Rheum week 2 - joint pain and rash Flashcards
What demographic has highest prevalence/risk of SLE ?
women are 9x more likely than men to develop SLE
African american women are 3x more likely to get lupus than white women
What info is good to know about presentation of a rash ?
- images of rash if not visible now
- exacerbating/relieving factors ?
- history of exposure to new meds or chemicals (allergic rash or photosensitivity)
What renal problem can SLE cause ?
nephrotic syndrome
proteinuria +++, hypoalbuminemia, oedema
What is seen in urine dip for
a) nephrotic syndrome
b) nephritic syndrome
Nephrotic = protein
Nephritic = protein + blood
What is the difference in amount of proteinuria in
a) nephrotic syndrome ?
b) nephritic syndrome ?
nephrotic = LOTS (>3-5g/24hrs)
nephritic = less (<2g/24hrs)
Which is more associated with foamy urine
a) nephrotic syndrome ?
b) nephritic syndrome ?
nephrotic = foamy urine
what are the defining characteristics of acute nephritic syndrome ?
- haematuria (micro or macroscopic)
- proteinuria (<2g/24hrs)
- hypertension (due to water and salt retention)
- oedema (periorbital, leg or sacral)
- oliguria
- uraemia
What are some associated symptoms of SLE?
- joint pains (sero negative inflammatory arthritis)
- mellor rash
- raynauds
- hair loss
- mucosal ulcers
- weight loss
- fatigue
What are the most common symptoms of SLE ?
- butterfly rash
- fatigue
- loss of appetite
- mouth ulcers
- low grade fever
- photosensitivity
- inflammatory arthritis
- muscle aches
- pericarditis
- pleural effusion
- poor circulation to extremities
What is an ENA blood test/what it used for ?
autoimmune screen, checking for antibodies
What specific antibody blood test is used to diagnose active SLE ?
dsDNA blood test
will be raised in active SLE
What usually happens to the CRP and ESR of a patient with active SLE ?
CRP stays normal or almost normal
ESR raised
if CRP is also raised, would need to rule out infection
What blood test is often used as a screening test for connective tissue disorders ?
ANA blood test
anti-nuclear antibody
Is ANA blood test specific to CTDs ?
no
you can get a positive ANA in a number of rheumatological and autoimmune disorders as well as in 5% of healthy people
does a negative ANA exclude SLE as a diagnosis?
almost always
if an ANA is positive, what further testing can be done to support a diagnosis ?
ENA blood test
What does a ‘speckled’ pattern of ANA fluorescence look like ?
green blobs with black speckles in middle
What does a ‘homogenous’ pattern of ANA fluorescence look like ?
green blobs (no speckles)
What does a ‘rim/peripheral’ pattern of ANA fluorescence look like ?
black blobs with a green rim round
What does a ‘nucleolar’ pattern of ANA fluorescence look like ?
black blobs with green speckles/dots inside
Which antibodies are associated with SLE on an ANA test ?
nDNA
Sm
nRNP
Which antibodies are associated with Sjögren’s syndrome on ANA testing ?
Ro(SSA)
La(SSB)
What is the relevance of sjögren’s syndrome and pregnancy ?
the Ro(SSA) and La(SSB) antibodies can cross the placenta and result in neonatal lupus manifesting as:
- rash, or
- complete heart block, or
- blood abnormalities (cytopaenias)
What is antiphospholipid syndrome (APLS) ?
autoimmune condition causing
- elevated APL antibodies
- thrombophilia or clotting problems
