Rheumatology Flashcards
Is SLE more F or M predominant
F
Typical onset of SLE
15-50yrs
Aetiology SLE
Exact cause unknown Genetics Sex hormone status Drugs UV light (can trigger attacks ) EBV exposure
Who is SLE a disease of
Young females
Which Autoantibodies are associated with SLE
ANA
Anti-dsANA
Anti-smith
Anti Ro
What happens to serum compliment levels in SLE
Decreases
Which organ does SLE affect
It is a multi system autoimmune disease
It affects many organs and many systems (systemic)
Who should you suspect SLE in
Young females
Face manifestations of SLE
Butterfly rash
Photosensitivity
Malar flush
What types of disease is SLE
Autoimmune
What is the main cause of SLE
Exact cause is unknown
Chest manifestations of SLE
Pleurisy
Pleural effusion
Fibrosis
Joint manifestation of SLE
Arthritis of small joints
Aseptic necrosis of hip
Nervous system manifestations of SLE
Fits Hemiplegia Ataxia Peripheral neuropathy CN lesions
Heart manifestations of SL
Pericarditis
Endocarditis
Aortic valve lesions
Cardiomyopathy
GI manifestations SLE
Abdo. pain
mouth ulcers
Blood manifestations of SLE
Anaemia
Leukopenia
Thrombocytopenia
General manifestations of lupus
Fever Depression Fatigue Malaise Weight loss Lymphadenopathy
What is a far more common cause of a face butterfly rash (compared to SLE)
Acne and rosacea
Ix for SLE
FBC Anaemia Urine dipstick ESr CRP U&Es Urea Creatinine
Ix autoantibodies for SLEP
Complement level ANA Anti-dsANA Anti-Smith Anti-Ro
Imaging Ix for SLE
Skin and kidney biopsy
CT scans
CXR
Rx for mild SLE
Hydroxychloroquine
High factor sunblock
NSAIDS
Rx for moderate SLE
Azathioprine
Methotrexate
Mycophenolate
What type of pattern does SLE follow
Relapse and remitting
Name another disease apart from SLE which follows a relapse and remitting course
Multiple Sclerosis
Rx for severe SLE
Cyclophosphamide
Rituximab
High dose steroids
Why can methotrexate not be given in pregnancy
It is teratogenic
Are SLE exacerbations more or less common in pregnancy
More common
What are pregnant ladies with SLE more susceptible to
Pre-eclampsia
What are safe pregnancy drugs for SLE
Azathioprine
Low dose oral steroids
Explain the SLE classification criteria
Any 4 or more criteria (1 clinical, 1 laboratory)
Or biopsy proven lupus nephritis with +ve ANA or +ve anti-DNA
What are the 11 clinical criteria for SLE
1) Acute cutaneous lupus/Malar rash (butterfly rash)
2) Chronic cutaneous lupus/Discoid rash (raised, scarring, permanent marks, non scarring alopecia)
3) Non-scarring alopecia
4) Oral/Nasal ulcers
5) Synovitis (2 joints at least)
6) Serositis (pleurisy or pericarditis)
7) Urinalysis (presence of proteinuria or red cell casts)
8) Neurological (unexplained seizures or psychosis)
9) Haematological/ Haemolytic anaemia
10) Leucopenia
11) Thrombocytopenia
What is the laboratory criteria for SLE
\+ve ANA \+ve Anti-dsANA \+ve Anti-Smith \+ve Anti-Phospholipi Low Complement \+ve Direct Coombs Test
What is the most common systemic vasculitis
Giant Cell Arteritis
What is GCA
Inflammatory granulomatous arteritis of temporal arteries
Signs of GCA
Increased ESR Temporal artery tenderness Reduced pulsation New headache Jaw claudication Beaded appearance
What is the most feared manifestation of GCA
Sudden painless temporary vision loess in one eye
What is vision loss caused by in GCA
Involvement of ophthalmic artery
What is the Dx for GCA
Temporal artery biopsy
Rx GCA
High dose prednisone
What is GCS associated with in 50%
Polymyalgia Rheumatica
What is Polymyositis characterised by
Insidious onset of progressive symmetrical proximal muscles weakness and autoimmune mediated striated muscle inflammation
What is dermatomyositis
When there is polymyositis with skin involvement
Signs of polymyositis
Proximal weakness of muscles
Muscle wasting
Skin signs of Dermatomyositis
Gottron’s Papules
Helitrope Rash
Macular rash
What is Shawl sign
Shawl sign is +ve if there is a muscular rash all over the back and shoulders
where does a heliotrope rash affect
The eyelids
Main symptoms of Polymyositis
Proximal muscle weakness
Which enzyme is elevated in polymyositis
Creatinine
Ix polymyositis
Creatinine
EMG
Muscle biopsy
Rx for polymyositis
Prednisolone (steroids)
Immunosuppression:
Methotrexate
To treat rashes:
Hydroxychloroquine
Topical Tacrolimus
What is the diagnosis
45 Y female presents with 3/7 Hx difficulty breathing and right sided chest pain worse with deep inspiration. Her CXR confirms right pleural effusion. Treatment with antibiotics makes no difference. Her FBC showed persistently low WCC of 3.0 then 3.2 and low platelets of 100. In the last year she has been experiencing intermittent pain and swelling in her joints and recurrent facial rash after sun exposure .
SLE
Complications polymyositis
Increased malignancy risk
Increased interstitial lung disease risk
Which gender does Sjogren’s much more commonly affect
Females
What are the primary symptoms of Sjogren;s
Dry eyes Dry mouth Dry skin Parotid gland enlargement Vaginal sryness
Ix for Sjogren’s
FBC RF ANA antibodies Anti-Ro Anti-La
Schirmer Tear Test
Rose Bengal staining
Biopsies
Rx for Sjogren’s
Artificial tears and saliva replacement solutions
Lubricants
Hydroxychloroquine
Complications of Sjogren’s
Lymphoma Non-Hodgkin’s B Cell Lymphoma Neuropathy Purpura Interstitial lung disease Renal tubular acidosis
Which disease does polymyalgia rheumatic have a close connection with
Giant cell arteritis
what is polymyalgia
Polymyalgia rheumatica (PMR) is an inflammatory rheumatological syndrome that manifests as pain and morning stiffness involving the neck, shoulder girdle, and/or pelvic girdle in individuals older than age 50 years.
What is the pathogenesis of polymyalgia rheumatica
Unknown
What is the most common presentation of polymyalgia rheumatica
Pain and stiffness in the neck, shoulder girdle +/- pelvic girdle
Rx of polymyalgia rheumatica
Corticosteroid (prednisolone)
Which medication should there be a dramatic response to in polymyalgia rheumatica
Corticosteroids
which criteria would indicate a positive diagnosis of Polymyalgia Rheumatica
Age >50yrs
Pain in shoulders or hips
Stiffness in the morning that persists >45 mins
Symptoms have lasted >2 weeks
Blood tests should increased ESR andCRP
Dramatic response to Prednisolone (corticosteroids)
what is a 2nd line rx for polymyalgia rheumatica
Methotrexate (DMARD)
Ix for Polymyalgia Rheumatcia
NO specific Ix or Test
Bloods:
CRP
ESR
RF (to rule out RA)
Strong suggestive diagnostic factors
Which gender is polymyalgia rheumatic more common in
Females
