Rheumatology 2 Flashcards
dsDNA role in SLE?
assess disease activity
What is not a/w increase risk of pseudogout?
Rheumatoid arthritis
What reduces serum urate level?
Oestrogen
Why Gout tend to occur in distal extremities?
lower Temperature - insoluble urate
Suspect amyloidosis - what biopsy?
Fat pad biopsy first - high sensitivity
Renal biopsy next
Amyloidosis histology?
Fibrills! - bind to apple congo red turning it into the typical green birefringence amyloid
Cardiac amyloidosis imaging sign?
TTE - speckled myocardium
Cardiac MRI - late Gadolinium enchancement
What hormone is a/w lupus flare?
Hyper prolactinemia
High osterogen
Low androgen
RA has felty syndrome
-part of felty syndrome has anaemia, neutropenia,thrombocytopenia
WHY?
Large granular lymphocyte syndrome
-clonal Lymphocyte proliferation
PAN histology shows?
Internal elastic lamina disruption —> aneurysmal dilatation
Fibrinoid necrosis + eosinophilia
Polymorphonuclear + mononuclear cells infiltration
Arterial involvement ONLY!
What makes gout -crystal deposition likely?
Lower temperature/pH
Rapid change in urate concentration
Tocilizumab adverse effect?
Intestinal perforation
Hyperlipidemia ( not significant to cause CVD)
Only arthritic more predominant in males?
Psoriatic arthritis
In SLE
CRP/ESR means?
High CRP/ESR = SLE serositis
Normal CRP/ HIGH ESR = Flare
HIGH CRP/Normal ESR = Infection
Rheumatoid pleural effusions - presentation?
Low BGL < 2
Moderate WBC < 10,000
Most significant poor prognosis factor of Ankylosing spondylitis?
Hip arthritis
Colchicine neuro-myopathy - what do you see in muscle biopsy?
Vacuolar myopathy
What anti-gout medication increases risk of renal stones?
Probenecid - it alkaline the urine
what are 2 pathways in pathogenesis of GCA?
Treatment according to the pathways?
IL-17 axis = steroid responsive
IFgamma = non-steroid responsive —> vessel stenosis and occlusion ( neo-angiogenesis and tunica intima hyperplasia)
IL17 - = Tocilizumab
IFy = Aspirin/Statin
How to differentiate cryoglobulinemia and PAN?
Clinical features same but
cryoglobulinemia has deplete C4 and positive RF
Nailford capillaroscopy - dilated,enlarged distorted loops vessel indicates?
Connective tissue disorder - MCD, Polymyositis, Dermatomyositis, RA
what are RF?
IgM acting against Fc portion of IgG
What sign on ultrasound for GCA?
Non-compressible halo sign
Why use TNFa with MTX?
synergistic effect
What features less likely in drug-induced SLE?
Rash
what medications can induce antibodies - dsDNA/ANA in previously negative - seronegative RF
Drug induced - TNFa inhibitors
PMR without GCA - what is present?
Reduced IFgamma - protective against GCA
Calcium pyrophosphate crystals (pseudo-gout) produced by and move around by?
Chondrocytes
Move by Transmembrane protein ANKH
Gout
- proximal tubule reabsorption channel?
- proximal tubule secretion channel?
Reabsortion - URAT1 and GLUT9
RA-Gout
Secretion - OAT3 and ABCG2
OA-BGone
Probenecid mechanism of action?
Inhibit OAT channel - so reduce secretion of drug ( B-lactam)
