[CLMD] Clinical Serology and Lab Testing [Johnston]

Question 1

ESR is a good marker for monitoring disease activity, especially in what 2 conditions?

Answer 1

Polymyalgia rheumatica and Giant Cell arteritis

Question 2

Between ESR and CRP, which rises and falls quicker?

Answer 2

CRP

Question 3

A CRP >____ mg/L is inflammatory

Answer 3

>8 mg/L

Question 4

In which type of RA will rheumatoid factor (RF) be present 100% of the time?

Answer 4

“Nodular” RA

Question 5

Rheumatoid Factor (RF) can positive in which conditions?

Answer 5

• Healthy pt’s and pt’s >60 y/o
• Sjogrens syndrome and SLE
• Sarcoidosis, malignancy, and lung disease
• Cryoglobulinemia
• Primary biliary cirrhosis
• Mixed CT diseases

Question 6

How does the the levels of Rheumatoid Factor (RF) correlate with a disease process?

Answer 6

High levels associated with aggressive dz, joint erosions, and worse prognosis

Question 7

Which markers, if positive, have a 99.5% specificity for RA?

Answer 7

Anti-CCP + RF (+)

Question 8

Anti-DS DNA antibody is seen in 50% of what?

Answer 8

SLE

Question 9

What are 4 hematologic (CBC) indicators of SLE?

Answer 9

• Hemolytic anemia w/ reitculocytosis

or

• Leukopenia (<4000/mm³ total)

or

• Lymphopenia (<1500/mm³ total) on 2+ occasions

or

• Thrombocytopenia (<100,000/mm³)

Question 10

What are ASO and anti DNAase B titers helpful in identifying?

Answer 10

Post-streptococcal reactive arthritis

Question 11

What is a hallmark feature of uric acid crystals?

Answer 11

Negative birefringent by polarized light microscopy

Question 12

What are the treatments for acute gout?

Answer 12

NSAIDS

Colchicine

Steroids

Question 13

Which imaging modality is sensitive for soft tissue abnormalities (synovitis, tendonitis, bursitis) and erosions; can also be used to aid in injecting/aspirating a joint?

Answer 13

Ultrasonography

Question 14

Which imaging modality is most sensitive for detecting bone erosions?

Answer 14

CT

Question 15

Which imaging modalty is the best for bony abnormalities (trabecular, cortical bone), erosions, fractures, degenerative or inflammatory arthritis?

Answer 15

CT

Question 16

What are 2 arthritic complications associated with Diabetes?

Answer 16

• Charcot’s
• Cheiroarthropathy

Question 17

What is MRI good for and what is one of the cons to using it?

Answer 17

• Useful for soft tissue abnormalities
• Good for spine, SI, synovitis, tenosynovitis, erosions, joint inflammation
• Gadolinium contrast taken up in inflammed synovium –> can cause nephrogenic systemic fibrosis in pt’s with kidney disease

Question 18

Number of joints involved:

Mono =

Oligo=

Pauci=

Poly=

Answer 18

Mono = Arthritis

Oligo= 3 or <

Pauci= 5 or <

Poly= >6

Question 19

What is the joint distributio for RA?

Answer 19

Question 20

What is the joint distribution for OA?

Answer 20

Question 21

Name the RA deformities

Answer 21

(Left) = Swan neck

(Right) = Boutonniere

Question 22

What are the endocrine comorbitities associated with diabetes?

Answer 22

Charcot’s

Cheiroarthropathy

Question 23

What are the endocrine comorbitities associated with thyroid?

Answer 23

Carpal/Tarsal Tunnel Syndrome

Question 24

What are the opthalmologic comorbitities associated with arthritis?

Answer 24

Retinopathies:

• Cytoid bodies
• Vasculitis