Serology and Lab Testing - Johnston Flashcards
Diagnostic labs for arthritis (7)
- RF
- Anti-CCP
- ANA
- ESR
- CRP
- ASOT (anti-streptolysin titer)
- Uric acid
RF + Anti-CCP = ____
RA (99.5% confidence)
ANA - means what alone?
Little - many people have them
ASOT - means what?
Previous streptococcal infection
List of acute phase reactants (7)
- ESR
- CRP
- Leukocytosis
- Thrombocytosis
- Ferritin
- Fibrinogen
- Complement
Which one is higher in women?
Also higher in who?
Diseases that this is especially good for? (2)
ESR
Older
Polymyalgia rheumatica, giant cell arteritis
CRP is a good marker for ___
Made where?
Does what?
Any inflammation (pro-inflammatory cytokines)
Liver
Activates complement, promotes phagocytosis
**CRP vs. ESR levels over time
CRP – rises and falls faster than ESR
CRP > ___ = inflammatory
8
RF is MOST commonly what?
Produced by what?
IgM – against Fc of IgG
B cells in synovial joints
Patients with _____ will 100% have RF antibodies
RA subQ nodules
Other autoimmune diseases that can have RF
Sjogrens, SLE, Cryoglobulinemia, Primary Biliary Cirrhosis, MCT disease, Endocarditis, Sarcoidosis, malignancy
Patients w/ RF are most likely to have what antibody?
Associated with?
Anti-CCP
Aggressive, erosive disease
Homogenous pattern of ANA immunofluorescence
Which ones? (3)
Drug-induced
Phenytoin, Procainamide, Hydralazine
Anti-Smith antibodies
SLE ONLY
Criteria for SLE (11)
Malar rash Discoid rash Photosensitivity Oral/nasal ulcers - painless Arthritis - 2+ peripheral joints Serositis - pleuritis, pericarditis Neurologic issue - seizure/psych Renal issue - proteinuria or casts ***Blood disorder - HA + reticulocytosis, low WBC (under 4000), low platelets (under 100,000) Immunologic issue - antibodies ANAs
False positive RPR (test for syphilis)
SLE
ASO titer
Previous Group A strep infection
Acute rheumatic fever - criteria
JONES criteria
- Joints (arthritis)
- Carditis
- Nodules (subQ)
- Erythema marginatum
- Sydenham chorea
Digital radiography is good for looking at what?
Joint erosions, osteopenia, etc.
Ultrasonography is good for looking at what?
Aid in doing what?
Soft tissue abnormalities - synovitis, tendonitis, bursitis
Injecting/aspirating joint
MRI is good for what?
Don’t use Gadolinium if…?
Soft tissue abnormalities - spine, SI, synovitis, tenosynovitis, erosions
Kidney disease - will cause nephrogenic systemic fibrosis
CT is good for what?
Bony abnormalities, erosions, fractures, degenerative or inflammatory arthritis
Pitting of nails
Psoriasis
Reactive arthritis
Balantitis
Reactive arthritis
Reiter’s syndrome
Erythema migrans
Lyme disease
Erythema multiforme
Multiple causes
Erythema nodosum
Hepatitis, Mono, Syphilis, Strep
Other stuff
Discoid plaques on face
SLE
Inflamed gut + sores in mouth + sores in genitals
Behcet’s disease
Reactive arthritis - bugs
Campylobacter
Salmonella
Shigella
Yersinia
Clubbing + arthritis + pulmonary disease
Hypertrophic pulmonary osteoarthritis (HPO)
Nodules in lungs + arthritis
RA, Wegeners, Paraneoplastic
Hilar nodes + arthritis
Sarcoidosis
RA
Lymphoma
Pulmonary infiltrates + arthritis
Septic
Wegeners
Charcot’s joint
DM – Neuropathic degeneration and distortion of a joint
Cheiroarthropathy
DM – Thickened skin, limited joint mobility of hands and fingers, causing flexion contractures
Hypothyroidism can present with what?
Carpal/Tarsal Tunnel Syndrome
Arthritis + conjunctivitis
Seronegative spondyloarthropathies
Arthritis + iritis
SNSA, Lyme, JRA, Sarcoid
Arthritis + lacrimal enlargement
Sarcoid, RA
Arthritis + xerophthalmia
Sjogren’s, Sarcoid
Arthritis + Scleromalacia (softening/degeneration of sclera)
RA
Arthritis + Episcleritis
RA