rheumatology Flashcards
what are characteristics of normal synovial fluid
- highly viscous (high hyaluronic acid)
- clear
- essentially acellular
- protein conc 1/3 of plasma
- glucose conc similar to that in plasma
what are the categories of joint effusions
- noninflammatory
- inflammatory
- septic
- hemorrhagic
differentiate color in normal, non-inflammatory, inflammatory, and septic joint fluid
- normal: clear
- non-inflammatory: yellow
- inflammatory: yellow to opalescent
- septic: yellow to green
differentiate WBC in normal, non-inflammatory, inflammatory, and septic joint fluid
- normal: <200
- noninflammatory: <2000
- inflammatory: 2000 - <100,000
- septic: 15,000 - >100,000
differentiate PMN% in normal, non-inflammatory, inflammatory, and septic joint fluid
- normal: <25%
- noninflammatory: <25%
- inflammatory: > or = 50%
- septic: > or = 75%
differentiate culture in normal, non-inflammatory, inflammatory, and septic joint fluid
septic joint would give the only positive culture
synovial fluid crystals that show negative birefringent; needle shaped crystlas is consistent with
- monosodium urate -> Gout
synovial fluid crystals that show positive birefrigent; rhomboid shape is consistent with
- calcium pyrophosphate ->pseudogout
what is the gold standard for evaluating crystals
- polarized light microscopy
- birefringent: particular material’s ability to refract light rays
clinical presentation
- morning stiffness
- symmetric polyarthritis
- fatigue
- erythema, warmth and edema of joints: PIP and MCP
- ulnar deviation of MCP joints
RA
rheumatoid factor is associated with
SEVERAL diseases, poor specificity
what systemic autoimmune conditions are associated with a positive ANA
- results -> titer and nuclear staining pattern
- the higher the titer, the higher the likelihood of presence of disease
- conditions
- RA
- SLE
- sjogren syndrome
- diffuse schleroderma
- CREST syndrome
- polymyositis/Dermatomyositis
what antinuclear antibodies are associated with SLE
- anti-ds DNA
- anti-smith
what antinuclear antibodies are associated with Sjogren syndrome
- anti-Ro/SSA
- anti-La/SSB
what antinuclear antibodies are associated with Systemic sclerosis
anti-scleroderma-70
what antinuclear antibodies are associated with CREST
anticentromere (ACA)
Positive results indicate what condition
- ANA
- RF
- anti-CCP
RA
Positive results indicate what condition
- ANA
- Anti-sm
- Anti-dsDNA
SLE
Positive results indicate what condition
- ANA
- Anti-Ro/SSA
- Anti-La/SSB
sjogren
Positive results indicate what condition
- ANA
- Anti-SCL-70
- ACA
systemic sclerosis (Scleroderma)
Positive results indicate what condition
- ANA
- ACA: anticentromere
CREST
- (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia)
anti-dsDNA antibodies are found in patients with
active SLE (65-80%)
- higher titers are characteristic of SLE
anti-smith antibodies are found in patients with
- subtype of ANA specific for SLE
- present in about 30% of patients with SLE
Anti-Ro/SSA are consistent with
- used to diagnose Sjogren syndrome
- present in 60-70% of patients with primary Sjogren syndrome
