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MSK II Final > Johnston: Laboratory Testing in Rheumatic Diseases > Flashcards

Johnston: Laboratory Testing in Rheumatic Diseases Flashcards

1
Q

Is there a single test that is diagnostic?

A

No!

-use your H and P

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2
Q

Markers of Inflammation

A
  • nonspecific
  • ESR: higher in women, rises with age, monitor disease activity, especially PMR (polymylagia rheumatica) and GCA (giant cell arteritis)
  • CRP: assessment of disease activity, made in liver, proinflammatory cytokines increase CRP, Can activate complement, promote phagocytosis, greater than 8 is inflammatory, rises and falls quicker than ESR
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3
Q

When immune complexes mediate consumption, what dereases?

A

-complement!

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4
Q

Rheumatoid factor

A
  • autoantibody that targets the Fc portion of IgG
  • can be any Ig subclass, IgM most common
  • RF is produced by B cells in synovial joints of RA pts
  • Sensitivity for RA is 66% specificity is 82%
  • present is 70-80% patients with RA; 100% in “nodular” RA
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5
Q

What other conditions do we find RF in?

A
  • Sjogrens
  • cryoglobulinemia
  • primary biliary cirrhosis
  • SLE
  • etc…
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6
Q

what does high levels of RF mean?

A

-associated aggressive disease, joint erosions, worse prognosis

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7
Q

do all people with RA have RF?

A

-no!

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8
Q

What is the other antibody in RA that is more reliable marker than RF?

A
  • Antibodies to citruliinated proteins (anti CCP)
  • more specific
  • if both Anti CCP and RF are there, probably have RA
  • associated wtiha ggresive, erosive disease
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9
Q

If someone has ANA, is it always lupus?

A
  • no

- happens in normal people

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10
Q

pattern of IF with ANA associated with drug induced lupus?

A

-homogenous pattern

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11
Q

If there is a rim pattern of IF for ANA, what antibody is there?

A

-andi DS DNA

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12
Q

Which antibody is ONLY seen in lupus (SLE)?

A

-anti smith antibodies

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13
Q

Anticentromere antibody

A

-scleroderma (CREST syndrome)

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14
Q

Criteria for SLE

A
  • Malar rash
  • discoid rash
  • photosensitivity: rash due to sunlight
  • oral ulcers: nasopharyngeal ulcers… usually painless
  • arthritis
  • serositis
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15
Q

What are some hematologic signs of lupus

A
  • hemolytic anemia with reticulocytosis
  • leukopenis
  • lymphopenia
  • thrombocytopenia
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16
Q

What does positive ASO titer and anti DNAase B titers mean?

A
  • preceding group A streptococcal infection

- often affects large joints and is asymmetric

17
Q

if we had lupus, what lab test would we expect?

A

-CBC indicating hemolytic anemia, leukopenia, and false positive RPR

18
Q

What lab tests would we expect for RA?

A
  • positive anti CCP
  • Elevated ESR
  • elevated RF level
19
Q

What is the wierd thing with a nodule that happens with RA

A

-it’s on their extensor surface of forearm

20
Q

with joint fluid analysis, what are the values for cells we need to know?

A
  • <200: normal
  • 200-2000 mononeuclear: non inflammatory
  • 2000-5000: inflammatory
21
Q

Which joint becomes symptomatic in gout?

A
  • 1st MTP

- that’s called podagra

22
Q

What are tophi

A

-MSU crystals… nodular deposits of it in skin

23
Q

what will gout present with?

A

-hot red swollen joint

24
Q

What imaging modality is sensitive for soft tissue?

A
  • Ultrasound

- no radiation

25
Q

Will radiography always catch RA?

A

-no, especially early in the disease course

26
Q

What patients do we have to watch out for if we are wanting to do an MRI?

A
  • kindey patients
  • gadolinium contrast taken up in inflammed synovium, IV gadolinium can cause nephrogenic systemic fibrosis (NSF) in pt with kidney disease
  • good for spine, SI, synovitis, tenosynovitis
27
Q

What is CT best for?

A

-bony abnormalities, erosions, fractures, degenerative or inflammatory arthritis

28
Q

what is the difference between oligo, pauci, and poly arthritis?

A
  • oligo: 3 or more
  • Pauci: 5 or more
  • Poly: >6
29
Q

What hand joint is spared in RA?

A
  • DIP!!!!!

- those Heberen’s nodes will be in osteoarthritis

30
Q

difference between swan neck and boutonniere deformity?

A
  • swan: the DIP is flexed

- boutonneire… it isnt

31
Q

what diseases have arthritis with involvement of the bowel?

A
  • UC, Crohns disease, and Behcet’s

- reactive arthritis…. with a bowel infection

32
Q

What does nail clubbing mean?

A
  • HPO

- Hypertrophic pulmonary osteoarthritis

33
Q

What is Charcot joint?

A

-diabetes, they have arthritis but they can’t feel it due to nerve damage

34
Q

What does Cytoidbodies and vasulitis mean with arthritis having to do with ophthalmologic causes?

A

-retinopathy

35
Q

What will there be in diabetes?

A
  • charcots

- cheiroarthropathy

36
Q

What will there be in thyroid disorders arthritis?

A

-carpal/tarsal tunnel syndrome

MSK II Final (13 decks)

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