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Clin Lab Med II > CLM rheum > Flashcards

CLM rheum Flashcards

1
Q

S/sx of rheumatic disease (think Systemic)

A
  • Arthralgias, myalgias,
  • Fatigue, generalized weakness,
  • HA, Fever, Wt change, easy bruising
  • Depression, sleep disturbance, GI,
  • Facial and skin features,
  • Hair loss, fetal loss
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2
Q

Ddx Rheumatic disease: Polyarthralgia

A
  • RA, OA, fibromyalgia
  • Gout and Pseudogout, SLE
  • Polymyositis, polymyalgia rheumatica
  • Polyarteritis nodosa, Malignancy
  • Sacoirdosis, MCtD
  • Sjogrens, ankylosing spondylitis
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3
Q

Ddx Rheumatic Disease: Fatigue

A
  • Depression, DM, Malignancy
  • Med SE, Anemia, Hypothyroidism
  • HyperCa, HIV, HF, COPD
  • Connective Tisse dz/Rheum dz
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4
Q

Approach to pt with suspected Rheum disease

A
  1. Thorough Hx
  2. Complete PE
  3. Serologic studies to SUPPORT (caution in ordering “rheum panel” – false + and needless pt anxiety)
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5
Q

What are the Lab tests in rheumatology

A
  1. ESR
  2. CRP
  3. RF
  4. Anti-CCP
  5. ANA
  6. Anti dsDNA
  7. Anti ssDNA
  8. Anti-smith antibodies
  9. Antiphospholipids: Anticardoplipin antibodies and Lupus anticoagulants
  10. ANA subtypes:
    - Anti SS-A (anti-Ro)
    - Anti SS-B (anti-La)
    - Anti SS-C
  11. Human Leukocyte antigen B27 (HLAB27)
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6
Q

Antibodies + in SLE

A

ANA (most sensitive screen), SLE prep, dsDNA (most specific), ssDNA, anti-DNP, SS-A

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7
Q

Antibodies + in drug induced SLE

A

Anti histone

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8
Q

Sjogren syndrome antibodies

A

RF, ANA, SS-A, SS-B

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9
Q

MCTD antibodies

A

ANA, RNP, RF, ssDNA

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10
Q

RA antibodies

A

RF, ANA, RANA, RAP

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11
Q

Primary biliary cirrhosis antibodies

A

AMA

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12
Q

Thyroiditis antibodies

A

Antimicrosomal antihyroglobulin

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13
Q

Chronic active hepatitis antibodies

A

ASMA

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14
Q

Scleroderma Antibodies

A

ANA, Scl-70, RNA, dsDNA

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15
Q

Non specific inflammatory marker tests

A

ESR, CRP

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16
Q

What is ESR

A
  • Measure of distance RBC fall in column over 1 hr; elevated in inflammation, infection, necrosis, neoplasia
  • These increase PRO content of plasma RBCs stack up and settle to bottom faster
  • ESR considered “inflammatory marker”
17
Q

What is CRP

A
  • Non Specific “acute phase reactant” PRO
  • Detects inflam d/o, bacterial infections, tissue necrosis
  • Synthesized in liver during inflammatory process
  • More sensitive and rapidly responding than CRP
  • High sensitivity CRP may be marker for CAD –inflammatory plaques (high risk >3 mg/dL)
18
Q

What is the best screening test for SLE, who should be screened, and what results suggest SLE?

A

• ANA, + in almost all SLE, but can be + in others (Scleroderma, Sjogrens, RA, fibromyalgia)
• Test for ANA only if ACR criteria: >2 unexplained s/sx
• ANA neg SLE requires rheumatologist
• + results reported in titer AND nuclear staining pattern (reflects intracellular target of ANA)
o Stain: *Homogenous, **Rim and Speckled = SLE
o Higher titer = higher likelihood of SLE (>1:320)

19
Q

What is the most specific test for SLE and how does it reflect disease activity

A
  • Anti dsDNA: 97% specific, 60% sensitive for SLE
  • Found in low freq in other rheum diseases
  • Fluctuates with disease activity: titers rise with flares can help monitor disease activity - Lupus nephritis
20
Q

How does anti ssDNA relate to SLE

A
  • Anti ssDNA is derived from kidneys of pt with lupus nephritis, less specific than anti dsDNA, also found in RA, drug related lupus and other rheum dz
  • Limited usefulness in dx of SLE
21
Q

What antibody is specific for SLE, only found in 20-30% of pt, and may be used dx when DNA tests are undetectable

A

• Anti smith antigen

22
Q

What are antiphospholipid antibodies? What are associated risks? Antiphospholipid syndrome?

