs in
Anti-Mi2 antibody
Dermatomyositis
Anti-SRP antibody
Polymyositis, associated with more severe disease
Features of psoriatic arthritis on clinical findings and X-ray
More destructive if older onset. Not as strongly linked to HLABR27
RF neg Symmetrical: similar to RA but DIP involved Osteolitis mutilans: osteolysis, joint disolution, pencil in cup, digit telescoping Spondylitis Psoriasis Achilles tendinitis Finger dactylis Nails: beau lines, onychilitis, pitting
Systemic sclerosis antibodies
- ANA
- Scl70/topoisomerase1: risk pul fibrosis, poor prognosis
- Anti RNA polymerase: Dx activity, increased skin involvement/renal crisis
- Anti Th/To: poor prognosis
CREST
Anti centromere: specificity 95%
Arteries involved in PMR/GCA
Ophthalmic Post ciliary Occipital Vertebral Carotid Temporal artery
Treatment of
- RA
- SLE
- ank spondylitis
- psoriasis
- reactive arthritis
- RA: DMARDs
- SLE: hydroxychloroquine
- AS: sulfasalazine (if IBD) adalimumab PO, etanercept IV
- Ps: MTX, ustekinumab
- Reactive: tx chlamydia, NSAIDs, topical steroids
Ustekinumab
Psoriatic arthritis
Anti IL 12 and 23
Scleroderma
Anti centromere
(limited)
Anti Scl, Anti topoisomerase
(diffuse)
SLE
ANA
Smith
dsDNA
Ribosomal p (10%, very specific)
What conditions are RF positive
RA
Sjogren
Cryoglobulinemia
