Rheumatology Flashcards
What disease is associated with anti-U1RNP?
Mixed connective tissue disease
What is anti-ANA antibody associated with?
Generic vasculitides and SLE
What antibody is seen in scleroderma (+types)?
Anti-centromere: scleroderma
Anti-DNA Topoisomerase 1: diffuse scleroderma
What antibody is specific for Goodpasture’s disease?
Anti-basement membrane antibody
What disease is associated with Anti- glutamate decarboxylase antibody?
Type 1 diabetes mellitus
What antibody is specific for polymyositis? And what is sensitive for myositis?
Polymyositis: Anti-Jo1 antibody
Dermatomyositis/polymyositis: Anti-Mi2 antibody
Lose your MiJo
What antibody is most specfic for Rheumatoid?
ANti-CCP (centrinylated peptide)
80% of RhA have positive Anti-IgG
Rheumatoid factor may be positive.
What antibody is seen in Hashimoto’s thyroiditis?
Anti-microsomal antibody
What antibodies are seen in Sjogren’s syndrome?
Sjogrens likes to RhoLa skate: anti-Rho and Anti-La (both are RiboNucleoProteins RNPs)
Which vasculitides are ANCA positive?
C-ANCA (pr3): Wegener’s vasculitis (GPA)
P-ANCA (mpo): Microscopic polyangiitis (MPA) and Chung-strauss (E-GP) Pancakes for ME!
Which antibody is specific for PBC?
Anti-mitochondrial antibody. NB. You can see anti-smooth muscle antibody in PBC and PSC and Type 1 autoimmune hepatitis
What antibody is seen in pemphigis vulgaris?
Anti-desmoglue
Specific antibody for SLE?
Anti-dsDNA (seen in only 60% but only seen in SLE)
Which antibody is most specific for sjogren’s syndrome?
Anti-IgG (although also commonly seen in Rheumatoid arthritis)
Diagnostic criteria for SLE?
MR. ANA PHOIDS has SLE -> need 4/11 Malar rash Renal disorder (proteinuria or haematuria) ANA+ Neurological: psychosis or seizures Arthritis (polyarticular, non-erosive, small joints e.g. Hands) Photosentivity Haematology: -paenia of any cell line Oral ulcers Immunological disorders: anti-dsDNA Ab and anti-smiff Ab Discoid rash Serositis (pleurisy, pericarditis)
Most sensitive antibody for SLE? Most specific?
Most sensitive: Anti- ANA (if negative, they are unlikely to have SLE)
most specific: Anti-dsDNA (only seen in 60%, but only in SLE)
How to distinguish drug induced SLE from other SLE?
Anti-histone Ab is specific for drug induced SLE. Also take a careful drug history. Renal involvement uncommon in drug-induced SLE. They recover once you remove drug.
What is Leidman-Sacks endocarditis?
Sterile endocarditis due to SLE
How to distinguish SLE and RhAr?
SLE: CRP normal, C3/C4 low, RhF- , ANA+ , Anti-DNA+
RhAr: CRP high, C3/C4 normal, RhF+ , ANA- , AntiDNA-
What are Anti-IgG antibodies?
IgM/IgA to Fc portion of own IgG
Do people with Sjogren’s syndrome live as long as general population?
No.
Primary disease (sicca) < secondary disease (other autoimmune condition)
Most commonly RhAr (CD4+ Tcells and plasma cells)
x40 increased risk of non-hodgekin’s lymphoma
Features of Systemic sclerosis?
Diffuse scleroderma (widespread skin, rapid progress -> viscera) OR Cutaneous scleroderma AKA CREST Calcinosis Raynaud's disease Esophageal dysmotility Sclerodactyl Telangectasia
Pt comes in ?SLE and has blood tests showing increased bleeding time and positive syphilis test- explain.
Anti-phospholipid antibodies: Main 2 are anti-cardiolipin or lupus anticoagulants
SLE: anti-cardiolipin antibodies cross react with syphilis test.
Also lupus anticoagulant results in decreased clotting in vitro (and increased clotting in vivo)
Features of polymyositis?
Rash around orbits, proximal muscle weakness and aching.
Immune complex deposition vasculitides?
SLE: autoimmune antigens
Penicillin- hapten
Secondary to infections e.g. Polyarteriitis nodosa is Hep B+ in 30% -> HBsAg-Ab complexes.
Which disease is caused by anti-endothelial cell antibodies?
Kawasaki’s disease.
What disease is caused by anti-basement membrane antibodies?
Goodpasture’s disease
Large vessel vasculitides?
Takayasu’s arteriitis/aortitis
Giant cell arteriitis
Complications of Takasayu’s arteriitis?
Transmural scarring and thickening of aorta. Aortic valve insufficiency.
Medium vessel vasculitides
PolyArteriitis Nodosa
Kawasaki’s arteriitis
What vasculitis is not associated with asthma or granulomas?
Microscopic polyangiitis
- asthma -> Chung-strauss
- granulomas -> Chung-strauss or wegener’s
