Rheumatology Flashcards
Which of the following is not useful in treatment of ankylosing spondylitis?
- Etanercept
- Adalimumab
- Secukinumab
- Abatacept
- Ixekizumab
- Abatacept
Principles of ank spond treatment:
1st line: physical therapy + NSAIDs
2nd line after failed x2 NSAIDs trialled for 2-4 weeks each: TNF alpha inhibitor (i.e. etanercept, adalimumab) OR IL-17 inhibitor (Ixekizumab, secukinumab(
3rd line: switch to IL-17 inhibitor OR trial a different TNF-alpha blocker (if inital response then failure)
Abatacept - T cell costimulator, evidence in RA and PsA but not Ank spond
What is the first line pharmacologic treatment for Raynaud’s?
What is the second line treatment?
Other than cold, what else can exacerbate Raynaud’s?
- Dihydropyrine ca channel blockers - amlodipine, nifedipine
- PDE5 inhibitors (i.e. sildenafil), topical nitrates (i.e. nitroglycerin ointment), some evidence for ARBs and fluoxetine
- Smoking, vasoconstricting drugs (i.e. tryptans)
Which of the following indicates the patient is more likely to have primary rather than secondary Raynaud’s?
- Signs of tissue ischemia
- Male gender
- Age >40
- Symmetry
- Positive nailfold capillaroscopy
- Symmetry is more common in primary Raynauds
Nailfold capillarascopy = scleroderma
Name 5 features of mixed connective tissue disease
- Pulmonary hypertension ( most common cause of death, associated with anti-cardiolipin IgG)
- Arthritis
- Antibodies - anti-U1-RNP (diagnostic), anti-SNRP
- Swollen hands
- Raynaud’s
- Esophageal dysmotility
- Myositis
- Acrosclerosis (stiff thick skin on distal fingers(
Which rheumatologic disorders are associated with anterior uvieitis?
Which is not?
Spondyloarthropathies - ank spond, psoriatic arthritis, reactive arthritis
JIA
Sjogren’s
Kawasaki’s
Sweet syndrome
AIN
Scleritis OR AU: SLE, Sarcoidosis, relapsing polychnditis, IBD
Anterior uveitis NOT associated with RA (scleritis/episcleritis is)
The following antibodies are associated with an increased risk of what in Scleroderma?
- Anti-Scl-70 (topoisomerase I)
- Anti-centremere
- Anti-RNA polymerase III
Anti-Scl-70 (topoisomerase I) - pulmonary fibrosis, more common with diffuse scleroderma
Anti-RNA-polymerase III - diffuse scleroderma, increased skin disease and renal crisis.
Anti-centromore - pulmonary HTN + esophageal disease, more common with limited scleroderma. Protective against fibrosis.
Rheumatologic disorder strongly associated with anti-U1 RNP (U1 ribonucleoprotein) antibodies? ANA pattern
Mixed connective tissue disorder
Speckled ANA
Rheumatologic disorder strongly associated with anti-histone antibodies
ANA pattern?
Drug induced lupus
Homogenous ANA
Seronegative polyarthritis with fever, rash and high ferritin
Still’s disease
Rheumatologic disorder strongly associated with Anti-SS-B (anti-La) antibodies
Sjogren’s. Poor specificity. Anti-Ro = CHB in SLE.
Rheumatologic disorder strongly associated with anti-ribosomal P protein antibodies
SLE. Highly specific but poor sensitivity. Associated cutaneous manifestation
Role of IL-1B in OA?
Inhibits chondrocytes (along with TNF)
Inhibits aggrecanase and collagen II
Stimulates release of MMPs
End product = cartilage destruction
Features of DISH (dish diffuse idiopathic skeletal hyperostosis)
Older male age >50
Diabetes in 20%
Negative HLA-B27
Thoracic spine pain with loss off thoracic lateral flexion)
Which autoimmune disorders can cause RTA? Which type?
Distal (Type 1)
Sjögren’s syndrome
Autoimmune hepatitis/primary biliary cirrhosis
Systemic lupus erythematosus (also can generate hyperkalemic RTA)
Rheumatoid arthritis
HLA type associated with Behcets
HLA-B51
HLA type associated with hypersensitivity to allopurinol
HLA-B58*01
Dermatomyositis associated with mild/amyopathic muscle involvement and rapidly progressive ILD
anti-MDA5 antibodies
What is bimekizumab and what is it used for?
Anti-IL17
Plaque psoriasis
What is avacopan and what is it used for?
Anti-C5 receptor
ANCA vasculitis
Which of the following does not have a role in Scleroderma ILD? A. Cyclophosphamide B. MTX C. Azathioprine D. Tociluzimab E. MMF
B - MTX
MMF 1st line, cyclo 2nd line
What is the “triad” of Felty syndrome
RA, Neutropenia, Splenomegaly.
5 factors associated with poor prognosis in RA
Smoking Elevated CRP/ESR High anti-CCP/RF titres Erosions at baseline HLA-DRB1*04 homozygosity Older age
What is the major cause for premature death in RA?
CVD
What percentage of patients with GCA will have vision loss?
15-20%
Which autoimmune diseases are associated with hyposplenism?
Antiphospholipid syndrome Goodpastures GPA (PR3) Hashimotos thyroiditis PAN RA SLE IBD Celiac
Also sarcoid/amyloid
Most common neurologic manifestation of RA
Carpal tunnel
Cardiac manifestations of RA
Pericarditis (restrictive and granulomatous) Myocarditis Coronary artery disease Heart failure Atrial fibrillation Asymptomatic myocardial disease
HLA type associatd with RA
HLA DRB1
What is the cause of GI hypomotility (oesophagus, stomach, and small/
large intestine) in scleroderma?
Autonomic nerve dysfunction of the GIT
Results in esophageal dysmotility, strictures, gastroparesis and psuedo-obstructive
Infection commonly associated with PAN
Hepatitis B
Key features of anti-synthetase syndrome
inflammatory myopathy interstitial lung disease "mechanic's hands" inflammatory arthritis, Raynaud phenomenon anti-Jo 1
HLA associated with Behcets
HLA B51