Tutorial 3 Flashcards
Titre meaning
How many times you have to dilute it
1 in 80
Give examples of ANA
dsDNA - LUPUS
Extranuclear antigens:
Ro, La, Sm, U1RNP - ribonuclear proteins
- can all be found in lupus
- Sm more specific for Lupus
- Ro and La - Sjogren’s
-Scl70 - diffuse cutaneous sytemic sclerosis
- centrometere - limited cutaneous systemic sclerosis -
What does Scl70 relate to?
Topiosmerase
Centromere
Limited cutaneous systemic sclerosis
ro and la
Sjogrens
Large cell arteritis
Takayasu - SE asian women
Giant cell arteritis
Medium vessel artertitis
Kawasaki
Polyarteritis nodosa - associated with hep B
Small vessel arteritis
ANCA associated vasculitis
- microscopic GPA (wegner)
- GPA
- eGPA (churgh strauss)
Immune complex vasculitis
Mixed vessel arteritis
Behcet’s disease - veins as well as arterities
Infective causes of arteritis
Subacute bacterial endocarditis
Meningococcal septicemia
Syphillus
EBV, CMV, HIV, HepB/C
Auto-inflammatory = without antibodies
Autoinflammatory diseasese
see path slide
SLE symptoms
Oral ulcers
Hair loss
Raynaud’s
Swelling of glands
Lupus screening tests
FBC
Renal function - creatinine
LFT
CRP
ESR
ANA
dsDNA
ENA
COmpletement
Anti-cardiolipin
Urine dip - red cells and protein - to check for glomerulonephritis
Anti-dsDNA
ESR levels
urine dip and chest xray
Disease activity - c3 and c4 (c4 goes down first)
Mx of lupus
Less severe - methotrexate
Flare - steroids and hydroxychloroquine
Do a biopsy of the kidney
Mycophenolate if kidney disease
If no kidney disease - methotrexate
Rituximab to suppress the B cells
If there is anti-Ro, what is the consequence in pregnancy?
Foetal heart block
so monitor foetal
Hydroxychloroquine mx
Affects antigen presentation
Alopecia
can be reversed with
What are the stages of SLE?
Mild - skin, hair, joints, lymphadenopathy
Moderate disease =
Pleurisy, pleural effusion
Pericardial effusion
Moderate dsiease = lungs and heart
Severe disease = kidneys
PMR is associated with?
Hip pain
Shoulder pain
Bursitis and humeral synovitis
Bilateral
Power in muscles are fine
GCA - temporal pain, pain brushing hair, jaw claudicaiton
PMR screening work up
ESR and CRP
CK
RF and anti-ccp as this can
FBC, U and E, LFT
PMR mx
15mg oral prednisolone
Bisphosphonate for bone protection
Calcium and vit D
Dramatic response within 1-2 days
Pain free
However they need to keep going with it
GCA screening work up
GCA probability score
Temporal artery - look for a halo sign, aka the artery being inflamed
Axillary artery
Examine eyes
you only really biospy if the hx or uss isn’t clear that it might be GCA
CRP and ESR
Mx of GCA
4-60mg pred for 18 months
60 esp if visual symptoms
Tociolizumab - steroid sparing - weekly, for 1 years
Pale disc
GCA is on a spectrum with three diseases, what is about?
GCA = temporal
Large vessel arteritis
PMR
Systemically unwell
Over 50
Sweats, fevers
ESR
Large vessel GCA is diagnosed on a FDG PET scan
Mx with 40-60mgmgs pred or methotrexate
Sjogren’s consequence
MALT lymphoma
Tear management
??
Features of diffuse cutaneous systemic sclerosis
Tightness, wooden, thickened skin
High blood pressure
Raynaud’s
Scl-70 positive
fibrotic element
ischemic element
Lupus is more proflierative infalmmatory neprhtiits
Narrowing of walls of kidneys - in diffuse cutaneous systemic sclerosis = renin release cos the kidney thinks it doesn’t have enough blood flow
Limited cutaneous systemic sclerosis
Limited = limited to hands
CREST
Pulmonary HTN
Anti-centromere
Inflammatory lung disease - give steroids
But if very high blood pressure - don’t give steroids
Dermatomyositis screening
Creatnine kinase
ANA
MRI - shows oedema
Biopsy
PET scan - why?
EMGs
Rash on dorsum of hands and knees
Polymyositis
muscles only
Lymphocytic infiltartion of muscles
white = inflamed
proximal >distal msucles
Prognosis - difficulty swallowing,
Dermatomyositis mx
Steroids -
hydroxycloroquine for rash
methotrex
Idiopathic inflammatory myositis can be split into
Dermatomyositis
Polymyositis
GPA
Upper
Lower resp
Kidney
Antibodies for GPA
c-ANCA
MPA - pANCA
What is another name for HSP
IgA vasculitis
Symptoms of IgA vasculitis
Purpuric rash
Arthritis
Bowel disease
A proportion of patients
