Estras Flashcards
Which vasculitides have granulomas
GCA
Takayasu
Wegners
Churg strauss
purpura in vasculitis points to
medium vessel
predom cell infiltrate in GCA is
CD4 positive T cells!!!!
Purpura on legs and no renal involvement
leukocytoclastic vasculitis from drugs often eg diuretics, penicillins
In GCA how treat
steroids
and ASPIRIN FOR ALL!!!
How do ANCA cause disease
Cause neutrophil self activation via Kurlander phenomenon
Prevents alpha 1 AT mopping up PR3
ACtivate endothelium
Link between alpha 1 AT and wegners
Normally alpha 1 will inhibit PR3- if not enought then uninhibited
Why IV over oral cyclo
less toxic
more likely to relapse but no survival difference
CF and ANCA
90% positive
correlates with vasculitic phenom, worse lung disease, pseudomonas
specific ank spond back pain
alternating buttock pain
wake in second half of night
what is mecahnism of dactylitis
inflamed FLEXOR TENDON SHEATH of digit
Episcleritis vs uveitis
epi- painless, localised redness over bit of white, blanche vessels with phenyephrine
uveitis- painful, whole eye red, photophobia, blurred vision
Skin in seroneg
keratoderma blennorhagicum- gross skin peeling soles
circumnate balanitis
sI joint grading
0-none 1-suspicious early 2-joint space narrowing with sclerosis minor 3. joint space widening 4 advanced alkylosis
Multip with bilateral areas of dense sclerosis on iliac side of SI joint bottom wihtout actual joint change
osteitis condensans ilii
On MRI, what do the ank spond bits look like
bone oedema looks white on STIR- TNF alphas reverse this
On T1 look black
what is best for structural changes in ank spond
X ray and CT more sens than MRI
ddx syndesmophytes in a man over 30 with diabetes on HLA negative
DISH diffuse isiopathic skeletal hyperostosis ossification of the ALL treat with simple analgesia and NSAIDS osteophytes come out of the sides, actual corners are clear
If young person with inflamm back pain and HLAB27 positive then how many have ank spond
1/3
If dad is known HLA b27 pos with AS, what is risk of child getting it?
50% chance will pass to child
20% chance if get that will develop
So actually only 10%
strongest predictor of worse outcome in AS
hip arthritis’
also smoking young at onset poor supports no NSAID response dactylitis, oligoarthtiris
In AS what is the first objective sign spine involvement
reduced lateral spine flexion
Are NSAIDS disease modifying in AS
yes, both axial and peripheral- better if take regularly and in comb with PT
TNF next line for axial disease if not enough NSAID response - no evidence that slow rad progression though, but improve spinal mobility, QOL, function
NOT DMARDS for axial
Peripheral disease local CS or TNF alpha blockers or sulfasalazine
EA features of AS- what works?
No NSAID effect, but TNF good (dont use ertanacept in IBD)
