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NMSK Exam 3 > Serology and Lab Testing in Rheumatic Diseases > Flashcards

Serology and Lab Testing in Rheumatic Diseases Flashcards

1
Q

What are important acute phase reactants - immediate responses to inflammation?

A
  1. ESR (erythrocyte sedimentation rate)
  2. CRP (c-reactive protein)
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2
Q

What is ESR?

  • ↑↑↑ with ____, highest in ______
A
  • Acute inflammatory marker used to monitor the activity of a disease, especially PMR (polymyalgia rheumatica) and GCA (giant cell arteritis)
  • ↑↑↑ with age, highest in women
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3
Q

What is CRP (C-reactive protein)?

  • What ↑↑↑ CRP?
A

Acute phase reactant used to assess disease activity that is made in the liver that promotes opsonization of pathogens and ↑↑↑ the capacity of MO to phagocytose.

  • Proinflammatory cytokines = ↑↑↑ CRP
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4
Q

_____ mg/l of CRP = inflammatory

How do the levels compare to ESR?

A

8 mg/L of CRP = inflammatory

Rise and fall quicker than ESR

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5
Q

Levels of what else ↑↑↑ with inflammation?

A
  1. Leukocytosis
  2. Thrombocytosis
  3. Ferritin
  4. Fibrinogen
  5. Complement
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6
Q

When immune complexes mediate consumption, what happens to compliment levels?

A

↓↓↓ C3 and C4

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7
Q

Between ESR and CRP, which rises and falls quicker?

A

CRP

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8
Q

What is Rheumatoid Factor (RF)

A

IgM autoAB made by B-cells in synovial joints of RA patients that targets the Fc portion of IgG (can be any Ig, but IgM is MC)

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9
Q

In which type of RA will rheumatoid factor (RF) be present 100% of the time?

A

“Nodular” RA

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10
Q

Rheumatoid Factor (RF) can positive in which conditions?

A
  1. Healthy pt’s (1-4%) and 20% of pt’s >60 y/o
  2. Sjogrens syndrome (95%) and SLE
  3. Cryoglobulinemia (40-100%)
  4. Primary biliary cirrhosis (70%)
  5. Sarcoidosis, malignancy, and lung disease
  6. Mixed CT diseases
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11
Q

How does the the levels of Rheumatoid Factor (RF) correlate with a disease process?

A

↑↑↑ levels = aggressive dz, joint erosions, and worse prognosis

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12
Q

(+) RF = ___

A

Depends on laboratory method;

  • ELISA: (+) RF >45 IU/ml
  • Latex fixation: (+) RF > 1:80
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13
Q

Does (+) RF = RA?

A

No, 20-30% of patients with RA are RF (-)

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14
Q

What is Anti-CCP?

A

Anti‐cycliccitrullinated peptide(anti‐CCP) = AB to citrullinated proteins that are associated with an aggressive, erosive disease

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15
Q

How does the prescence of Anti-CCP compare to (+) RF in patients with RA?

A

Anti-CCP = Present in 70% of patients with early RA

Anti- CCP = more specific than than RF for RA: (96%specificity; 78%sensitivity)

Anti-CCP + (+) RF= 99.5% specificity for RA

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16
Q

What markers are 99.5% specific for RA?

A

Anti-CCP plus (+) RF

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17
Q

Anti-DS DNA Ab is seen in 50% of what?

A

SLE

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18
Q

When do you see a homogenous pattern of ANA with ABs to histone?

A

>95% Drug Induced Lupus

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19
Q

When do you see a rim pattern of ANA with anti-dsDNA ab?

A

50% SLE

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20
Q

When do you see a speckled pattern of ANA with anti-SM (smith) ab?

A

Lupus

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21
Q

When do you see a speckled pattern of ANA with anti-SS-A/SS-B ab?

A

Sjrogen syndrome

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22
Q

When do you see a anti-centromere AB of ANA?

A

Scleroderma CREST/PSS

23
Q

When do you see a anti-scl 70 AB of ANA?

A

PSS/CREST

24
Q

Characteristics for SLE

A
  1. Malar rash: Erythema, malar eminence spare nasolabial folds(butterfly rash)
  2. Discoid rash: Erythematous patches
  3. Photosensitivity: Rash due to sunlight
  4. Oral ulcers: painless
  5. Arthritis: MC in 2or more peripheral joints, tender, swelling/effusion; nonerosive arthritis
  6. Serositis: Pleuritis, rub or plerual effusion or pericarditis, ECGchanges
25
Q

How does SLE affect kidneys and neuro?

A
  1. Renal: Proteinuria > 500 mg/day or > 3+ or casts (either RBC, Hb, tubular, granular or mixed)
  2. Neuro: seizures or pyschosis
26
Q

What are 4 hematologic (CBC) indicators of SLE?

A

- Hemolytic anemia w/ reitculocytosis

or

  • Leukopenia (<4000/mm3 total)

or

  • Lymphopenia (<1500/mm3 total) on 2+ occasions

or

  • Thrombocytopenia (<100,000/mm3)
27
Q

What are 6 immunologic indicators of SLE?

A
  1. Anti-DNA Ab OR
  2. Anti-SM OR
  3. Anti-phospholipid Ab, based on IgG or IgM cardiolipin Ab OR
  4. (+) lupus anticoagulants (can form clots) OR
  5. False (+) RPR (test for syphillis) OR
  6. ABNL ANA titer
28
Q

When are Anti-streptolysin O Ab (ASO titer) and anti-DNAase B titers positive?

A

Group A Strep Infection: ↑↑↑ or rises during infection.

