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BRS Year 2 > SLE, Systemic manifestations and RA > Flashcards

SLE, Systemic manifestations and RA Flashcards

1
Q

what is rheumatoid arthritis

A

Chronic joint inflammation (synovium) can result in joint damage
Associated with autoantibodies (RF and Anti-CCP)

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2
Q

Which autoantibodies are associated with rheumatoid arthritis

A

Rheumatoid factor

Anti-CCP

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3
Q

What is ankylosing spondylitis

A

Chronic spinal inflammation that can result in spinal fusion and deformity
Site of inflammation includes the enthesis

No autoantibodies (‘seronegative’)

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4
Q

What are the consequences with ankylosing spondylitis

A

Spinal fusion

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5
Q

How is spinal fusion evidently seen on a radiograph

A

Bamboo spine

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6
Q

examples of seronegative spondyloarthopathies

A

Ankylosing spondylitis
Reactive arthritis (Reiter’s Syndrome)
Psoriatic arthritis
Arthritis associated with gastrointestinal inflammation (enterohepatic synovitis)

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7
Q

main features of SLE

A

Chronic tissue inflammation in the presence of antibodies directed against self antigens
Multi-site inflammation but particularly the joints, skin and kidney

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8
Q

key autoantibodies in SLE

A

Antinuclear antibodies
Anti-double stranded DNA antibodies
Anti-phospholipid antibodies

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9
Q

arthralgia

A

Pain in joints
Tenderness but not obvious inflammation

Common in connective tissue disorders

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10
Q

What is Raynaud’s phenomenon

A

Intermittent vasospasm of digits on exposure to cold
Typical colour changes – white to blue to red
Vasospasm leads to blanching of digit
Cyanosis as static venous blood deoxygenates
Reactive hyperaemia

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11
Q

main manifestations of SLE

A

Malar rash – butterfly, photosensitive
Mouth ulcers
Hair loss
Raynaud’s phenomenon
Arthralgia and sometimes arthritis
Serositis (pericarditis, pleuritis, less commonly peritonitis)
Renal disease – glomerulonephritis (‘lupus nephritis’)
Cerebral disease – ‘cerebral lupus’ e.g. psychosis

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12
Q

demographic of SLE

A

females 15-45

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13
Q

Which rheumatoid conditions are seronegative

A

OA
Reactive arthritis
Gout
Ankylosing Spondylitis

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14
Q

What type of hypersensitivity is associated with SLE

A

Type 3 hypersensitivity -due to formation of immune complexes

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15
Q

three stages of Raynaud’s

A

1) Vasospasm
2) Cyanosis
3) Reactive hyperaemia

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16
Q

key investigations for SLE

A

ESR
CRP is usually normal
Autoantibodies
Antiphospholipid antibodies

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17
Q

haematological findings SLE

A

Haemolytic anaemia, Lymphopenia, Thrombocytopenia

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18
Q

What is the main clinical risk in a neonate with neonatal lupus syndrome

A

Permanent heart block - conduct ECG

19
Q

renal investigations performed in patients with SLE

A

Measure urine protein: Creatinine ratio
Albumin
eGFR

20
Q

How can we measure disease activity in SLE

A

Immune complexes

Unwell lupus patient has LOW complement C3 and C4 levels and HIGH levels of anti-ds-DNA antibodies

21
Q

aim of SLE treatment

A

aims at remission or low disease activity and prevention of flares

22
Q

What should patients with SLE be assessed for

A

antiphospholipid antibody status

infectious and cardiovascular diseases risk profile

23
Q

What is Sjorgren’s syndrome

A

Autoimmune exocrinopathy
lymphocytic infiltration of especially exocrine glands and sometimes of other organs (extra-glandular involvement)
non-erosive arthritis and raynauds common

24
Q

What is inflammatory muscle disease

A

Proximal muscle weakness due to autoimmune-mediated inflammation either with (dermatomyositis) or without (polymyositis) a rash
associated with malignancy and pulmonary fibrosis

25
Q

skin changes in dermatomyositis

A

heliotrope rash on eyelids, malar regionm nsao-labial folds
red or purple lesions on knuckles - gottrons papules
subcutaneous calcinosis
mechanics hands - cracking over finger pads

26
Q

Which serum markers are elevated in dermatomyositis

A

Creatine phosphokinase

27
Q

symptoms of sjorgens

A

dey eyes
dry mouth
parotid gland enlargement

28
Q

What is systemic sclerosis

A

Thickened skin with Raynaud’s phenomenon
Dermal fibrosis, cutaneous calcinosis and telangiectasia
Skin changes may be limited or diffuse

29
Q

What is overlap syndrome

A

When features of more than 1 connective tissue disorder are present e.g. SLE and inflammatory muscle disease we can use the term overlap syndrome

30
Q

investigation findings inflammatory muscle disease

A

elevated CPK
abnormal electromyography
abnormal muscle biopsy

31
Q

manifestations of diffuse systemic sclerosis

A

Fibrotic skin proximal to elbows or knees (excluding face and neck)
Anti-topoisomerase-I (Anti-Scl-70) antibodies.
Pulmonary fibrosis, renal (thrombotic microangiopathy) involvement.
Short history of Raynaud’s phenomenon

32
Q

manifestations of limited systemic sclerosis

A

Fibrotic skin hands, forearms, feet, neck and face
Anti-centromere antibodies
Pulmonary hypertension
Long history of Raynaud’s phenomenon

33
Q

Which antibodies are associated with CREST and limited systemic sclerosis

A

Anti-centromere antibodies

34
Q

CREST

A

sub-type of limited systemic sclerosis:

Calcinosis, Raynaud’s phenomenon, Oesophageal dysmotility, Sclerodactyly, Telangiectasia

35
Q

autoantibodies are associated with polymyositis

A

Anti-tRNA transferase

36
Q

auto-antibody is associated with mixed connective tissue disorder

A

Anti-U1 RNP antibody

37
Q

auto-antibody is associated with diffuse systemic sclerosis

A

Anti-Scl-70

38
Q

anti nuclear antibodies

A

seen in all SLE

not specific for SLE

39
Q

anti double stranded DNA antibodies

A

specific for SLE

levels indicate disease activity

40
Q

anti phospholipid antibodies

A

associated with risk of arterial and venous thrombosis in SLE
can occur without SLE - primary antiphospholipid antibody syndrome

41
Q

investigations for synovitis

A

ultrasound - thickening, increased blood flow

42
Q

treatment of rheumatoid arthritis

A 
steroids short term for the inflammation
DMARDs - methotrexate and hydrochloriquine
if DMARDs dont work:
anti TNFa,  anti IL-6, B cell biologic
JaK inhibitors
43
Q

clinical signs for checking for psoriatic arthritis

A

nail signs - pitting, thickening under nail, oncholysis (separation)

BRS Year 2 (67 decks)

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