Tutorial 3

Question 1

Titre meaning

Answer 1

How many times you have to dilute it

1 in 80

Question 2

Give examples of ANA

Answer 2

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 -

Question 3

What does Scl70 relate to?

Answer 3

Topiosmerase

Question 4

Centromere

Answer 4

Limited cutaneous systemic sclerosis

Question 5

ro and la

Answer 5

Sjogrens

Question 6

Large cell arteritis

Answer 6

Takayasu - SE asian women
Giant cell arteritis

Question 7

Medium vessel artertitis

Answer 7

Kawasaki
Polyarteritis nodosa - associated with hep B

Question 8

Small vessel arteritis

Answer 8

ANCA associated vasculitis

• microscopic GPA (wegner)
• GPA
• eGPA (churgh strauss)

Immune complex vasculitis

Question 9

Mixed vessel arteritis

Answer 9

Behcet’s disease - veins as well as arterities

Question 10

Infective causes of arteritis

Answer 10

Subacute bacterial endocarditis
Meningococcal septicemia
Syphillus
EBV, CMV, HIV, HepB/C

Answer 11

Auto-inflammatory = without antibodies

Question 12

Autoinflammatory diseasese

Answer 12

see path slide

Question 13

SLE symptoms

Answer 13

Oral ulcers
Hair loss
Raynaud’s
Swelling of glands

Question 14

Lupus screening tests

Answer 14

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)

Question 15

Mx of lupus

Answer 15

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

Question 16

If there is anti-Ro, what is the consequence in pregnancy?

Answer 16

Foetal heart block
so monitor foetal

Question 17

Hydroxychloroquine mx

Answer 17

Affects antigen presentation

Question 18

Alopecia

Answer 18

can be reversed with

Question 19

What are the stages of SLE?

Answer 19

Mild - skin, hair, joints, lymphadenopathy

Moderate disease =
Pleurisy, pleural effusion
Pericardial effusion

Moderate dsiease = lungs and heart
Severe disease = kidneys

Question 20

PMR is associated with?

Answer 20

Hip pain
Shoulder pain
Bursitis and humeral synovitis
Bilateral
Power in muscles are fine

GCA - temporal pain, pain brushing hair, jaw claudicaiton

Question 21

PMR screening work up

Answer 21

ESR and CRP
CK
RF and anti-ccp as this can
FBC, U and E, LFT

Question 22

PMR mx

Answer 22

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

Question 23

GCA screening work up

Answer 23

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

Question 24

Mx of GCA

Answer 24

4-60mg pred for 18 months
60 esp if visual symptoms

Tociolizumab - steroid sparing - weekly, for 1 years

Question 25

Pale disc

Question 26

GCA is on a spectrum with three diseases, what is about?

Answer 26

GCA = temporal Large vessel arteritis PMR

Answer 27

Systemically unwell Over 50 Sweats, fevers ESR Large vessel GCA is diagnosed on a FDG PET scan Mx with 40-60mgmgs pred or methotrexate

Answer 28

Sjogren's consequence MALT lymphoma

Answer 29

Tear management ??

Question 30

Features of diffuse cutaneous systemic sclerosis

Answer 30

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

Question 31

Limited cutaneous systemic sclerosis

Answer 31

Limited = limited to hands CREST Pulmonary HTN Anti-centromere

Answer 32

Inflammatory lung disease - give steroids But if very high blood pressure - don't give steroids

Question 33

Dermatomyositis screening

Answer 33

Creatnine kinase ANA MRI - shows oedema Biopsy PET scan - why? EMGs

Answer 34

Rash on dorsum of hands and knees

Question 35

Polymyositis

Answer 35

muscles only Lymphocytic infiltartion of muscles white = inflamed proximal >distal msucles Prognosis - difficulty swallowing,

Question 36

Dermatomyositis mx

Answer 36

Steroids - hydroxycloroquine for rash methotrex

Question 37

Idiopathic inflammatory myositis can be split into

Answer 37

Dermatomyositis Polymyositis

Question 38

GPA

Answer 38

Upper Lower resp Kidney

Question 39

Antibodies for GPA

Answer 39

c-ANCA MPA - pANCA

Question 40

What is another name for HSP

Answer 40

IgA vasculitis

Question 41

Symptoms of IgA vasculitis

Answer 41

Purpuric rash Arthritis Bowel disease A proportion of patients