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BPT > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What does positive rheumatoid factor indicate?

A

RhF is an autoantibody directed against Fc domain of IgG

It is used in the diagnosis of rheumatoid arthritis - sensitivity 70-80%, specificity 85%.

Also positive in multiple other conditions:

  • Felty’s syndrome (100%)
  • Sjogren’s syndrome (100%)
  • Mixed connective tissue disease (50%)
  • SLE (40%)
  • Systemic sclerosis (30%)
  • Infection (50%)
  • Normal people (2-10%)
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2
Q

What does positive anti-CCP indicate?

A

Very specific for diagnosis of RA (94-98% specific)
Sensitivity about 80%
Also predicts more aggressive disease in RA (more erosions)

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3
Q

What does positive anti-dsDNA indicate?

A

Very specific for diagnosis of SLE (95%)

Sensitivity about 60%

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4
Q

Levels of which antibody correlate with disease severity in SLE?

A

Anti-dsDNA

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5
Q

Which auto-antibody is specific for drug induced lupus?

A

Anti-histone

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6
Q

What are the antibodies used to test for antiphospholipid syndrome?

A
  1. Anticardiolipin
  2. Anti-beta-2 glycoprotein
  3. Lupus anticoagulant testing - involves three steps
    - > Demonstration of prolonged phospholipid dependent screening test of haemostasis (either prolonged dilute Russel viper venom time (dRVVT) or prolonged lupus aPTT)
    - > Mixing patient plasma with normal plasma fails to correct prolonged screening tests (suggests presence of inhibitor)
    - > Addition of excess phospholipid shortens or corrects the prolonged coagulation test (demonstrates phospholipid dependence)
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7
Q

What does positive anti-Ro (SSA) antibody indicate?

A

Positive in Sjogren’s syndrome (40-95%), SLE (32%), systemic sclerosis (21%), RA (15%)

Associated with neonatal lupus (+ complete heart block)

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8
Q

What does positive anti-La (SSB) antibody indicate

A

In combination with +ve anti-Ro, it is quite specific for Sjogren’s or SLE

Associated with neonatal lupus (+ complete heart block)

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9
Q

What does positive anti-Smith Ab indicate?

A

Most specific test for SLE (99%) but not very sensitive (<30%)

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10
Q

What is the most specific antibody test for SLE? What is the most sensitive?

A

Most specific - anti-Smith (99%)

Most sensitive - ANA (98-100%)

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11
Q

What does positive anti-ribosomal P antibody indicate?

A

Highly specific for SLE (98%) but not very sensitive (15%)

Associated with CNS lupus and lupus hepatitis

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12
Q

What does positive anti-Jo-1 antibody indicate?

A

Assoc with polymyositis and anti-synthetase syndrome

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13
Q

What does positive anti-Mi-2 antibody indicate?

A

Assoc with dermatomyositis

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14
Q

What does positive anti-Scl70 (anti-topoisomerase I) indicate?

A

Highly specific for systemic sclerosis (100%) and particularly the diffuse type
Increased risk of pulmonary fibrosis/ILD

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15
Q

What does positive anti-centromere Ab indicate?

A

Specific for limited systemic sclerosis, particularly CREST syndrome
More likely to develop pulmonary HTN

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16
Q

What does positive c-ANCA antibody indicate?

A

c-ANCA is directed against PR3
(remember C = 3)

Highly specific + sensitive for granulomatosis with polyangiitis in the right clinical context (Wegener’s)

17
Q

What does positive p-ANCA antibody indicate?

A

p-ANCA is directed against MPO

Positive in a variety of conditions including: microscopic polyangiitis, Churg-strauss, ulcerative colitis, PAN, RPGN

18
Q

What does positive anti-U1-RNP indicate?

A

This antibody is always positive in mixed connective tissue disease
However it is also positive sometimes in SLE (40%)
Thus not specific for MCTD

19
Q

What antibodies are associated with a SPECKLED ANA?

A

Speckled ANA - fine or coarse speckles throughout the nucleus

Associated with the ENAs:

  • U1-RNP [MCTD]
  • Sm [SLE]
  • La, Ro [SS, SLE]
  • SCl-70 (topoisomerase) [DcSSc]
  • RNA polymerase II and III [DcScc]
20
Q

What does positive anti-RNA polymerase III indicate?

A 
Highly specific (>99.5%) for systemic sclerosis
Assoc with DcSSc and in particular rapidly progressive skin involvement and development of scleroderma renal crisis
21
Q

What conditions are associated with a HOMOGENOUS ANA?

A

Drug induced lupus, SLE, Sjogren’s, JIA

10% of normal population

22
Q

What antibody is associated with a PERIPHERAL RIM ANA?

A

Anti-dsDNA (SLE)

23
Q

What antibody is associated with a CENTROMERE ANA distribution?

A

Anti-centromere antibody

Condition - limited scleroderma, esp associated with pulmonary HTN

24
Q

What antibody is associated with a NUCLEOLAR ANA staining pattern?

A

RNA polymerase I
Th
Pm-Scl

Conditions: SLE, diffuse scleroderma, polymyositis, nucleolar dot with PBC, 5% normal population

BPT (2 decks)

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