Rheumatoid Arthritis & SLE

Question 1

Common in connective tissues disorders

Answer 1

Raynaud’s phenomenon

Question 2

Raynaud’s phenomenon

Answer 2

Intermittent vasospasm of digits on exposure to cold
Typical colour changes - white to blue to red
-vasospasms lead to blanching of digit
-cyanosis as static venous blood deoxygenates
-reactive hyperaemia
Most commonly isolated and benign condition

Question 3

Autoantibodies of RA

Answer 3

Rheumatoid factor
Anti-cyclic citrullinated peptide antibody

Question 4

Autoantibodies of SLE

Answer 4

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

Question 5

Autoantibodies of osteoarthritis

Answer 5

None

Question 6

Autoantibodies of reactive arthritis

Answer 6

None

Question 7

Autoantibodies of gout

Answer 7

None

Question 8

Autoantibodies of ankylosing spondylitis

Answer 8

None

Question 9

ANA significance

Answer 9

Seen in all SLE cases
Not specific for SLE

Question 10

Anti-dsDNA significance

Answer 10

Specific for SLE
Serum level of antibody correlates with disease activity

Question 11

Anti-Ro antibodies significance

Answer 11

Secondary Sjögren’s syndrome
Neonatal lupus syndrome

Question 12

Anti-La antibodies significance

Answer 12

Secondary Sjögren’s syndrome
Neonatal lupus syndrome

Question 13

Sjogren’s syndrome

Answer 13

Autoimmune exocrinopathy
Exocrine gland pathology results in
-dry eyes
-dry mouth
-parotid gland enlargement

Question 14

Inflammatory muscle disease

Answer 14

Proximal muscle weakness due to autoimmune mediated inflammation either with or without a rash
Skin changes in dermatomyositis
-lilac coloured rash
-red or purple flat or raised lesion on knuckles
-subcutaneous calcinosis
-mechanic’s hands
Elevated CPK, abnormal EMG, abnormal muscle biopsy
Associated with malignancy and pulmonary fibrosis

Question 15

Sjogren’s syndrome autoantibody

Answer 15

No unique antibodies

Question 16

Mixed connective tissue disease autoantibody

Answer 16

Anti-U1-RNP antibodies

Question 17

SLE clinical manifestation

Answer 17

Malar rash - erythema that spares nasolabial fold
Photosensitive rash
Mouth ulcers
Hair loss
Raynaud’s phenomenon

Question 18

SLE pathogenesis

Answer 18

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

Tissue damage by antibody effector mechanisms e.g. complement activation and Fc receptor engagement

Question 19

Autoantibodies of systemic vasculitis

Answer 19

Antinuclear cytoplasmic antibodies

Question 20

Anti phospholipid antibodies significance

Answer 20

Risk of arterial and venous thrombosis in SLE
May occur in absence of SLE

Question 21

Anti-Sm antibodies

Answer 21

Specific for SLE
Serum level of antibody does NOT correlate with disease activity

Question 22

Anti-ribosomal P antibodies

Answer 22

Cerebral lupus

Question 23

SLE investigations

Answer 23

Inflammation - high ESR but normal C-reactive protein
Clotting - antiphospholipid antibodies

Question 24

SLE management

Answer 24

Aims at remission or low disease activity and prevention of flares

Hydroxychloroquine is recommended
Maintenance glucocorticoid should be minimised and when possible withdrawn
In persistently active or severe disease we use cyclophosphamide and B cell targeted therapies

Assessed for infectious and cardiovascular disease

Pregnancy planning

Question 25

Diffuse systemic sclerosis autoantibodies

Answer 25

Anti-Scl-70 antibody

Question 26

Limited systemic sclerosis autoantibody

Answer 26

Anti-centromere antibodies

Question 27

Dermato-/polymyositis autoantibodies

Answer 27

Anti-tRNA transferase antibodies