Rheumatology Flashcards
Autoantibody associated with congenital heart block?
Anti-Ro
(Ro=slow)
Before commencing azathioprine…
Check Thiopurine methyltransferase (TPMT) deficiency
- predisposes to azathioprine related pancytopenia
Azathioprine side effects
- bone marrow depression
(consider a full blood count if infection/bleeding occurs) - nausea/vomiting
- pancreatitis
- increased risk of non-melanoma skin cancer
- Safe in pregnancy
DEXA T scores are a measure of
bone density compared to young healthy adults
DEXA Z scores are a measure of
bone density comapred to same age gender and ethnicity as patient
for assessing secondary causes of osteoporosis
T score cut offs
-1 to -2.5 = osteopenia
Less than -2.5 = osteporosis
Z score cut offs
Less than -2 suggests bone mineral density below expected for patient
Hydroxychloroquine adverse effects
Retinopathy - may be permanent
‘Bulls eye’
Need yearly eye screening
Hydroxychloroquine in pregnancy
safe during conception pregnancy and breastfeeding
Pain on the radial side of the wrist/tenderness over the radial styloid process
De Quervians tenosynovitis
Affected protein in Marfans
Fibrillin-1
Low serum calcium, low serum phosphate, raised ALP and raised PTH
Osteomalacia
Reactive arthritis features
Arthritis
Uveitis
Urethritis
Keratoderma blenorrhagica
circinate balanitis
increased serum and urine levels of hydroxyproline
Pagets
Extra articular manifestations of Ank SPond
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
Poor prognostic features of RA
rheumatoid factor positive
anti-CCP antibodies
poor functional status at presentation
X-ray: early erosions (e.g. after < 2 years)
extra articular features e.g. nodules
HLA DR4
insidious onset
antibody associted with MCTD
antiribonuclear protein
(anti-RNP)
Sjogrens and malignancy
increased risk of lymphoid malignancies
Pseudoxanthoma elasticum
autosomal recessive condition characterised by an abnormality in elastic fibres
- retinal angioid streaks
‘plucked chicken skin’ appearance
- small yellow papules on the neck, antecubital fossa and axillae
- mitral valve prolapse
- increased risk of ischaemic heart disease
- gastrointestinal haemorrhage
mycophenolate mofetil mechanism
iosine-5’-monophosphate dehydrogenase inhibitor
- reduces lymphocyte production
most common cause of death in systemic sclerosis
respiratory involvement
Key cytokine in RA pathology
TNF
Osteporosis in man. Check…
Testosterone
(Hypogonadism is a common cause of osteoporosis in men)
Reactive arthritis joint aspirate
No organisms seen
Antibody for diffuse systemic sclerosis
Anti-Scl-70
Antibody for limited cutaneous systemic sclerosis
Ant-centromere
Apremilast mechanism
phosphodiesterase type-4 (PDE4) inhibitor
Anti-TNF agents
Adalimumab,
etanercept
infliximab
May reactivate TB
Ciclosporin mechanism
calcineurin inhibitor
Antiphospholipid syndrome
Recurrent miscarriage
Arterial or venous thrombus
Livedo Reticularis
Paradoxically prolonged APTT
Thrombocytopenia
Antibodies- anticardiolipin,
anti-beta2 glycoprotein I (anti-beta2GPI) antibodies,
lupus anticoagulant
Management of discoid lupus
1st - Topical steroids
2nd -Oral hydroxychloroquine
Pagets treatment
1st - Bisphosphonates
2nd - Calcitonin
Pagets biochemistry…
Normal calcium and phosphate
Isolated elevated ALP
Elevated hydroxyproline
Drug induced lupus
arthralgia
myalgia
skin (e.g. malar rash) and pulmonary involvement (e.g. pleurisy) are common
ANA positive in 100%, dsDNA negative
anti-histone antibodies are found in 80-90%
Antibody for granulomatosis with polyangiitis (Churg Strauss)
c-anca
Antibody for eosinophilic granulomatosis with polyangiitis
p-anca
Methotrexate is a…
dihydrofolate reductase inhibitor
avoid co-trimoxazole (will worsen any potential pancytopenia)
Denosumab mechanism
RANKL inhibitor
- prevents osteoclast development
Causative drugs in drug-induced lupus
Common- procainamide, hydralazine
Less common - isoniazid, phenytoin, minocycline
Neurological complication of polyarteritis nodosa
Mononeuritis multiplex
Azathioprine in pregnancy…
safe in pregnancy and breastfeeding alongside sulfasalazine and mesalazine
Rheumatoid factor is…
an IgM antibody against IgG
Most SENSITIVE antibody for SLE
ANA
Most SPECIFIC antibodies for SLE
anti-dsDNA
anti-Smith
Most specific antibody for dermatomyositis
Anti-Mi-2
McArdle’s disease
- autosomal recessive type V
- glycogen storage disease
caused by myophosphorylase deficiency - cramping, myoglobinuria, ‘second wind’ phenomenon
