Rheumatology 4 Flashcards
Early diffuse Scleroderma with ILD - monitoring regimen?
DLCO - 3 monthly for 3 years then annually
Predictors of Diffuse Scleroderma with ILD?
HRCT = > 20% fibrosis
then
FVC < 70%
Treatment for Diffuse Scleroderma with ILD?
MMF - 1st line
Group I pHTN is idiopathic but what’s the proposed mechanism?
pre-capillary
angioproliferative vasculopathy affects pulmonary ARTERIES - remodelling and RIGHT HEART FAILURE
Group 5 pHTN mechanism?
pulmonary veno-occlusive disease
Characteristic of pre-capillary pHTN (Group 1,3,4) measurement?
mPAP > 20 mmHG
PCWP < 15 mmHG
In systemic Sclerosis - what concurrent disorder confers worst prognosis?
Iron deficiency
Scleroderma renal crisis - risk factors?
If associated with neurologic involvement (headache, visual changes) - what drug?
RNA polymerase III
Tendon friction rubs
IV nitroprusside - to quickly lower HTN
Esophageal and gastric dysmotility in Scleroderma - treatment?
Shortening gastric emptying process, reduce reflux
- Busprirone ( 5-HT1a receptor agonist)
- Masopride (5-HT4 receptor agonist) -
Dermatomyositis has what type of cells?
Inclusion body myositis has what type of cells?
response to treatment?
CD4 T cells
CD4 and CD8 T cells, plasma cells
-less responsive to immunosuppressant
MDA-5 antibodies - significance?
Melanoma differentiation associated gene-5
-HIGH RISK OF ILD
CDAM ( clinically amyopathic dermatomyositis) - clinical significance?
No muscle involvement but malignancy
MDA-5 positive
Antibodies in myositis confers higher risk of malignancy?
Anti-TIF1
Anti-NXP
Antibodies in myositis confers worst prognosis?
antibodies in myositis confers best prognosis?
Anti-SRP/Anti Jo-1
Anti-Mi2
Aspirin suppresses what cytokine in GCA?
IFNy
IL6 role in GCA?
cause TH to differentiate into TH17 which secretes IL17
When avoid probenecid in gout?
history of urate nephrolithiasis
CKD ( not effective)
What disorder found in Limited Scleroderma apart from CREST?
What disorder found in diffuse scleroderma?
Limited Scleroderma;
Group I pHTN
Centromere antibodies
Diffuse Scleroderma
Group III pHTN, ILD ( lungs!)
SCL-70 antibodies
Sacro-iliitis INFECTIVE - whats the usual cause? and treatment?
Brucella
TB
Treatment is Doxycyline and Rifampicin
Which antibodies in myositis have subacute cutaneous lupus?
Anti SSA/Ro
Treatment for scleroderma renal crisis?
Short acting ACEI - captopril to reach BP of 120/70
2nd line - Dihydropyridine CCB can be added
Treatment for Reactive arthritis?
Self-limiting
NSAIDS - acute phase
Intra-articular steroids - in mono/oligo-arthritis/bursitis
Systemic steroids - polyarthritis
In paget’s disease - if intolerant to zolendronic acid or CrCL < 30ml/min - alternative?
Calcitonin
What lymphoma strongly associated with sjogren syndrome?
B- cell Non-Hodgkin Lymphoma
Allopurinol mechanism of action?
Purine + Pyrimidine analogue - compete and attract XO to metabolism them
- less real purine being metabolised to uric acid
Best proven medications for Fibromyalgia?
Amitriptyline
Pregabalin
5HT2 antagonist (cyclobenzaprine)
When to give IVIG in IBM?
ONLY IF oropharyngeal dysphasia
Ctx - bone resorption marker is useful for?
Monitoring osteoporosis and MM
Pseudogout a/w what condition?
HyperPTH
FHH
What is catastrophic APL?
Treatment for it?
Multiple thrombi affecting 3 or more organ systems - organ failure
Whack everything -
PLEX + IVIG
Steroids
Anticoagulation
Difference between primary and secondary Raynaud’s phenomenon?
Secondary Raynaud = Endothelial dysfunction
-Reduced NO, increased Endothelin-1 = vasoconstriction
