Rheumatalogy Flashcards
Symptoms/signs of SLE
Mild - skin malar rash, hair, joints, lymphadenopathy
Moderate - lungs and heart haem
Severe
Kidneys and brain
SLE
Glomerulonephritis
Pleurisy and pleural effusion
Pericarditis with pericardial effusion
Antibodies for SLE
Anti-dsDNA is more specific for lupus
Can also look at ANA - Ro, La, Sm, RNP
SLE CRP ESR
CRP NORMAL
ESR high
What tests do you do for SLE?
FBC Urinalysis - more sensitive for inflammatory nephritis and creatinine and urea LFTs CXRs Lung function ECG Echo
Mild SLE treatment
Hydroxychloroquine
Moderate/severe treatment for SLE
Prednisolone
Name some other drugs used for suppression of moderate/severe disease
Mycophenolate mofetil
Azathioprine
Primary Sjogren’s syndrome
Inflammatory infiltration and destruction of exocrine glands -
lacrimal glands and salivary glands
Causing dryness of eyes and mouth
Signs in sjogren’s
Enlarged parotid glands
Dry mouth
No saliva pooling when you ask pt to move tongue upwards
Dry eyes
Diagnosis of Sjogrens - which antibodies do you look for?
ANA positive
ENA postiive (anti-Ro, anti-La)
RF positive
What are Ro and La
Ribonuclear proteins
Which part of the body do you biopsy
Foci of lymphocytic infiltrates in lip gland biopsy
Treatment for Sjogren’s
Tear substitues
Saliva substitutes
Pilocarpine (cholinergic agonist to stimulate saliva)
Complication with sjogren’s
Increased risk of lymphoma due to B cell activity
Which muscles are more m
Proximal muslces more invovled than distal muslces
Which muscles are more involved in polymyositis?
Proximal muslces more involved than distal muslces
Idiopathic inflammatory myositis signs
Gottron's papules over MCP and PIP joints purpley/red thickening Shawl sign Shawl sign Heliotrope rash Mechanic's hands
Antibodies for scleroderma
ANA:
- anti-centromere Ab
- anti-topoisomerase antibody (Scl70)
Pathological features of scleroderma
Fibroblast activation Fibrosis Th2 and Th17 inflammation Fibrosis Vascular disease
Signs of scleroderma
Calcinosis Raynauld's Esophageal dysmotility (fibrosis) Sclerodactyly (tightening of skin due to fibrosis) Telangiectasia
Limited cutaneous systemic sclerosis features
Primary pulmonary HTN
Anticentromere staining
Diffuse cutaneous systemic sclerosis features
Interstitial lung disease
Scleroderma kidney/renal crisis
Anti-Scl70 staining
Management of scleroderma
Pred
Steroid sparing agents
Nifedipine for Raynaud’s if vascular disease (vasodilation)
Systemic symptoms of vasculitis
Myalgia Fever Weight loss Fatigue Arthralgia
Systemic vasculitis classification
Large vessel
Large vessel vasculitis
Aorta/branch of aorta
GCA
Takayasu arteritis
Medium vessel vasculitis
Kawasaki
Polyarteritis nodosa
Small vessel vasculitis
ANCA-associated to neutrophils
Immune complex vasculitis
Mixed vessel vasculitis
Behcet’s disease - to both artery and vein
Presentation/features of takayasu arteritis
Upper limb claudication / right arm crampy pain
CNS disease if carotid involvement
HTN if renal artery stenosis
not granulomatous
Epidemiology of takayasu arteritis
Young women from ‘east’
What is GCA
Inflammation and ischemia
Aorta and branches
Scan for GCA
FDG PET scan to look for inflammation
Symptoms of GCA
Tender temporal region plus headache
Artery to masseter involvement- jaw claudication
Opthalmic/retinal/ciliary arteries - visual loss
Investigations for GCA
Raised ESR and CRP
Abnromal temp artery ultrasound scan - halo sign
Temporal artery biopsy
Treatment for GCA
High dose pred - 40-60mgs/day start before biopsy
Where is the inflammation in PMR?
Bursitis - subacromial, trochanteric
Synovitis - shoulder, hip, other joints
Investigation findings for PMR
Raised ESR and CRP
Normal CK
Presentation of PMR
Stiff arms/limbs
Tender over trochanteric/subacromial bursea
Restricted movement
Worse in morning
Treatment for PMR
Pred 15 mgs
What is polyarteritis nodosa? What can you get with it?
Rare inflammation of middle sized arteries in middle aged men.
GI tract Coronary arteries Renal arteries Skin - palpable nodules Nerves - mononeuritis multiplex
Complications of Polyarteritis nodosa?
Aneurysms
Note also association with hep B
(treat with pred + steroid sparing agent + treat hep B)
What is small vessel vasculitis associated with?
Anti neutrophil cytoplasmic antibodies
Types of small vessel vasculitis
Microscopic polyangiitis
GPA - granulomatosis with polyangiitis
eGPA - Eosinophilic granulomatosis with polyangiitis
Symptoms of small vessel vasculitis
Sinusitis Nose bleeds Collapse of nose septum Pulmonary haemorrhage due to nodules glomerulonephritis
Example of immune complex vasculitis
IgA disease
Symptoms of IgA disease
Purpuric rash often triggered by URTI Arthritis Glomerulonephritis Abdo pain Self limiting
