Rheumatology Revision Flashcards
What are the antibodies of SLE?
ANA, dsDNA, anti-Sm, anti-histone (drug-induced)
What can be used as a marker of disesase activity in lupus?
dsDNA, C3/C4
What is the most specific antibody for SLE?
anti-Sm
What are the antibodies of sjogren’s
ANA, Ro, La
What antibodies are in mixed connective tissues disease?
anti RNP
What antibodies are in scleroderma?
ANA, anti Scl-70 (diffuse), anti centromere (limited), RNA polymerase III (renal crisis
What antibodies are in myositis?
ANA, anti Jo1
What test should be ordered in statin induced necrotising myopathy?
anti-HMG co-A reductase antibodies
What antibodies are in RA?
RF, anti CCP
Are RF and anti CCP markers of disease activity in RA?
No
What antibodies are in ANCA associated vasculitis?
ANCA
What are the three types of ANCA associated vasculitis?
granulomatosis with polyangitis, microscopic polyangits, eosinophilic granulomatosis with polyangitis
Which ANCA subtype is associated with GPA?
PR3 antibodies
Which ANCA subtype is associated with MPA?
MPO antibodies
Which ANCA subtype is associated with EGPA?
MPO and PR3 antibodies
Should ANA ever be repeated?
No
What is a DMARD?
a disease modifying anti rheumatic drug
What are the common conventional synthetic DMARDs?
methotrexate, sulfasalazine, hydroxychloroquine, leflunomide, azathioprine
What is the mechanism of action of methotrexate?
purine metabolism inhibitor
What are the common side effects of methotrexate?
GI upset, fatigue, mental clouding, mouth ulcers, hair thinning, low blood counts, abnormal LFTs, pneumonitis
Why do you need to check UECs in methotrexate?
because it is renally cleared, but it is not renal toxic
What medication should be avoided when on methotrexate?
trimethoprim
How do you minimise GI SEs of sulfasalazine?
start slow
What are the SEs of sulsasalazine?
headaches, GI upset, orange discolourtation of urine/sweat, low blood counts, abnormal LFTs
What are the SEs of hydroxychloroquine?
GI side effects, increased sensitibity to sun, blurred vision, worse psoriasis, retinal toxicity
How often should patients on hydroxychloroquine get an opthalmology review?
every 12-18 months
What are the SEs of leflunomide?
diarrhoea, dry mouth, mouth ulcers, hair thinning, HTN, dizziness, low blood count, abnormal LFTs, pneumonitis, peripheral neuropathy, shingles
What test should be done in all patients before starting a DMARD?
quantiferon gold and CXR, Hep B, Hep C, HIV
What vaccinations are recommended while on DMARDs?
pneumovax, fluvax and to have any live vaccines required before starting
Which rheumatic medications can be used in pregnancy?
glucocorticoids, azathioprine, cyclosporine, tacrolimus, sulfasalazine, anti TNFs, IVIG
Which rheumatic medications cant be used in pregnancy?
cyclophosphamide, methotrexate, mycophenolate, leflunomide, NSAIDs
What should be done if someone accidentally conceives while on methotrexate?
cease and continue 5mg folate throughout pregnancy
Can biologics be used in pregnancy?
TNF inhibitors are safe however others should be ceased
What needs to be done about DMARDs in perioperative management?
csDMARDs can continue but biologics need to be stopped
What should be done for SLE in perioperative management?
If not severe SLE stop 1/52 prior to surgery
