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Flashcards in Clinical conditions 2 Deck (9)
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1
Q

Describe the pathophysiology of SLE.

A

i. Inefficient removal of apoptotic bodies by phagocytosis… nuclear self-Ag (DNA and histones) are transferred to lymphoid tissue and taken up by APCs…
ii. activation of TH cells and B cells… production of anti-dsDNA, anti-SM and anti-phospholipid Abs…
iii. form circulating ICs or deposit into tissues…
iv. activation of complement and neutrophil influx… inflammation and tissue damage.

2
Q

Suggest signs and symptoms of SLE.

A

Skin (85%):

  • malar rash
  • photosensitivity
  • urticaria
  • purpura

Joints (90%):
- small joint arthritis

General:

  • fever
  • fatigue
  • weight loss
  • depression

Blood (75%):

  • anaemia (can be Coombs +ve)
  • thrombocytopenia
  • leucopenia

Heart (25%):

  • pericarditis
  • endocarditis
  • aortic valve lesions

Nervous system (60%):

  • seizures
  • CN lesions
  • demyelinating syndromes
3
Q

Which features might be seen in the blood test of a person with SLE?

A
  1. presence of anti-nuclear Abs, e.g. anti-dsDNA, anto-SM, anti-phospholipid Abs
  2. decreased Hb, WBC and platelets
  3. decreased C2, C3 and C4W
4
Q

Describe 3 points for the management of SLE.

A
  1. P education: lifestyle modification, e.g. use of sunscreen
  2. Anti-inflammatory drugs, e.g. prednisolone
  3. DMARDs, e.g. azathioprine or mAbs, e.g. rituximab
5
Q

Describe the pathophysiology of RA.

A

i. T3 & T4HS involving production of rheumatoid factor Ab against Fc portion of IgG, +/- anti-citrullinated peptide Ab…
ii. deposition of IC into joint synovial membrane… activation of complement and inflammation…
iii. lymphocyte recruitment… B and TH cells activate macrophages… TNFa production… joint destruction and production of further cytokines, e.g. IL-6

6
Q

Suggest signs and symptoms of RA.

A

Joints:
- pain, stiffness and swelling of small joints that is worse in the morning and better with activity

Lungs:

  • nodules
  • interstitial lung disease

Heart:
- pericarditis

General:

  • dever
  • fatigue
  • weight loss

Other:

  • dry eyes and mouth
  • rheumatoid bursitis/nodules
  • splenomegaly
  • tendon sheath swelling and carpal tunnel syndrome
7
Q

Which features might be seen in the blood test of a person with RA?

A
  1. presence of rheumatoid factor and/or ACPA
  2. increased CRP
  3. often anaemia
8
Q

Describe 5 X-ray features typical of RA.

A
  1. loss of joint space
  2. swelling of soft tissues
  3. marginal erosions
  4. juxta-articular osteoporosis (later generalised)
  5. subluxation and gross deformity (late/severe disease)
9
Q

Name 4 drugs that could be used in the management of RA.

A
  1. Corticosteroids, e.g. prednisolone
  2. Methotrexate (1st line)
  3. Anti-TNFa mAbs, e.g. inflixmab, etanercept
  4. Rituximab (anti-CD20 on B cells causing B cells apoptosis)