Rheumatoid Arthritis and SLE

Question 1

Describe lupus in an overview

Answer 1

Chronic tissue inflammation in the presence of antibodies directed against self antigens

Question 2

What 3 types of autoantibodies is lupus associated with?

Answer 2

Antinuclear antibodies
Anti-double stranded DNA antibodies
Anti-phospholipid antibodies

Question 3

Describe RA in an overview

Answer 3

Chronic joint inflammation that can result in joint damage

Question 4

What is the sight of inflammation in RA?

Answer 4

Synovium

Question 5

What 2 types of autoantibodies is RA associated with?

Answer 5

Rheumatoid factor

Anti-cyclic citrullinated peptide (CCP) antibodies

Question 6

How often does RA cause joint damage?

Answer 6

Rarely, usually it is not erosive and doesn’t cause joint damage but often tenderness is visible on presentation

Question 7

Describe ankylosing spondylitis in an overview

Answer 7

Chronic spinal inflammation that can result in spinal fusion and deformity

Question 8

What is the sight of inflammation in ankylosing spondylitis?

Answer 8

Enthesis

Question 9

Out of SLE, ankylosing spondylitis and rheumatoid arthritis which have autoantibodies?

Answer 9

SLE and rheumatoid arthritis

Question 10

What phenomenon is common in LE, ankylosing spondylitis and rheumatoid arthritis? Describe it

Answer 10

Reynaud’s phenomenon, there is intermittent vasospasm of digits on exposure to cold, typical colour changes are white to blue to red
Vasospasm leads to blanching of digit

Question 11

What is the common demographic for SLE?

Answer 11

Women between 15-45 yrs old

Question 12

What are clinical manifestations of SLE?

Answer 12

Malar rash
Photosensitive rash
Mouth ulcers
Hair loss
Raynaud’s phenomenon
Arthralgia and sometimes arthritis
Serositis (pericarditis, pleuritis, less commonly peritonitis)
Renal disease – glomerulonephritis (‘lupus nephritis’)
Cerebral disease – ‘cerebral lupus’ e.g. psychosis

Question 13

What is the pathogenesis of SLE thought to be?

Answer 13

Apoptosis leads to translocation of nuclear antigens to membrane surface
Impaired clearance of apoptotic cells results in enhanced presentation of nuclear antigens to immune cells
B cell autoimmunity

Question 14

What do anti phospholipid antibodies increase risk of in SLE?

Answer 14

Arterial and venous thrombosis

Question 15

What does level of anti-dsDNA correlate with in lupus?

Answer 15

Disease activity

Question 16

What will show after haematology investigations in SLE?

Answer 16

Haemolytic anaemia, Lymphopenia, Thrombocytopenia

Question 17

What is it important to measure in SLE in relation to renal function?

Answer 17

Urine protein (protein:creatinine ratio and albumin)

Question 18

What is it important to remember in treated SLE patients?

Answer 18

Changes may reflect adverse reactions to medication

Question 19

What will anti ds-DNA antibody, C4 and C3 levels be in someone with SLE?

Answer 19

Anti ds-DNA levels will be high

C3 and C4 levels will be low

Question 20

What is recommended for all patients with SLE?

Answer 20

Hydroxychloroquine

Question 21

What is given if SLE presents acutely?

Answer 21

Glucocorticoids

Question 22

When are glucocorticoids given in SLE?

Answer 22

When the patient presents acutely to stop the flare up but they cannot be used long term for maintenance

Question 23

What do SLE patients need to be assessed for?

Answer 23

Antiphospholipid antibody status as they may be at risk of coagulations and in that case need to be given anticoagulants
Infectious disease risk profile
Cardiovascular disease risk profile

Question 24

What is Sjorgen’s syndrome?

Answer 24

Autoimmune damage to the endocrine glands

Question 25

What are glandular manifestations of Sjorgen’s syndrome?

Answer 25

Dry eyes
Dry mouth
Parotid gland enlargement

Question 26

What are non glandular manifestations of Sjorgen’s syndrome?

Answer 26

Non erosive arthritis

Raynaud’s syndrome

Question 27

Describe inflammatory muscle disease in an overview

Answer 27

Proximal muscle weakness due to autoimmune-mediated inflammation

Question 28

What are the 2 types of inflammatory muscle disease and how are they differentiated?

Answer 28

With rash= dermatomyotisis

Without rash= polymyositis

Question 29

What skin changes occur in dermatomyotisis?

Answer 29

Lilac-coloured rash on eyelids, malar region and naso-labial folds
Red or purple flat or raised lesions on knuckles (Gottron’s papules)
Subcutaneous calcinosis
Mechanic’s hands (fissuring and cracking of skin over finger pads)

Question 30

What is abnormal in muscle biopsy in those with polymyolitis?

Answer 30

There are a high no of CD8 T cells

Question 31

What is abnormal in muscle biopsy in those with dermatomyositis?

Answer 31

There are a high no of CD4 T cells and B cells

Question 32

What is scleroderma?

Answer 32

Thickened skin with Raynaud’s phenomenon

Question 33

What are the 2 categories of skin changes in scleroderma?

Answer 33

Diffuse and limited

Question 34

What is overlap syndrome?

Answer 34

When features of more than 1 connective tissue disorder are present

Question 35

What is undifferentiated connective tissue disease?

Answer 35

When incomplete features of a connective tissue disease are present

Question 36

What auto antibody is present in diffuse systemic sclerosis?

Answer 36

Anti-Scl-70 antobody

Question 37

What auto antibody is present in limited systemic sclerosis?

Answer 37

Anti-centromere antibodies

Question 38

What auto antibody is present in dermato/polymyositis?

Answer 38

Anti-tRNA transferase antibodies

Question 39

What auto antibody is present in mixed connective tissue disease?

Answer 39

Anti-U1-RNP antibodies