A

• Anticardiolipin antibody & Lupus anticoagulant (not assoc with bleeding tendencies) – replaced +LE prep
• You can test + for one and not the other or + for one or both and not have SLE
• 40% SLE pt have antiphospholpid antibodies risk for thrombosis, abortions, neuropsych disorders, thrombocytopenia
• ANTIPHOSPHOLIPID ANTIBODY SYNDROME: thrombosis + miscarriage + thrombocytopenia
o These pt do not necessarily have SLE
o Eval all pt with recent unexplained CVA, MI or miscarriage

23
Q

What antibodies are present in drug induced SLE? What drugs can be the cause?

A
  • Anti-histone antibodies + (anti dsDNA and antiSm antibodies are negative)
  • Drugs: HIP! Hydralazine, isoniazid, Procainamide, methyldopa, quinidine, chlorpromazine etc
  • Suspect if pt on these drugs causes arthralgias, myalgias, rash, fever, serositis
24
Q

How should we manage pt with SLE

A

• ACR recommends: PCP to consult rheumatologist if you suspect characteristic SLE or seronegative disease

25
Q

Physical/lab findings associated with RA

A
  • Swan Neck deformity, Boutonniere

* +RA, +anti CCP, elevated ESR and CRP

26
Q

What is Rheumatoid Factor useful for? Not useful for?

A

• Present in about 80% of pt with RA
• Can be + in pt with SJogren’s cryoglobulinemia, MCTD and some infectious dz
• Most useful when dx of RA is suspected:
o Clinical suspicion is low, then test is unlikely to be helpful, high incidence of false + in general population
• Not useful for following progression of disease
• 20% of pt with RA are seroneg, 40% may be seroneg early

27
Q

RF titer of what is considered +? Overall summary points of RF include?

A
  • titer >1:80 = +RF
  • poor screening test, only order if high index of suspicion for RA (higher titer = higher prognostic value)
  • Remember seronegative RA is possible
  • 66% sensitive and 82% specific
28
Q

What is anti-CCP useful for

A
  • Useful in dx of RA; very specific, rarely + in other dz
  • Especially useful when RF is negative
  • Pt with early RA may be seronegative (ie neg RF) but if anti CCP is elevated, dx of RA likely
  • 67% sensitive, 99% specific
29
Q

What is Sjogren’s syndrome

A

• Autoimmune disorder
• Chronic dysfunction of exocrine glands
o dry eye, mouth, mucous membrane
o Keratoconjunctivtiis sicca: inadequate tear production; lymphocytic and plasma cell infiltration of Lacrimal glands
• Assoc w/ ofther rheum conditions (ie have RA and sjog)
• Female to male 9:1

30
Q

What are lab findings associated with Sjogrens disease

A
  • CBC: mild anemia, leukopenia, eosinophelia
  • Polyclonal Hypergammaglobulinemia
  • +RF (70%)
  • +ANA (95%)
    • Schirmer test – measure quantity of tears
  • Lip biopsy
  • Salivary Gland Biopsy – only for atypical pt, lymphoid foci = + for Sjogren
31
Q

Anti SS-A aka?
Anti SS-B aka?
Anti SSC?
What are they associated with?

A
  • Anti SSA = Ro
  • Anti SSB = La
  • Anti SSC, just that
  • These are subtypes of ANA
  • Ro and La strongly associated with SJOGRENS (70-95%)
  • Ro and La = SPECKLED immunofluorescent pattern
  • +RO and +La = CONFIRMATORY for Sjogren
  • Anti SSC + in 75% of pt with RA who have secondary Sjogren SSC differentiate primary from secondary sjogrens
32
Q

What findings are associated with secondary Sjogren (ie secondary to RA)

A

• +Anti SSC

33
Q

Buzz words for Sjogrens (primary)

A

• Ro, La, Speckled pattern, schirmer test, lip biopsy, salivary gland biopsy, lymphoid foci

34
Q

What is Anti SSC useful for

A

• Differentiating Primary from secondary Sjogrens

35
Q

What are the usual sx (suggested diagnostic criteria) of polymyalgia Rheumatica

A

• >50yo
• Bilateral aching and morning stiffness x1mth and involving at least 2/3 areas: neck or torso, shoulder or proximal arms, hips or proximal thighs (shoulder girdle, hip girdle)
• ESR >40
Associated with Temporal Arteritis (risk for vascular problems, blindness)
Both characterized by elevated ESR

36
Q

What helps indicate risk for Ankylosing spondylitis? And when is testing for that useful?

A
  • HLA-B27: Antigen that indicates risk for spondyloarthropathies
  • Occurs in >90% ankylosing spondylitis
  • Occurs in 80% pt with Reiters syndrome
  • Also seen in psoriatic arthritis and IBD associated arthritis
  • THUS testing only useful when ankylosing spondylitis strongly suspected (may also see elevated ESR)

Clin Lab Med II (3 decks)

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