Rhueumatology X3 Flashcards
Systemic Lupus Erythematosus cause and risks
Autoimmune: Deposition of immune antibody complexes in tissues
F>M
- syptoms during child bearing age
AA> white
Lupus Presentation
Gen: fever, fatigue**, LAD, weight loss
- Malar rash
- Discoid patches on sun exposed areas
- Mucocutaneous painless oral or nasal mucosa ulcers
- alopecia
- Raynaus Phenomenon- vasoplasm of digital artereis when exposed to cold
- Nepheritis
- Joint paint or swelling
- N/V ab pain
- ^ risk for MI
- Neuro-seizures or dep or migraines
- can effect many organs so this is not exhaustive
Drug induced lupus
Clinical and immunologic pictur similar to spotaneous SLE
Procainamide, isoniazid, hydralazine
+ they will have a pos ANA BUT neg anti-dsDNA anti-Sm Ab
SLE dx lab testing
Antinuclear Antibody-ANA
- >95% cardinal feature but not specific
- comes back as a titer
ANA subtypes:
-anti-dsDNA, anti-Sm, antiphospholipid antibodies
* other system tests see slide 20
Lupus non pharm tx
Sun prot diet and exc smoking cessation immunixations tx for comorbid condition ( cholesterol or DM) Preg and contraception
Lupus Pharm Tx
Antimalarials: Hyroxychloroquine
- need eye exam!!
Addition
- NSAIDS, immunosupp, corticosteroids
Polymyositis
idiopathic inflammatory condition causing symetric proximal muscle meakness
- delt and hip flexor common
F>M 40-50yo
- gradual onset over weeks to months
Polysmyositis pres
Muscle weakness symetric
LungsL cough/SOB (intersitiail lung disease)
Esophageal disease
Cardiac disease
Raynaud phenomenon
risk for aspiration pnemoni and issues with the lungs and heart
Dermatomyositis
Polymosisits and cutaneous manifestations
- heliotrope rash
- gattrons papules
- shawls sign
- **link between inflammatory myopathy and occult malignancy!!!
Dermatomyositis and Polysmyositis labs and Dx
Muscle enzymes: CK and aldolase elevated
ANA +
might want to check:Chest Xray CT MRI US electromyography, muscle biopsy, skin biopsy
Polysmyositis tx
Goal to improve strength and decrease inflammation
1st line glucocorticoids
- steroid sparing agents may be added
Sjorgren Syndrome eitology and risks
Systemic chronic autoimmune inflammatory dis with the exocrine gland
- can be primary or associated with other diseases
F>M 40-50
Sjorgren Syndrome pres
-affects lacrimal and salviary glads ( sicca complex)
xeropthalmia and xerostomia
- arthritis, myalgia , raynaud, GI, hepatic, renal
- Think about the dryness of other feature other dry areas
Sjorgren Syndrome diagnostic
Schirmer test- test tear production ANA- anti Ro Anti-La RF+ ESR,CRP,CBC, Renal/Liver test - sometimes salivary gland biopsy
Sjorgren Syndrome Tx
Dry eyes: artificial tears cyclosporin
Xerostomia: artificial salvia and sugarless gandy
Extraglandular manifestations
-NSAIDS, acetaminophen
Polyarteritis Nodosa PAN
systemic necrotizing vasculitis
- inflammation of muscular arteries also leads to narrowing > resulting in thrombosis, ischemia, infart
M>F middle to older adults
COmmonly affects kidnys, skin, joints, muscles, nerves
PAN test
Renal Artery biopsy
- diffuse inflamation
- lumen is narrowed
Pan present
Fever wight loss malaise weakness arthralgia and mysalgia cutaneous tender nodules ulcer purpura Bx: will come back as leukocytoclastic vasculitis Renal manifestations common
Labs for PAN
ESR CRP
serum creatinine, muscle enzymes, liver function studies
ANCA- negative!!
- pos will point to other kinds of vasculitis
-tissue biopsy of affected orans
-arteriography- will se many microaneurisms
PAn tx
initial
mild; glucocorticoids
mod: glucocorticoids/immunosuppressive meds
if associated with hep B or C treat those and glucocorticoids depedning on severity
Systemic Sclerosis
Autoimmune disorder causes diffuse fibrosis or skin and internal organs vasuclar arrowing of blood vessels - more fibroblasts are forming F>M onset 20-50
Systemic Sclerosis CREST synd
Calcinosis, Raynauds, esophageal dysfunction, scelrodactyly, telangiectasias
Systemic Sclerosis labs
ANA
- ACA- usually limited SSc
- ANtitipoisomerase. diffuse
- Anti RNA poylmerase III> associated with rapidly progressing diffuse SSc
