Rheum week 2 - joint pain and rash

Question 1

What demographic has highest prevalence/risk of SLE ?

Answer 1

women are 9x more likely than men to develop SLE
African american women are 3x more likely to get lupus than white women

Question 2

What info is good to know about presentation of a rash ?

Answer 2

• images of rash if not visible now
• exacerbating/relieving factors ?
• history of exposure to new meds or chemicals (allergic rash or photosensitivity)

Question 3

What renal problem can SLE cause ?

Answer 3

nephrotic syndrome

proteinuria +++, hypoalbuminemia, oedema

Question 4

What is seen in urine dip for
a) nephrotic syndrome
b) nephritic syndrome

Answer 4

Nephrotic = protein

Nephritic = protein + blood

Question 5

What is the difference in amount of proteinuria in
a) nephrotic syndrome ?
b) nephritic syndrome ?

Answer 5

nephrotic = LOTS (>3-5g/24hrs)

nephritic = less (<2g/24hrs)

Question 6

Which is more associated with foamy urine
a) nephrotic syndrome ?
b) nephritic syndrome ?

Answer 6

nephrotic = foamy urine

Question 7

what are the defining characteristics of acute nephritic syndrome ?

Answer 7

• haematuria (micro or macroscopic)
• proteinuria (<2g/24hrs)
• hypertension (due to water and salt retention)
• oedema (periorbital, leg or sacral)
• oliguria
• uraemia

Question 8

What are some associated symptoms of SLE?

Answer 8

• joint pains (sero negative inflammatory arthritis)
• mellor rash
• raynauds
• hair loss
• mucosal ulcers
• weight loss
• fatigue

Question 9

What are the most common symptoms of SLE ?

Answer 9

• butterfly rash
• fatigue
• loss of appetite
• mouth ulcers
• low grade fever
• photosensitivity
• inflammatory arthritis
• muscle aches
• pericarditis
• pleural effusion
• poor circulation to extremities

Question 10

What is an ENA blood test/what it used for ?

Answer 10

autoimmune screen, checking for antibodies

Question 11

What specific antibody blood test is used to diagnose active SLE ?

Answer 11

dsDNA blood test

will be raised in active SLE

Question 12

What usually happens to the CRP and ESR of a patient with active SLE ?

Answer 12

CRP stays normal or almost normal
ESR raised

if CRP is also raised, would need to rule out infection

Question 13

What blood test is often used as a screening test for connective tissue disorders ?

Answer 13

ANA blood test

anti-nuclear antibody

Question 14

Is ANA blood test specific to CTDs ?

Answer 14

no

you can get a positive ANA in a number of rheumatological and autoimmune disorders as well as in 5% of healthy people

Question 15

does a negative ANA exclude SLE as a diagnosis?

Answer 15

almost always

Question 16

if an ANA is positive, what further testing can be done to support a diagnosis ?

Answer 16

ENA blood test

Question 17

What does a ‘speckled’ pattern of ANA fluorescence look like ?

Answer 17

green blobs with black speckles in middle

Question 18

What does a ‘homogenous’ pattern of ANA fluorescence look like ?

Answer 18

green blobs (no speckles)

Question 19

What does a ‘rim/peripheral’ pattern of ANA fluorescence look like ?

Answer 19

black blobs with a green rim round

Question 20

What does a ‘nucleolar’ pattern of ANA fluorescence look like ?

Answer 20

black blobs with green speckles/dots inside

Question 21

Which antibodies are associated with SLE on an ANA test ?

Answer 21

nDNA
Sm
nRNP

Question 22

Which antibodies are associated with Sjögren’s syndrome on ANA testing ?

Answer 22

Ro(SSA)
La(SSB)

Question 23

What is the relevance of sjögren’s syndrome and pregnancy ?

Answer 23

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)

Question 24

What is antiphospholipid syndrome (APLS) ?

Answer 24

autoimmune condition causing
- elevated APL antibodies
- thrombophilia or clotting problems

Question 25

What is SLE ? explain to a patient …

Answer 25

SLE is an autoimmune condition which essentially means the system in your body that usually fights against infection has got confused and started fighting against your own cells.
The condition results in a chronic inflammatory response and can effect in skin changes and other changes to some of the organs in your body.
SLE can be triggered by genetics and the environment

Question 26

Which organ is the most commonly targeted organ in SLE ?

Answer 26

kidneys

in up to 60% of SLE patients during the course of the disease

25-50% may have kidney involvement at the time of SLE diagnosis

Question 27

How do you monitor renal involvement of SLE patients ?

Answer 27

regular clinical review including urine dip and BP

Question 28

What is the treatment for SLE ?

Answer 28

no cure

reduce inflammation with corticosteroids and immunosuppression