Rheumatology Flashcards
TNF adverse effects to know
1) hold in severe infections
2) reactivation of hepatitis B, which can be fatal
3) check for latent TB and screen regularly
4) avoid in class III/IV heart failure
5) Considered safe in pregnancy
6) positive ANA, with lupus-like syndromes
7) demyelination, similar to MS
Warning for lymphoma risk, though this is controversial
anti-smith
SLE (specific for diagnosis)
- do not correlate with disease activity, use to diagnose
anti-U1-RNP
MCTD
Anticentromere pattern of ANA
CREST syndrome, SSc and PH
anti-dsDNA ab
correlates with SLE disease activity
anti-smooth muscle
autoimmune hepatitis
anti-La/SSB
Sjogren syndrome, neonatal lupus
anti-Scl70
SSc, pulmonary fibrosis, diffuse cutaneous SSc
Antihistone
drug-induced SLE
Anti-Ro/SSA
Sjogren syndrome, subacute cutaneous lupus
c-ANCA (anti-PR3)
GPA
Need a GPA of 3 to Pass Rheumatology (PR3)
p-ANCA (anti-MPO)
Eosinophili granulomatosis with polyangiitis, and MPA
Anti-Jo-1
Polymyositis, and antisynthetase syndrome
Anti-CCP
RA
Anti-TNF biologics used in RA
1) Enteracept
2) Adalimumab
3) infliximab
4) Golimumab
5) Certolizumab
increased risk of infection, avoid live vaccines
Non-TNF biologics used in RA
1) Tocilizumab/sorilumab (Anti- IL-6)
2) Abtacept (CTLA-4 IgG)
3) Ritixuimab (B cell agent)
4) Anakinra (IL-1 inhibitor)
Findings in microscopic polyangiitis
nongranulomatous necrotizing pauci-immune vasculitis of the small vessels or pauci-immune necrotizing crescenteric GN
Clinical findings: pulmonary hemorrhage, pauci-immune small-vessel necrotizing vasculitis of the skin, proteinuria, inflammatory arthritis, positive p-ANCA (MPO, perinuclear)
histology differences between GPA, MPA, Eosinophilic GPA
GPA: granulomatous pauci-immune vasculitis
MPA: nongranulomatous pauci-immune vasculitis
E GPA: granulomatous pauci-immune vasculitis with eosinophilia
In severe refractory tophaceous gout, which IV therapy is indicated
Pegloticase infusion (porcine-derived uricase enzyme)
Stop other uric acid treatments, as serum urate levels are trended to screen for antibody development, and this may obscure this screening
Start prophylaxis for gout flares with either NSAIDs, glucocorticoids, or colchicine