Intro to Rheum Flashcards
rheumatology encompasses….
Define
arthritis
arthralgia
rhumatism
monoarthritis
oligoarthrisit
polyarthritis
Emcompasses
- MSK
- systemic autoimmune conditions of eyes, skin, nervous system, organs
- vasculitis
- connective tissue disease
Define
Arthritis: Joint inflammation
arthraliga: joint pain
rhumatism: any disease with pain OR infammation of joint, muslce or connective tissue
monoarthritis: 1 joint
oligoarthrisit: 2-4 joints
plyarthritis: 5+ joints
Genetic Risk Factors
MArfans (autosomal dominant)
Ehlers-Danlos (many modes)
HLA (human leukoycte antigen)
- groupe of genes on chromosome 6
- play a big role in immune system function
Diagnostics of Rheum.
Arthrocentesis & Fluid Analysis
Arthrocentesis
- joint fluid evaluation
- looking for inflammation (crystals?) , non–inflammatory or septic
Contraindcations
- overlying cllulits or psoriaisi (skin issues)
- INR > 3 = bleed risk
Fluid Analysis
Bloody Fluid
- a bleeding disorder
- trauma
- tramatic tap
- benign hematoma
Crystal analysis (via polarized light microscopy)
- negative birefringent crystals = monosodium urate = GOUT
- postive birefringent crystals = calcium pyrophosphate = PSEUDOGOUT
Inflammatory
- 2000-75,000 WBCs with > 50% PMN
Purulent
- > 100,000 WBC with > 75% PMNs
- + culutres
ESR v CRP
ESR: sedimentation rate
- an indirect measure of inflammation
- wont be positive in non-inflammatory diseases
- slow to rise and fall
- its measureing the distance the RBCs fall voer a given amount of time in the blood sample
- they will fall fast (hence higher ESR) if there are more antibodies on the RBC: less repulsion of the RBCs from each other, able to fall quicker
High ESR: age, pregnancy, anemia, obesity, kideny disease, cancer
very high = infection, cancer or vasculitis
CRP: C reactive Protein
- direct measure of inflammation
- a protein produced by the liver: part of the innate immune system
- rises and falls faster thatn ESR
- it correlates with disease activity!! and thus it correlates with thearpy!
- negatve test can rule out adult inflammation
Normal Immunity v Autoimmunity
- normal immune system will recognize itself (good thing)
- auto-immunity = antibodies which recognized self antigens (still ok)
autoimmune disease: is when the body’s autoantibodies directly react to their antigens; causing pathology
ANA
antinuclear antibodies
- reported as a titer
- some healthy people can have + ANA
- a NEGATIVE ANA can rule out some disease states
what will have + ANA
- drug induced lupus = + (hydralazine, procanamide, isonizaid)
- SLE = 98-100% will = +
- mixed connective tissue disease
- scleroderma
- sjorgen
- dermatomyositis/polymyositis
- RA
anti-dsDNA
- a subtype of ANA
- very specific for SLE especially with renal disease involvement
- but not for allll lupus pt. but for the renal diseae pt.
anti-smith ANA
- these are anti-bodies against the nuclear proteins within the DNA
- very SPECIFIC for lupus (but NOT sensitive: meaning not everyone with lupus will have this)
- stays consistent over time (not flux. up and down)
- doesnt correlate with renal dsiease like anti-dsDNA antbody does
Anti-SSA (Anti-RO) and Anti-SSB (anti-LA)
not specific, but found in the following
- SLE and neonatal lupus
- sjogren’s
- sicca syndrome
not sensitive either
if someone is + for Sjogrens, this increased risk of non-hodgkins lymphoma
can be given to baby from mom
Anti-RNA polymerase III (Anti-RNP)
found in systemic Scleroderma with kidney disease involvement
if this is + ….. risk for
- lung cancer via chronic interstital lung disease
- esophageal cancer from GERD
- pulmonary HTN
- skin disease
Anti Histone
Anti Centromere
Anti Scl 70
Anti-Histone
- specific to drug induced lupus > lupus
Anti-Centromere
- specific to limited scleroderma > diffuse scleroderma
Anti-Scl 70 (anti-topoisomerase I)
- specific to systemic sclerosis (type of scleroderma)
- these pt. increased liekly to develop pulmonary fiberosis and decreased survival
ANCA
Anti-CCP
ANCA
- autoantibodies against cytoplasm of neutrophils and monocytes
- specific for small vessel vasculitis (wegeners and Churg-Strauss)
Anti-CCP
- specific for RA pts. but not as senstive
- if this is POSITIVE in RA patienet: more liekly for joint erosin and deformity
Rhemuatoid Factor (RF)
antibody against the immunoglobulin antibody
(antibody againts the antibody)
- can also be a cryoglobulin (the antibody precipitates when cooled)
high levels in the plasma will show a worse prognosis + increased risk of joint ersoin and defmority
seen in the following conditions
- seropostive inflammatory arthriris (RA, SLE, sjorgens, systemic sclerosis)
- interstitial pulm. fiberosis
- Hep B
- mixed cryoglobulinemia
- infectious mono
- TB
- hematologic malignacy
- infective endocarditis
what are the seronegative arthritis (RF-)
HLAB27 arthritis
psoriatic arthritis
ankylosing spondolyis
IBD assocaited arthrisi
reactive arthritis
HLA- B27 and HLA-DR2-8
- these are antigens on the WBC
HLA-B27
- seen in seroneg. spondoloarthritis
- healthy people
- acute anterior uveitis
HLA-DR-2-8
- many other categories
