Lymphoid/Rheum IM Flashcards
How to differentiate autoantibodies in testing of rheumatic conditions?
Ab against Nuclear antigens (ANA)
Ab against cytoplasmic antigens (ANCA)
Diagnosis of individual conditions can be further supported by detecting disease-specific ANAs or ANCAs
Examples of conditions where there are specific ANCAs?
Granulomatosis with polyangiitis (and a few other polyangiitis)
Primary Sclerosing Cholangitis
Ulcerative Colitis
ANCAs observed in especially vasculitides
Examples of conditions where there are specific ANAs?
SLE = Anti-dsDNA
Systemic Sclerosis (Scleroderma)
Sjögren syndrome
Polymyositis, dermatomyositis
Generally elevated in connective tissue disorders!
Causes of Reactive neutrophilia?
Reactive is the commonest cause of neutrophilia
Acute bacterial infection
Chronic inflammatory state
Bone marrow stimulation
Drugs
Solid organ tumour
What is Stevens-Johnson syndrome / Toxic Epidermal Necrolysis?
Skin rxn causing extensive epidermal detachment.
Is Rheumatoid Factor useful as a marker for seronegative arthropathies?
No. Rheumatoid factors can be raised in up to 20% of seronegative arthropathies. They can be raised in almost any form of autoimmune inflammation.
How to differentiate mAb drugs, whether human/humanized/chimeric?
Mumab = human
Zumab = humanized
Ximab = Chimeric
Chimeric drugs have higher risk of immune response / hypersensitivity
Which 2 cancers does RA raise risk of?
Lung cancer
Lymphoma
How to identify lung pathologies due to RA?
From King Julian tutorials - how to compartmentalize differentials
Go by compartments!
Parenchyma = inflammation, infection, malignancy
Airway = bronchiectasis,** rheumatoid nodules that can cause obstruction and hence atelectasis**
Interstitium = ILD
VEssels = pulmonary vasculitis
Pleura = pleuritis, pleural effusion
What is Erythema Multiforme?
Inflammation of SubQ fat caused by delayed hypersensitivity rxn.
Associated with infection, autoimmune diseases e.g. sarcoidosis, UC etc, pregnancy, OCP
Firm, erythematous nodular rashes over both LL
Bilateral hilar lymphadenopathy
Common genes in SLE?
HLA-DR2, HLA-DR3
Skin manifestations of SLE?
Malar rash sparing nasolabial folds
Raynaud phenomenon
Photosensitivity causing maculopapular rash
Discoid rash
Oral ulcers
Non-scarring alopecia
Periungual telangiectasia
Common joints affected in SLE?
Fingers, carpal joints, knee.
Usually distal symmetrical polyarthritis
Which NSAIDs are known to cause psoriasis flares?
1
Indomethacin and Naproxen
What heart valvular disease is Ankylosing Spondylitis associated with?
Aortic regurgitation.
Likely due to sclerosing inflammatory process involving aortic root
What are “B” symptoms? In which conditions?
Systemic symptoms of LOW, fever, night sweats that are a/w lymphomas and leukemias.
Screening vs Diagnostic for SLE?
ANA for screening
dsDNA for diagnostic.
Screen with ANA. If +ve, test Anti-dsDNA
Active SLE has low C3 C4 complement levels
Commonest cutaneous manifestation of sarcoidosis?
Erythema nodosum.
Often comes with bilateral hilar lymphadenopathy
CREST syndrome in Scleroderma?
Calcinosis Cutis
Raynaud phenomenon
Esophageal hypomotility
Sclerodactyly
Telangiectasia
Common triggers of psoriasis?
Infection = URTI, staphs, HIV
Mechanical irritation
Drugs
5 types of psoriasis?
Plaque psoriasis = standard.
Inverse psoriasis = plaques on flexor surfaces
Pustular psoriasis = pustules surrounded by inflamed skin
Guttate psoriasis = small round papules that are raised and sometimes scaly.
Erythrodermic psoriasis = worst type.
Presentation of psoriasis? Excluding arthritic part
Well-demarcated, scaly, pruritic, erythematous plaques/papules with silver-white scaling
Mainly on extensor surfaces, scalp, trunk, elbows.
Auspitz sign = small telangiectasia when scales are scraped off. Removal of scales expose dermal papillae, causing bleeding
Koebner phenomenon = physical stimuli or skin injury can cause appearance of psoriatic skin lesions on previously unaffected skin
Classic DRSAM presentation of Psoriatic arthritis?
DIPJ involvement
RA-like
Spondylitis, sacroilitis
Asymmetric oligoarthritis
Mutilans
Risk factors for RA
HLA-DR4 and HLA-DR1 gene
Smoking
Pre-menopausal women
Infection, obesity, family hx
Hand manifestation of RA?
Symmetrical (usually) pain and swelling of joints
Swan neck deformity
Boutonniere deformity
Z thumb
Hitchhiker thumb
Ulnar deviation of fingers
Piano key sign
Hammer toe or claw toe
Atlantoaxial subluxation
Rheumatoid nodules
Joints commonly affected by RA?
MCPJ, PIPJ
Wrist
Knee
MTPJ
X-Ray findings of RA?
Narrowing of joint space
Thickening of subchondral bone
Subchondral cyst
Osteophytes
Marginal erosion of cartilage and bone
Osteopenia
Soft tissue swelling
Triad of reactive arthritis?
Arthritis
Conjunctivitis
Urethritis
Presentation of REactive Arthritis?
Latency of 1-4 weeks
Arthritis can be symmetrical or asymmetrical.
- sacroilitis
- Dactylitis
- Enthesitis
- Arthritis predominantly in lower extremities
Diagnostics of Reactive arthritis?
Send stool culture.
Check for STI in case of genitourinary chlamydia (Nucleic acid Amplification Test).
Usual bloods e.g. CRP ESR, high TW.
Negative rheumatoid factor or anti-CCP Ab.
Arthrocentesis will show negative gram stain/cultures, no crystals. Just high WBC.
XR signs of reactive arthritis?
Loss of lumbar lordosis
Ankylosis of costosternal and costovertebral joints
Dagger sign
Bamboo sign
Shiny corners sign
Skin manifestations of Dermatomyositis?
Heliotrope rash
Gotttron’s papules
V sign
Shawl sign
Mechanic hands
What is multiple sclerosis?
Chronic degenerative disease of CNS characterized by demyelination and axonal degeneration in brain and spinal cord, caused by an immune-meiated inflammatory process
Diagnosis of Dermatomyositis?
Mostly clinical diagnosis
Muscle biopsy showing muscle fibre damage
How to confirm diagnosis of Multiple Sclerosis?
McDonald criteria of both DIT and DIS must be met
Dissemination in Time = Appearance of new CNS lesions over time that can be confirmed clinically, with imaging, or with CSF analysis
Dissemination in Space = Presence of lesions in different regions of CNS that can be confirmed clinically or in MRI
MRI is imaging of choice, showing MS plaques with finger-like radial extensions (Dawson fingers)
Contrast-enhancement of active lesions
CSF exam showing oligoclonal bands in CSF is highly suggestive of MS
