Malaise and Generalized Pain Flashcards
what Abs are associated with SLE?
- anti-dsDNA - correlates with disease activity
- anti-Smith - does not correlate with disease activity
what Abs are associated with drug-induced SLE?
anti-histone Ab
what Abs are associated with Sjögren’s syndrome?
- anti-Ro
- anti-La
what Abs are associated with limited systemic sclerosis?
anti-centromere
what disease is associated with polymyalgia rheumatica?
giant cell (temporal) arteritis
what disease is associated with giant cell (temporal) arteritis?
polymyalgia rheumatica
what disease is associated with hepatitis B infection?
polyarteritis nodosa
what Abs are associated with diffuse scleroderma?
- anti-Scl70 (anti-DNA topoisomerase I)
- anti-RNA polymerase III
what Abs are associated with rheumatoid arthritis?
anti-CCP (cyclic citrullinated peptide)
homogenous staining patterns are seen with what diseases?
- drug-induced SLE
- Sjögren’s syndrome
- SLE
speckled staining patterns are associated with what diseases?
- Sjögren’s syndrome
- diffuse systemic sclerosis
- SLE
centromere staining patterns are associated with what disease?
limited systemic sclerosis (CREST)
nuclolar staining patterns are associated with what diseass?
- diffuse systemic sclerosis
- SLE
what demographics are associated with SLE?
- females
- african americans
- poor without insurance
what are clinical manifestations of SLE?
- malar rash, photosensitivity
- arthritis
- thrombosis
- atherosclerosis –> MI, pericarditis, libman-sacks endocarditis (vegetations are thrombi)
- nephritis
what is primary antiphospholipid antibody syndrome?
seen in pateints without SLE
type 1 antiphospholipid Abs
cause a false positive for syphylis (VLDR or RPR tests)
type 2 antiphospholipid Abs
lupus anticoagulant
- incrase risk for thrombosis and miscarriage
- prolongs aPTT
- check for Abs with DRVVT
type 3 antiphospholipid Abs
anti-cardiolipin Abs
- β2GPI Ab
what diseases are associated with cotton wool spots?
- SLE
- antiphospholipid antibody syndrome
what complications can be seen in babies from mothers with Ro or La (Sjögrens) Abs?
permanent complete heart block
what is the treatment for SLE?
- avoid the sun
- NSAIDs
- corticosteroids
- hydroxychloroquine
what is the primary cause of death in early and late SLE?
- early SLE - infection
- late SLE - myocardial infarction
morphology of discoid lupus
well-defined inflammatory plaques that evolve into atrophic, disfiguring scars
limited systemic sclerosis
Calcinosis, Raynauds (2°), Esophageal dysmotility, Sclerodactyly, Telangiectasia
- associated with pulmonary hypertension
- renal involvement is uncommon
diffuse systemic sclerosis
- infammatory edematous phase –> fibrotic phase
- loss of eccrine/sebaceous glands –> dry, itchy skin
- fibrotic joint –> stiffness
- carpal tunnel
- Raynaud’s presents later
- associated with interstitial lung disease
- renal crisis is common
renal crisis in diffuse sclerosis
- abrupt onset of malignant HTN
- hemolytic anemia
- progressive renal insufficiency
GI manifestations of scleroderms
- malnutrition
- GERD –> Barrett’s –> increased risk of esophageal adenoCA
- gastric antral vascular ectasia (GAVE; watermelon stomach)
what treatment is contraindicated in scleroderma?
glucocorticoids
- they may –> renal crisis
localized scleroderma
- affects children
- morphea - discrete areas of discolored skin induration
- no Raynaud’s and not systemic
what other disease is Sjögren’s syndrome associated with?
B cell non-Hodgkin lymphoma (MALT lymphoma)
what drugs are contraindicated in Sjögren’s syndrome?
atropinic (anti-muscarinic) drugs–they will dry the patient out further
dermatomyositis
- weakness w/o sensory symptoms
- characteristic lesions
- grotton’s patches - violaceous lesions on the DIP, PIP, and MCP
- helitrope rash
- poikiloderma - “shawl sign”, v-neck erythema
- increased risk of OCCULT MALIGNANCIES
- perifascicular atrophy on bx
what Abs are associated with dermatomyositis?
- anti-Jo-1
- anti-Mi2
- anti-MDA5
- anti-PI55/PI40
when you see a patient with dermatomyositis, what should you do?
look for occult malignancy
- ovarian > lung > pancreatic > stomach > colorectal > non-Hodgkin lymphoma
polymyositis
- proximal muscle weakness
- no skin changes
- endomysial inflammation on biopsy
what Abs are associated with polymyositis?
anti-Jo-1
what is the treatment for dermatomyositis and polymyositis?
corticosteroids
inclusion body myositis
- affects males
- weakness with finger flexion and in the quadriceps
- biopsy shows endomysial inflammation and rimmed vacuoles
what Abs are associated with inclusion body myositis?
anti-cN1A
Henoch-Sconlein purpura
- small vessel disease
- affects kids
- often preceded by a URI w/ streptococcus
- tetrad of
- palpable purpura - no thrombocytopenia
- arthritis/arthralgia
- abdominal pain –> intussiception
- renal disease
- IgA deposits seen on biopsy
anti-glomerular basement membrane (GBM; Goodpasture’s syndrome)
- small vessel disease
- affects capillaries in the lungs and kidney
- biopsy shows deposition of anti-basement membrane Abs
Takayasu arteritis
- large vessel (aorta)
- asian women < 40 yo
- long, tapered stenosis –> “pulseless disease”
- –> aortic dilations, regurg, aneurysm, and rupture
- renal artery stenosis –> HTN –> copper wire retinopathy
- biopsy shows granulomas w giant cells
Beçet syndrome
- triad of
- recurrent mouth ulcers
- genital ulcers
- eye inflammation
- mimics multiple sclerosis
- ulcers in distal ileum or cecum
- pathergy - pustules at site of needle pricks
- associated with HLA-B51
what is the treatment for Beçect syndrome
low dose glucocorticoids
polyarteritis nodosa
- segmental involvement
- associated with hepatitis B virus
- skin shows livedo reticularis, distal gangrene
- –> vasculitis neuropathy and foot drop
- THE LUNGS ARE SPARED
- biopsy shows fibrinoid necrosis and no granulomas
Kawasaki disease (mucocutaneous lymph node syndrome)
- medium vessel
- affects asians < 5 yo
- fever, LAD, STRAWBERRY TONGUE
- aneurysm or MI years later –> death
what is the treatment for Kawasaki diseaes?
IVIG and ASA (even in a peds patient w fever)
granulomatosis with polyangiitis (wegener’s granulomatosis)
- seen in males > 40 yo
- biopsy shows granulomatous inflammation, necrotizing vasculitis, and segmental glomerulonephritis
- –> hearing loss, VTE
- involves the respiratory tract
- NASAL involvement - saddle nose
what disease is saddle nose associated with?
granulomatosis with polyangiitis (wegener’s granulomatosis)
asthma + eosinophilia
eosinophilic granulomatosis with polyangiitis (Churg-strauss)
eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
- asthma + eosinophilia
- prodromal phase - allergic
- eosinophilia/tissue infiltration phase
- vasculitis phase - palpable purpura
thromboangiitis obliterans (Buerger disease)
- young males
- ONLY OCCURS IN SMOKERS
- treat with smoking cessation
how should giant cell (temporal) arteritis be treated?
if you suspect GCA, start corticosteroids before biopsy
polymyalgia rheumatica
- presents with stiffness, soreness, and pain
-
weakness d/t pain
- its not true weakness
- trouble combing hair, putting on coat
