(msk) connective tissue disorders

Question 1

what is rheumatoid arthritis?

Answer 1

chronic joint inflammation that can result in joint damage

Question 2

what is the main site of inflammation in rheumatoid arthritis?

Answer 2

synovium

Question 3

which two autoantibodies are associated with rheumatoid arthritis?

Answer 3

rheumatoid factor (RF)

anti- CCP antibodies (cyclic citrullinated peptides)

Question 4

what is the key pathological process occurring in rheumatoid arthritis?

Answer 4

synovitis

Question 5

name the most common spondyloarthropathy

Answer 5

ankylosing spondylitis

Question 6

what is ankylosing spondylitis?

Answer 6

chronic spinal inflammation that can result in spinal fusion and deformity

Question 7

what are the sites of pathogenesis in ankylosing spondylitis?

Answer 7

enthesis

joints of the spine

sacroiliac joints

Question 8

name four seronegative spondyloarthropathies

Answer 8

(all lack RF and anti-CCP)

ankylosing spondylitis

reactive arthritis

psoriatic arthritis

enteropathic synovitis (arthritis assocaited with GI inflammation)

Question 9

how does the spinal deformity in ankylosing spondylitis present?

Answer 9

loss of lumbar lordosis

increased kyphosis (hunched back)

Question 10

what is the key pathological process occurring in ankylosing spondylitis?

Answer 10

enthesitis

Question 11

what is systemic lupus erythematosus?

Answer 11

chronic tissue inflammation in the presence of autoantibodies directed against self antigens

Question 12

which autoantibodies are most commonly associated with SLE?

Answer 12

antinuclear antibodies

anti-dsDNA antibodies

anti-phosphiolipid antibodies

Question 13

what are anti-phospholipid antibodies associated with in SLE?

Answer 13

increased risk of arterial and venous thrombosis

thromboembolic events

Question 14

differentiate between arthralgia and arthritis

Answer 14

arthralgia = joint stiffness

arthritis = joint inflammation which can lead to joint stiffness and swelling

Question 15

what is the characteristic feature of SLE?

Answer 15

multi-site inflammation affecting mainly the skin, kidney and joints

Question 16

which phenomenon is commonly seen in connective tissue disorders?

Answer 16

Raynaud’s phenomenon

SLE, scleroderma

Question 17

what is Raynaud’s phenomenon?

Answer 17

intermittent vasospasm of the vessels supplying the fingers due to exposure to cold

= decreased blood flow to fingers
= blanching of the digits

Question 18

why do fingers go white in Raynaud’s phenomenon?

Answer 18

= decreased blood flow to fingers

= blanching of the digits

Question 19

why do fingers go blue in Raynaud’s phenomenon?

Answer 19

cyanosis as static venous blood deoxygenates

Question 20

why do fingers go red in Raynaud’s phenomenon?

Answer 20

reactive hyperaemia

= blood rushes back to the fingers as arteries dilate

Question 21

who is affected most commonly by SLE?

Answer 21

female aged between 15-45 years

Question 22

what are some clinical manifestations of SLE?

Answer 22

skin (malar) rash

photosensitive rash

arthritis

mouth ulcers

Raynaud’s phenomenon

pericardial/pleural effusion

haematological features

(renal, cerebral disease)

Question 23

why is an antibody panel done after receiving a positive ANA result in SLE?

Answer 23

if ANA is positive the clinical laboratory will perform further tests to determine which type of ANA is causing the symptoms

Question 24

what are the ESR and CRP levels in SLE?

Answer 24

high ESR but CRP is typically normal unless infection or pericardial/pleural effusion (in which case, it is elevated)

Question 25

what haematological features arise in SLE?

Answer 25

haemolytic anaemia

lymphopenia

thrombocytopenia

Question 26

which blood tests are carried out for SLE?

Answer 26

FBC
U&E
LFTs
bone profile
ESR
CRP

(ANA, autoantibody panel,

Question 27

which test is carried out to assess for the presence of anti-phospholipid antibody?

Answer 27

lupus anticoagulant and anti-cardiolipin antibodies

Question 28

why is it important to measure albumin in SLE?

Answer 28

early sign of glomerulonephritis

Question 29

subsequent to diagnosis, why may there be changes in an SLE patient’s blood tests?

Answer 29

reflects adverse reactions to medication

1) abnormal liver function = transaminitis
2) fall in neutrophil count (neutropenia) = if bone marrow is affected

Question 30

as SLE progresses, how do anti-dsDNA and C3/C4 levels vary?

Answer 30

vary but as disease worsens, anti-dsDNA increases and C3, C4 levels fall
= serologically active