CT disorders and autoimmune disease

Question 1

RA: ethiopathogenesis

Answer 1

Chronic inflammatory autoimmune disease involving synovium of joints. Symmetric arthritis with unkown etiology. Usual onset: 20-40 yrs and

Question 2

RA clinical picture

Answer 2

Morning stiffness >1 h, improves with use. Symmetric joint involvement. Constitutional symptoms. Initially involves small joints of hand and feet. MCP; PIP, wrist, ankles, elbow, hips, shoulder. Can have cardiac and pulmonary involvement. anemia, vasculitis. cervical spine instability. development of pannus. subcutaneous rheumoatoid nodules over extensor surfaces.

Question 3

Characteristic hand deformities

Answer 3

Ulnar deviation of the MCP joints, boutonniere deformeties of PIP joints, swan-neck contractures of the finger.

Question 4

diagnosis of RA

Answer 4

three or more joint involvement. > 6 w, morning stiffness > 1 , increased CRP and ESR. + RF and ACPA- Radiographic changes. symmetrical involvement

Question 5

Treatment. RA

Answer 5

Methotraxate(gold standard, first line tx, slow onset of action = 8-12W). NSAIS, steroids, +- biologic (retuximab)

Question 6

RA diff dx

Answer 6

psoriatic arthritis, SLE, sjøgrens, osteoarthritis, myelodysplastic syndrome, Lyme disease, fibromyalgia, polychondritis.

Question 7

Detection of antibodies:

Answer 7

indirect immunofluoresence, radial immunodiffusion, ELISA, immunoblotting

Question 8

SLE def:

Answer 8

SLE is a chronic autoimmune disease that can affect almost any organ system; thus, its presentation and course are highly variable. Most commonly affect women during their reproductive years. follow as relapsing and remitting course.

Question 9

ssx of sle

Answer 9

SOAP BRAIN MD: Serositits, Oral ulcer, Arthritis(nonerosive), Photosensitivity, Blood (pancytopenia), Renal (proteinuria), ANCA, Immunologic (Anti ds-DNA, anti Sm, APS), Neurologic (psyhosis, seizures) Malar rash, Discoid rash

Question 10

drug induced lupus

Answer 10

anti histone ab, similar to lupus but no renal or CNS involvement. Drugs: procainamide, isoniazid, methyldopa, chlorpromazine.

Question 11

Tx of lupus

Answer 11

NSAID, avoid sun, steroids (when having an acute flare or for severe manifestations), azathioprine, cyclophosphamide(for active glomerulonephritis. Antimalarial drugs; best long term therapy.

Question 12

autoantibodies in sle

Answer 12

ANA, anti-ds DNA, anti-sm ab- may also have RO og LA.

Question 13

autoantibodies in drug induced lupus

Answer 13

antihistone ab

Question 14

autoantibodies in scleroderma limited

Answer 14

anticentromere ab

Question 15

autoantibodies in sleroderma diffuse

Answer 15

antitopoisomerase I/anti-scl 70

Question 16

autoantibodies in sjøgrens

Answer 16

ANA, RF, RO LA

Question 17

autoantibodies in RA

Answer 17

RF and ACPA

Question 18

autoantibodies in churg-strauss syndrome

Answer 18

P ANCA

Question 19

autoantibodies in Wegeners granulomatosis

Answer 19

C ANCA

Question 20

autoantibodies in PAN

Answer 20

P ANCA

Question 21

Autoimmune hepatitis

Answer 21

ANA, ASMA (type 1), ALKM-1 and ALC-1 (type 2)

Question 22

autoantibodies in primary biliary cirrhosis

Answer 22

AMA (antimitochondrial ab)