Massive resvision Flashcards
Poor prognostic indicators for RA
- young age at onset
- male
- HLA DR4 positive
- many active joints
- delayed referral
- high CRP/PV at outset
- RhF/CCP positive
- early radiological erosions
- poorer functional scores at outset
- adverse socioeconomic circumstances
- extraarticular features
Anti-CD20
Biologic agent –> B cell depletion
Rituximab
Disruption of T cell costimulation
Abatacept
IL-1 inhibitor
Anakira
IL-6 inhibitor
Tocilizumab
Genes in RA
HLA-DR4, HLA-DR1
Who is SLE more common in
Women, asian, afro-carribean, hispanic etc
Not african blacks
Hormonal factors influencing SLE
incidence increased in those with higher oestrogen exposure - early menarche, on oestrogen containing contraceptives and HRT
Environmental factors and SLE
Viruses eg Epstein-Barr Virus
UV light may stimulate skin cells to secrete cytokines stimulating B-cells
Silica dust (found in cleaning powders, cigarette smoke and cement) may increase risk of developing SLE
Anti-Blys
Belimumab
What do patients with SLE die from?
Infection important cause of death in the early / medium stage of disease
Cardiovascular disease the major the cause of death in the late stages
Complications of SLE in the first few years
Late onset of disease
Male SLE
Lower socioeconomic class
Anti-ENA in SLE and
Secondary sjogrens features
Congenital heart block
Definition of vasculitis?
Presence of leukocytes/immune complexes in the vessel wall with reactive damage to mural structures
How do you assess vasculitis?
BVAS (Birmingham vasculitis score)
Takayasu arteritis
Large vessel
Giant cell arteritis
Large vessel
Kawasaki’s
Medium vessel
PAN
Medium vessel
Isolated CNS vasculitis
Medium vessel
Churg-strauss
Small vessel
Wegeners
Small vessel
Microscopic polyangitis
Small vessel
HSP
Small vessel
Essential cryoglobulinemia
Small vessel
Hypersensitivity vasculitis
Small vessel
Spondylolysis
Defect in the pars interarticularis of the vertebra
Spondylolisthesis
Forward slippage of one vertebra on another
Kyphosis
Centre of gravity anterior to spine High pre – load May be “opposite” of scoliosis Treatment of limited success Surgical treatment very risky
When do you give surgical treatment for kyphosis?
When conservative treatment has failed
Adolescent with > 50% slip
Progressive neurological deficit
Postural deformity
Treatment for spondylolisthesis?
Grade 1 or 2: Abnormal neighbouring discs
-Posterolateral stabilisation in situ
Grade 3+ : Combined discogenic + nerve root problem
-one stage combined anterior and posterior stabilisation
Epimysium
Surrounds entire muscle
Endomysium
Surrounds individual muscle fibres
Perimysium
Surrounds bundles of muscle fibre
Red fibres
(Type 1, slow twitch); large mitochondria & myoglobin
White fibres
White fibres (Type 2, fast twitch); small mitochondria & large motor end-plates
Definitive test for Dermatomyositis?
Muscle biopsy!!
CK levels lower than in PM
Muscle biopsy shows inclusion bodies
Responds poorly to therapy
Inclusion body myositis
Treatment for polymyositis/dermatomyositis?
Glucocorticoids Azathioprine Methotrexate Ciclosporin IV immunoglobulin
