msk Flashcards
What are the risk factors for SLE and epidemiology
more in women, younger ages (20-40), afrocaribean and asian women
presentation of SLE
(thing flaws) low grade fever, VERY FATIGUED, weight loss
and then system specific symptoms, because SLE is a systemic disease it can affect pretty much any organ so difficult to diagnose!
skin: mouth or other ulcers, butterfly rash or other
joints: small> large joint pain and stiffness
renal: haematuria (and proteinuria but that finding- lupus nephritis)
lungs: breathlessness
brain: depression
heart; pericarditis or myocarditis?
lymphadenopathy
SLE pathophysiology
autoimmune condition with infiltrates in any system?
HLA, B8 , DR2, DR3 are some immune complexes involved in the infiltration of the organs
SLE diagnostics, give one very SENSITIVE and one very SPECIFIC ANTIBODIES
sensitive: ANA (99%)
SPECIFIC: anti-ds DNA but only 70% sensitive
other diagnostic indicators
FBC findings:
anaemia
lymphocytopenia
thrombocytopenia due to immune mediated destruction
GIVE a v specific but very poor sensitivity
anti-smith antibody
general management of SLE
basics are NSAIDS and sun-block
Hydroxychloroquine is the suggested drug
then if specific organs have porblems consider prednisolone and cyclophosphamide
use of ESR and CRP in lupus?
ESR is generally used to monitor disease
during active disease the CRP may be normal - a raised CRP may indicate underlying infection
comment on complement and anti ds-DNA levels as a tool to monitor LUPUs
complement (C3 and C4 usually low since they are used up in complexes deposited in the organs
polymyalgia rheumatica presentation and demographic
large joint pain and stiffness, mainly shoulders and hips
older patients so 60+
usually RAPID ONSET
also kinda FLAWS- low grade fevers, lethargy, appetite loss, weight, sweats, mild polyarthralgia (think case seen on video with retired man thats just feeling sick all the time)
is muscle weakness a feature of polymyalgia rheumatica?
noooooo
polymyalgia rheumatica commonly associated condition
giant cell/ temporal arteritis
polymyalgia rheumatica management
steroids, patients typically respond dramatically to steroids, failure to do so should prompt consideration of an alternative diagnosis
investigations in polymyalgia rheumatica
raised inflammatory markers e.g. ESR > 40 mm/hr
note creatine kinase and EMG normal
myasthenia gravis presentation
it is a progressive
myasthenia gravis muscle groups commonly affected and consequent symptom produced
extraocular muscles (diplopia)
face muscles (ptosis) ,
neck muscles (dysphagia)
limb griddles - limb weakness
associated conditions with myasthenia gravis
- thymoma in 15% of people which is quite high really
- other autoimmune diseases
- thymic hyperplasia in 50-70%
investigations for myasthenia gravis
- single fibre electromyography (high sensitivity)
- CT thorax to exclude thymoma
- acetylcholine receptor antibodies present in 85-90% of people
(of the ones that don’t have these abs 40% have another ab: anti- muscle specific tyrosine kinase abs )
long term management of myasthenia gravis first line
- long acting acetylcholinesterase inhibitors
what other treatments may be required for management of myasthenia gravis down the line
immunosuppression with prednisolone initially and then maybe azathioprine or some other options
thymectomy
myasthenia gravis crisis management
plasmapheresis and IV immunoglobulins
