immuno tests Flashcards
causes of increased ESR
infection malignancy inflammatory dz trauma ischemia
causes of falsely elevated ESR
abnl RBC- PV, spherocytosis, sickle cell
increased WBC
HF
tech errors- clotting oof blood, delay, room temp
CRP characterstics compared to ESR
produced by liver
increases and decreases faster than ESR
RA tests and their level of sensitivity/specificty
RF - sensitive
CCP/ACPA: specific, bag prognosis
RF positive also for
other autoimmune dz
inflamm (hep B, C, TB)
nl in age>60, 5-25%
ANA tested in symptomatic or asx patient?
symptomtic
ANA reported how
titer
greater the denominator, the stronger the dx
be suspicious with ANA> 1/160
positive ANA if
family member with AI disease
female
drugs (hydralazine, monocycline, TNF in)
recent virus
dsDNA
lupus
glomerulonephritis
anti-smith
specific
lupus
anti-RNP
mixed connective tissue disease
lupus
anti-SSA (Ro) and SSB (la)
sjogren
lupus
photosensitive
neonatal lupus- heart block
antiphospholipid antibodies types
anti- cardiolipin: nonspecific
anti beta GP1: specific
lupus anticoagulant- inc APTT
elevated or decreased C3 causes
decreased: used up in active disease or cirrhosis (made in liver)
elevated: infection
scleroderma antibodies
anti-centromere- CREST
–> pulm HTN
anti topo I- severe
–> ILD
anti-RNA pol III
–> renal crisis
myositis antibodies
HMG coA reducatase
p155/140 - paraneoplastic
anti-tRNA synthetase (anti jo1 ) anitobodies for which dz’s
muscle disease
ILD
what % of PMN’s in synovial fluid analysis is indicative of increased risk of septic arthritis?
> 75%
rheum joint diseases that can affect 1 joint
trauma hemarthrosis spondyloarthropathy septic arthritis crystal
rheum joint diseases that are oligoarticular
spondyloarthropathy
crystal
infection related
rheum joint diseases that are polyarticular
RLA
SLE
crystal
infectious
OA most commonly affects which joints
hands- PIP, DIP feet- big toe hips AC joint facet joints of cervical and lumbosacral
RA affects which joints
wrist, MCP PIP
swan neck, boutonniere
RA vs OA which ulnar vs radial deviated
RA- ulnar
OA- radial
extra- RA manifestation
ILD
vaculitis
scleritis
risk of CAD
is there kidney involvement in RA?
no! think lupus if there is
short term vs long term treatment of RA
short: prednisone
long: NSAIDS, DMARDs (methotrexate), biologics, hydroxychloroquine
treatment for seroneg spondyloarthropathy
similar to RA
except no hydroxychloroquine!!
humera good
TNF alpha inhibitors are mainstay
short term vs long term treatment for gout
short: NSAIDs, colchicine, steroids
long: allopurinol, feboxustat, probenicid
pseudogout treatment
acute: NSAIDs, colchicine, steroids
long term: methotrexate in refractory cases
how should you alter long term allopurinol during gout attack
DONT CHANGE DOSE
what does malar rash spare
nasolabial fold
SLE sxs
SOAP BRAIN MD
serositis
Oral ulcers
Arthritis
Photosensitive
Blood disorder Renal disorder ANA Immune abnl Neuro sxs (HA, seizure, MDD, psychosis)
Malar rash
Discoid rash
what can improve survival in SLE mild dz?
hydroxychloroquine
mod-severe dz treatment of SLE
azathioprine
mycophenolate mofetil
rituximab
cyclophosphamide
short term treatment of SLE
prednisone
CREST syn
calicnosis raynauds Esophageal dysmotility Scelrodactyly Telengiecasias
raynauds is painful in which phase
red
lung involvement in scleroderma
limited: pulm HTN
diffuse: ILD
what to treat scleroderma renal crisis
ACEI
NOT PREDNISONE!!
how to best treat scleorderma
treat each symptom ( eg. CCB for raynauds)
is temporal pulse dec or inc in giant cell arteritis
decreased
treatment for large vessel vasculitis
high dose steroids
shawl sign, heliotrope rash, mechanic’s hands seen in which disease
dermatomyositis
diagnosis of myositis
biopsy
be suspicious in elevated muscle enzymes and proximal muscle weakness
extra-muscle involvement in myositis
ILD
malignancy: breast, ovarian, adeno
