Rheumatology Flashcards
Which diseases have a nucleolar ENA/ANA pattern?
SS and polymyositis
Which diseases have a Centromere ENA/ANA pattern?
Limited SS
ENA pattern of SLE
Homogenous dsDNA and speckled anti-smith antigen
ENA pattern of DLE
Homogenous anti histone
ENA pattern of diffuse systemic sclerosis
Speckled anti-RNA poymerase III and speckled SCL-70
ENA pattern of sjorgren’s
Speckled Ro (SSA) and La (SSB)
What is Crest syndrome?
Found in limited SS: Calcinosis Raynauds Esophageal motility Sclerodactyl Telengectasia Also get scleroderma of face/neck (as far up as elbow and knees), pulmonary hypertension, Fibrotic lung disease and mild GI disease
Stomach complication of SS
GAVE - Gastric Arterial Vascular Ectasia - dilated submucosal vessels that can bleed. Resembles watermelon
Treatment progression for raynauds
Ca2+ blockers, then sildenafil, then IV misoprostol
Difference between myalgia and myositis
Both can have pain but myositis has raised muscle enzymes and weakness
Skin manifestations of dermatosmyositis
Gotrans papules, heliotrope rash, periorbital oedema and shawl sign
ANA present in MCTD
Anti-U1 RNP
First line management of ankylosing spondylitis
NSAIDs
Most common organism causing septic arthritis
Staph aureus esp RA and diabetics
ENA in limited systemic sclerosis
Anti-centromere
X-ray features of paget’s disease of bone
Coarsened trabeculae, mixed lytic/sclerotic appearance, bone deformities and osteoarthritis, loss of distinction between corticises and medullary bone and bone fractures
Lab finding of pagets disease of the bone
Elevated serum ALP and elevated urinary hydroxyproline. Ca2+ levels are usually normal
Treatment for pagets disease of the bone
NSAIDs, pain relief and physio if mild. Oral bisphosphonates (and potentially calcitonin) if more severe
What type of crystals are found in gout on microscopy
Negatively birefringent needles
How long after acute gout flare should allopurinol be initiated?
2 weeks
Most common tissue type in which crystals are deposited in pseudogout
Synovium
Are rheumatoid nodules more common in patients who are RF positive or negative?
RF positive
Complement level changes in SLE
Low C3 and C4
Main demographic for SLE
Young women
Triad characterising EGPA
Late onset asthma/allergic rhinitis
Systemic vasculitis (constitutional symptoms, arthropathies, GI, rash, mononeutitis multiplex etc)
Peripheral eosinophilia - pANCA suggestive too.
Which drugs can unmask vasculitic syndrome in EGPA diagnosed with asthma?
Leukotriene receptor antagonists - e.g. Montelukast
Triad characterising GPA
Upper respiratory tract and sinus involvement (chronic sinusitis, rhinitis, nosebleed, septal perforation and saddle nose deformity) Lung involvement (Haemoptysis and cavitating lesions) Kidney involvement (necrotising glomerulonephritis or rapidly progressive glomerulonephritis) Can affect other systems too and often positive for c-ANCA
Antibodies for dematomyositis
ANA, anti-JO-1, anti-MI-2
Felty’s syndrome
Very active rheumatoid disease, splenic enlargement and neutropenia
Which vasculitis is associated with hep B infection?
PAN
What is Lofgren syndrome?
Acute arthopathy in sarcoidosis - often associated with erythema nodosum and a fever
Which serum enzyme is raised in sarcoidosis?
ACE
What bacterial infection can cause acute migratory tenosynovitis in young adults (ep Women)?
Disseminated gonnococcal infection (test for c6-9 complement deficiency)
Which antibody is present in Lambert Eaton syndrome?
Anti-VGCC
What Ix must be done in RA sufferers prior to surgery?
Cervical spine x-rays - may C1-2 instability which could be subluxed during intubation
