Rheumatology Flashcards by Tawera Wharetohunga

What antibodies cause neonatal CHB in lupus?

Anti-ro/La

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What is Anti-La ass with?

Sjogren’s syndrome

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What is the most specific antibody for lupus?

Anti-Sm (renal and CNS disease)

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What is Anti-U1RNP/RNP associated with?

Myositis, mixed connective tissue

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What is ds-DNA associated with?

If elevated - marker of disease activity in lupus

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What is spared in a malar rash?

nasolabial folds

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Whats the most common cardiac manifestation of SLE?

Pericarditis

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Autoimmune hepatitis from lupus is rare, what marker is it associated with?

Ribosomal P

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Whats the main side effect/concern with long term hydroxychloroquine use?

Retinal toxicity.
Should be screened basline then annually after 5 years with fundoscopy

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What happens to RA and lupus in pregnancy ?

RA - goes into remission

Lupus - Commonly flares

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When does congenital heart block most commonly occur in SLE pregnancy?

between 16-26 weeks - irreversible once establoished

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What autoimmune condition is infliximab contraindicated in?

MS - cannot be used in family members of people with MS

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Why cant you use TNF inhibitors in MS?

Can cause demyelination + precipitate MS in susceptible individuals

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What are some side effects of tocilizumab?

Cannot be used in patients with dierticulosis due to risk of bowel perforation
It does not need to be used WITH methotrexate
It has interactions with other CYP3A4 drugs

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Nailfold capilloroscopy showing a relative paucity of capillary loops with enlarged and distorted loops with background of raynauds indicates what?

Raynauds from connective dissue disorder e.g polymyositis

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What HLA subtypes are associated with increased risk of SLE?

HLA-A1, HLA-B8, and HLA-DR3

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What are the histological findings of polyarteritis nodosa?

characterized by segmental transmural inflammation of muscular arteries

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What do you give to patients in scleroderma renal crisis?

Ace inhibitors!

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What conditions lead to primary urate over production?

Accelerated synthesis ( PRPPP synthase enzyme hyperactivity)
Imparired purine salvage HGPRT1 deficiency
G6PD deficiency

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What conditions lead to secondary urate over production?

Anything that leads to increased RBC turnover

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How is urate excreted?

ABCG2 transporter in the gut
Renal: Prox tubule - OAT1, and ABCG2

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What meds increase gout?

Diuretics, low dose aspirin, pyrazinamide, ciclosporin

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What proinflammatory receptors signal when monosodium urate crystals precipitate in the joint?

TLR 2 and 4 on chrondrocytes.

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What does light microscopy of gout show?

intra-cellular needle shaped, negatively birefringent crstals. When the light is parallel - yellow, when the light is perpendicular - blue

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What does gout XR show?

Bone erosions - cortical breakdown “punched-out” erosions with sclerotic margins in a marginal and juxta-articular distribution Preserved joint space

What is the Moa of probenecid in gout?

Uricosuric agent - promotes urinary excretion of uric acid Contraindicated in people with nephrolithissis

whats the urate target?

0.36

what is the consideration for febuxostat?

inc CVD risk

HLA5801 does what?

inc risk hypersensitivity to allopurinol (SJS reaction)

what are the important drug interactions with allopurinol?

Azathioprine, mercaptopurine, theophylline.

what conditions are associated with cppd?

joint trauma, Hypomag, hyperPTH, haemochromatosis, hypophosphatasi

joint most commonly affected by cppd?

knee

what are xr findings of cppd?

Radiographic chondrocalcinosis is common and frequently asymptomatic - Involvement at sites uncommon for primary OA Prominent oseteophyte formation, hook osteophytes of the MCPJ

Anti-SRP assiciated with what?

Immune mediated necrotising myopathy, also Anti-HMGCR

What are the antibodies in dermatomyositis?

Anti-IFH1 antibody, MDA-5 in amyopathic DM, Anti-Mi2, TIF gamma, MJ

What myositis is associated with malignancy?

Dermatomyositis

What antibodies are involved in inclusion body myositis?

Anti-cN1A

What antibodies ass with antisynthetase syndome?

Anti-ARS, anti-Jo1, anti-PL7, anti-PL112

What antibodu is associated with mixed connective tissue disease?

URNP

What are clinical manifestations of antisynthetase syndrome?

Myositis/proximal weakness, pain, ILD (UIP pattern), athritis, raynauds, mchanics hands

What are clinical features of dermatomyositis?

Heliotrope rash with periorbital/infraorbital oedema. Gottrons papules and mechanic hands. 1/5 will be amyopathic

What are RF antibodies targeted against?

The Fc portion of human IgG

In RA which patients have higher risk of ILD?

Anti-CCP positive patients, UIP pattern for RA-ILD

What are XR findings in RA?

- Periartiicular soft tissue swelling - Juxta-articular osteoporosis - Marginal erosions - Joint space narrowing Symmetrical involvement

What using TNFi in RA can you stop MTX?

No additiv ebenefit is in combination with MTX All biologics are better with methotrexate, with the exception of JAKi which can be used as monotherapy

What is abatacept?

CTLA4 mimic - T-cell co-stimulator inhibitor - response similar to TNFi

What is felty syndrome>

Seropositive RA + Splenomegaly + neutropenia

How do people with Felty syndrome present?

They are at increased risk of bacterias infection - present with infection + neutropenia

How do you treat Felty syndrome?

Treat the underlying disease with DMARD, GCSF for neutropenia, and if refractory to treatment and ongoing recurrent infections then splenectomy. DMARD - methotrexate then if refractory add Ritux, avoid TNF

Can patients taking tofacitinib have live vaccines?

What are adverse outcomes of tofacitinib?

MACE and cancer risk increased.

What marker shows that a cell is a T-reg cell?

FoxP3

What does tofacitinib block?

JAK1/3

What does baricitinib block?

JAK1/2

Which TNFi is least likely to cause drug induced lupus?

Etanercept

whats the most common clinical feature of AxSpa?

Sacroiliitis inflammation occurs both first and most commonly

what % of patients with AxSpa have normal inflamatory markers?

25%

when dont you use ertanercept in axspa?

(less effectvie if uveitis and IBD),

What biologic therapy can cause flares of IBD in axSpa?

IL-17 inhibitors - secukinumba, ixekinumab They are very effective if overlapping psoriasis however

What is the HLA associated with scleroderma?

HLADRB1

What scleroderma antibody is associated with scleroderma renal crisis?

RNA polymerase III antibody, speckled ANA pattern

What is the treatment for scleroderma renal crisis?

ACEi for rapid BP control - ARBS not proven to help ACEi + plasma exchange better survival if MAHA present AVOID B-blockers

What do you do in scleroderma renal crisi if normal BP?

Still give ACEi

What are the nailfold capilloroscopy findings in secondary raynauds>

Drop outs, megacapilladies, disorganisation, microhaemorrihages