Clinical conditions 2 Flashcards
Describe the pathophysiology of SLE.
i. Inefficient removal of apoptotic bodies by phagocytosis… nuclear self-Ag (DNA and histones) are transferred to lymphoid tissue and taken up by APCs…
ii. activation of TH cells and B cells… production of anti-dsDNA, anti-SM and anti-phospholipid Abs…
iii. form circulating ICs or deposit into tissues…
iv. activation of complement and neutrophil influx… inflammation and tissue damage.
Suggest signs and symptoms of SLE.
Skin (85%):
- malar rash
- photosensitivity
- urticaria
- purpura
Joints (90%):
- small joint arthritis
General:
- fever
- fatigue
- weight loss
- depression
Blood (75%):
- anaemia (can be Coombs +ve)
- thrombocytopenia
- leucopenia
Heart (25%):
- pericarditis
- endocarditis
- aortic valve lesions
Nervous system (60%):
- seizures
- CN lesions
- demyelinating syndromes
Which features might be seen in the blood test of a person with SLE?
- presence of anti-nuclear Abs, e.g. anti-dsDNA, anto-SM, anti-phospholipid Abs
- decreased Hb, WBC and platelets
- decreased C2, C3 and C4W
Describe 3 points for the management of SLE.
- P education: lifestyle modification, e.g. use of sunscreen
- Anti-inflammatory drugs, e.g. prednisolone
- DMARDs, e.g. azathioprine or mAbs, e.g. rituximab
Describe the pathophysiology of RA.
i. T3 & T4HS involving production of rheumatoid factor Ab against Fc portion of IgG, +/- anti-citrullinated peptide Ab…
ii. deposition of IC into joint synovial membrane… activation of complement and inflammation…
iii. lymphocyte recruitment… B and TH cells activate macrophages… TNFa production… joint destruction and production of further cytokines, e.g. IL-6
Suggest signs and symptoms of RA.
Joints:
- pain, stiffness and swelling of small joints that is worse in the morning and better with activity
Lungs:
- nodules
- interstitial lung disease
Heart:
- pericarditis
General:
- dever
- fatigue
- weight loss
Other:
- dry eyes and mouth
- rheumatoid bursitis/nodules
- splenomegaly
- tendon sheath swelling and carpal tunnel syndrome
Which features might be seen in the blood test of a person with RA?
- presence of rheumatoid factor and/or ACPA
- increased CRP
- often anaemia
Describe 5 X-ray features typical of RA.
- loss of joint space
- swelling of soft tissues
- marginal erosions
- juxta-articular osteoporosis (later generalised)
- subluxation and gross deformity (late/severe disease)
Name 4 drugs that could be used in the management of RA.
- Corticosteroids, e.g. prednisolone
- Methotrexate (1st line)
- Anti-TNFa mAbs, e.g. inflixmab, etanercept
- Rituximab (anti-CD20 on B cells causing B cells apoptosis)
