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Immunology/Rheumatology > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Urate targets in gout treatment

A

Low disease burden <0.36 mmol/L High disease burden <0.3 mmol/L

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2
Q

What is this?

A

Double conture sign

Seen in gout due to a layer of crystals on the surface of the cartilage

Sens 44% Spec 99%

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3
Q

What type of crystal is seen in gout?

A

Monosodium urate

Strongly negatively birefringent needle shapped crystals:

‘Yellow when parrallel to the polariser’

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4
Q

What is the HLA association with allopurinol hypersensitivity?

A

HLA -B*58:01

Test Han Chinese, Thai, Korean

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5
Q

What are the key inflammatory components of gout attack?

A

Inflammasone assembly

IL1 production

Phagocytosis by macrophages

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6
Q

What non-traditional urate lowering drugs can lower serum urate?

A

Losartan

Fenofibrate

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7
Q

What are the XR changes seen in osteoarthritis?

A

L - Loss of joint space

O - Osteophytes

S - Subchondral cysts

S - Subchondral sclerosis

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8
Q

What is the HLA association with rheumatoid arthritis?

A

Increased risk with HLA-DRB1

Felty syndrome is associated with HLA DR4

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9
Q

What pattern is rheumatoid associated interstitial lung disease?

A

Usually UIP, worse prognosis than NSIP

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10
Q

What is Felty Syndrome?

A

Triad of persistant rheumatoid arthritis, splenomegaly and neutropenia

Can have other extra-articular manifestations

Associated with HLA-DR4

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11
Q

What are the key cytokines seen in RA?

A

TNF-a

IL-6

IL-1

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12
Q

What is the classification of lupus nephritis?

A
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13
Q

What are the principles of the 2019 EULAR-ACR SLE classification criteria?

A

Must have ANA > 1:80 at any point in time

Must have at least 1 clinical criteria and total score >10

The clinical criteria contain - fever, cutaneous, arthritis, neurological, serositis, haematological and renal manifestations

Immunological criteria - anti-phospholipid, complement, dsDNA, anti-SM

If there is a renal biopsy demonstrating lupus nephritis this is diagnostic

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14
Q

What are the changes in complement seen in SLE?

A

Low C3 C4 in active disease

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15
Q

How is disease acitvity in lupus monitored?

A

Clinically

ESR>CRP

dsDNA

Complement levels

Proteinuria

Disease activity scoring systems

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16
Q

What is the management of lupus nephritis?

A
  1. General measures with ACEI, BP management, CVD management, hydroxychloroquine
  2. Immunosuppress class III, IV and possibly V
    - Induction with steroids + mycophenolate or cyclophosphamide
    - Maintance with low dose steroids + mycophenolate or azathioprine
17
Q

What are anti-Ro and anti-La antibodies associated with?

A

Sjogrens

Sjogren manifestations in SLE

Congentital heart block, neonatal lupus

18
Q

What antibodies are associated with neurolupus?

A

Anti-ribosomal P

19
Q

What are the risk factors for poor pregnancy outomes in SLE?

A

Disease activity in preceeding 6 months

Stopping hydroxychloroquine

Serological activity

Lupus nephritis

Anti-phosopholipid syndrome

Organ damage

Anti Ro and Anti La (SSA and SSB)

20
Q

What are the antibodies seen in scleroderma and whar are they associated with?

A

Centromere - limited, Pul HTN

Topoisomerase 1 (Scl-70) - ILD

RNA polymerase III - diffuse, renal involvement

21
Q

What antibody is associated with mixed connective tissue disease?

A

ANA speckled

ENA - U1RNP

22
Q

What is the classic clinical feature of mixed connective tissue disease?

A

Puffy hands

23
Q

What types of rash are seen in dermatomyositis?

A

Gotrans patches - over knuckles of hands

Shawl sign - back of neck/shoulders

Heliotrope rash - eye lids

24
Q

What is the muscle involvement pattern with inclusion body myositis?

A

Distal upper limb

Proximal lower limb

Can be asymmetric

25
Q

What is the HLA association with immune mediated necrotizing myopathy? What is the antibody?

A

HLA DRB1*11:01

ANti0HMGCR antibodies highly specific

26
Q

What is anti-synthetase syndrome?

A

ILD

Raynauds

Mechanics hands

Arthritis

Myositis

Most commonly Jo-1 positive

27
Q

What is Lofgren syndrome?

A

A particular sarcoidosis syndrome

  • hilar lymphadenopathy
  • Joint pain - often ankle
  • Erythema nodosum
28
Q

What are the key inflammatory drivers of ankylosing spondylitis?

A

IL-23 driving Th17 picture which produces IL-17 and TNFa

29
Q

What are the cardiac manifestations of ankylosing spondylitis?

A

Ischaemic heart disease

Conduction defects

Aortic regurgitation

30
Q

What types of lung disease is seen in ankylosing spondylitis?

A

Restrictive lung defect from reduced chest wall expansion

Interstitial fibrosis - in the upper lobes

31
Q

What is the treatment for ankylosing spondylitis?

A

1st - NSAID (continous) and physio, education, smoking cessation

**Extra-axial disease - local steroid injections, MTX, sulfasalazine

2nd - anti-TNFa or secukinumab (anti-IL17)

32
Q

In ankylosing spondylitis what agents should not be used in co-existing IBD?

A

Etanercept (anti-TNF) - not effective in IBD

Secukinumab (anti-IL17) - not effective, may be harmful

33
Q

What forms of arthritis affect the DIP joints?

A

Osteoarthritis

Psoriatic arthritis

Gouty arthrtitis

34
Q

What are the radiographic features of psoriatic arthritis?

A

Pencil in cup deformity

Marginal erosions with adjacent proliferation

Small joint ankylosis

Asymmetric sacroiliitis

35
Q

What antibody is associated with inclusion body myositis?

A

Anti-5NT1A

Highly specific but not sesnitive

Associated with more severe disease

36
Q

Which dermatomyositis anibody is associated with highest malignancy risk?

A

TIF gamma antibody

NXP2

Anti-P155

37
Q

What are the common ANA patterns? What are they associated with?

A

Homogenous - dsDNA, histone, chromatin

Rim or peripheral staining - dsDNA, sclerosis

Speckled - most eg SS-A, SS-B

Nucleolar - sclerosis, polymyositis

Centromere - sclerosis, primary biliary cirrhosis

Immunology/Rheumatology (2 decks)

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