  • GAS infection can cause:
      1. Acute rheumatic fever (ARF)
      1. Arthritis, often polyarticular (>1 joint), large joints, assymatric and migratory/fever,
29
Q

A 46‐year‐old male presents with fatigue, malaise, pain in both wrists and bilateral swelling over MCP joints. He admits to previous history of lupus. The symptoms have been present for past 6 weeks. Physical exam reveals decreased strength in both hands, swollen wrists, PIPs and MCP joints bilaterally, and a nodule on the extensor surface of the left arm.

Which laboratory tests would you expect to be abnormal in this case?

A.CBC indicating hemolytic anemia, leukocytosis and a negative RPR

B.Low complement (C3), decreased ferritin and elevated platelet count

C.Positive anti‐CCP, elevated ESR and elevated rheumatoid factor level

D.Positive ANA, negative rheumatoid factor and elevated CRP

E.Thrombocytosis, hypocalcemia and normal ESR

A

C.

+ anti CCP AND + RF = 99.5% for RA

30
Q

What is considered NL in a joint fluid analysis?

A

NL fluid

  • Clear and viscous
  • < 200 cells /mm3
31
Q

What is considered a non-inflammatory process in a joint fluid analysis?

A

200 - 2,000 mononuclear cells

32
Q

What is considered an inflammatory states in a joint fluid analysis?

A
  • Inflammatory = 2,000 - 50,000 mononuclear cells that is cloudy
  • Septic = > 50,000 cells that is cloudy and opaque
33
Q

Hyperuricemia is when uric acid levels are _____

A

> 6.8 mg/dl

34
Q

Hyperuricemia can cause what?

A
  • Gouty arthritis = monosodium urate crystals in fluids of joint or tophi (nodular monosodium urate crystal deposts in skin) due to overproduction or under-excretion of uric acid.
35
Q

What do monosodium urate crystals look like under polarized light?

A

Needle-shaped, negative birifringence

36
Q

What is the MC presentation of gout?

A

Acute onset, monoarticular, most often affecting the 1st MTP of the big toe.

  • Pain is so bad will wake you up at night.
  • Joints are hot, swollen, tender, dusky/red
  • Pt will have fever
37
Q
  • Who is gout MC?
  • What can promote gout?
A
  • 90% of gout in M (40-60s)
    • Post-menopausal W
  • Alcohol
38
Q

Which imaging modality is sensitive for soft tissue abnormalities (synovitis, tendonitis, bursitis), swelling, and erosions; can also be used to help in injecting/aspirating a joint?

A

Ultrasound

39
Q

Which imaging modality is most sensitive for detecting bone erosions?

A

CT

40
Q

Which imaging modalty is the best for bony abnormalities (trabecular, cortical bone), erosions**, **fractures, degenerative or inflammatory arthritis?

A

CT

41
Q

What is MRI good for and what is one of the cons to using it?

A
  • Useful for soft tissue abnormalities
  • Good for spine, SI, synovitis, tenosynovitis, erosions, joint inflammation
  • CON: Gadolinium contrast taken up in inflammed synovium => cause nephrogenic systemic fibrosis (NSF) in pt’s with kidney disease
42
Q

Is XR good for visualization of soft tissue?

A
  • Digital XR have ↑↑↑ spatial resolution, but POOR visualization of ST.
  • Plain XR may not detect early arthritic changes
43
Q

A 50‐year‐old carpenter presents with pain, swelling and decreased range of motion in the right elbow (he is right side dominant). The elbow is swollen and very tender to touch. He relates to doing a lot of hammering, lifting boards and sawing. PMH: Diabetes Mellitus, Crohn’s disease, and COPD.

Which imaging study is indicated in the evaluation of the patient’s complaint?

  • A.CT of right arm – attention elbow
  • B.Plain radiography (x‐rays) of elbow
  • C.MRI right arm – attention elbow
  • D.Ultrasonography – attention right elbow
  • E.Bone scan – attention right elbow
A

D. Ultrasonography – attention right elbow

US is sensitive for

  • -ST abnormalities
  • -ST swelling
  • -Synovitis
  • -Tendonitis
  • -Bursitis
44
Q

What is Arthritis?

A

Inflammation of a joint

Pain = major feature

45
Q

How many joints are involved?

  • Monoarthritis =
  • Oligo
  • Pauci
  • Poly
A
  • Monoarthritis = 1
  • Oligo= 2 or 3
  • Pauci = 4 or 5
  • Poly= >6
46
Q

How can we describe arthritis based on joints affected?

A

1. Symmetric

2. Asymmetric

3. Specific joints

47
Q

Cardinal features of inflammation?

A
  1. Pain
  2. Swelling
  3. Red
  4. Heat
  5. Tender
  6. Other: loss of function or stifness
48
Q

What are the 3 types of swelling?

A
  1. Bony
  2. Effusion (synovial fluid, pus or blood) = can be inflammatory or non
  3. ST
49
Q

Give examples of RA deformities.

A
  • 1. Swan-neck deformity = hyperextension of PIP joint
    1. Boutonniere = hyperflexion of PIP joint
50
Q

What are examples of bony swellings?

A
  1. Herberden nodes
  2. Bouchard nodes
51
Q

What are 2 arthritic complications associated with Diabetes?

A
  1. - Charcot’s
  2. - Cheiroarthropathy
52
Q

What is a arthritic complications associated with thyroid disease?

A

Carpal/tarsal tunnel syndrome

53
Q

What are 2 opthalamic complications associated with arthritis?

A
  • Retinopathy (cytoid bodies, vasculitis)

NMSK Exam 3 (17 decks)

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