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14 Cards in this Set
- Front
- Back
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SLE: Therapy
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Avoid sunlight exposure
NSAIDs for arthritis if no renal toxicity Hydroxychloroquine for skin and joints Steroids for acute flares and organ involvement Cyclophosphamide for life–threatening manifestations Other immunosuppressants Azathioprine Mycophenolate |
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Symmetric inflammatory arthritis with systemic vasculitis
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Rheumatoid Arthritis/Disease. Onset as young–middle aged adults (45–65 years old)
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Rheumatoid Arthritis/Disease HLA associations
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HLA–B27 seen in 70% of Caucasians
HLA DR4, RR = 49 |
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Rheumatoid Arthritis/Disease pathogenesis
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Overactivity of Th2 cells –> RheumatoidFactor –> immune complexes in joint–> pannus formation of synovial lining –> joint destruction
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Rheumatoid Disease presentation in joints
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synovitis with erosion of articular cartilage/marginal bone
MCP, PIP (never DIP like OA) C1 and C2 |
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Rheumatoid disease presentation in the
1-skin 2-cardiovascular 3-lung 4-eye 5-neurologic 6-renal |
Skin: rheumatoid nodules, ulcers
Cardiovascular: vasculitis, pericarditis, MI, CHF, higher mortality Lung: nodules, pleuritis, interstitial fibrosis Eye: scleritis, conjunctivitis Neurologic: mononeuritis, compression neuropathy Renal: amyloidosis |
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Rheumatoid disease lab findings
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Anti–cyclic citrullinated peptide antibodies more specific
Rheumatoid factor Elevated erythrocyte sedimentation rate Hypochromic/normochromic normocytic anemia Granulocytopenia (Felty’s syndrome) |
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An anti–IgG Fc fragment Ab (usually IgM class) aka rheumatoid factor titer correlates with
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Degree of joint erosion
Systemic vasculitis Overall prognosis -Increases with age in healthy adults |
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Anti–Citrullinated Cyclic Peptide Antibodies (ACPA) development
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Peptidyl arginine deiminase performs post-translational modification of arginine to citrulline in cyclic peptides
This is upregulated in inflammatory states This alters the cyclic peptide’s conformation and may make it antigenic in susceptible individuals |
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Anti–Citrullinated Cyclic Peptide Antibodies (ACPA)
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Peptidyl arginine deiminase performs post-translational modification of arginine to citrulline in cyclic peptides
This is upregulated in inflammatory states This alters the cyclic peptide’s conformation and may make it antigenic in susceptible individuals |
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what is the significance of ACPA in rheumatoid arthritis
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Present in 50% at presentation, 80% eventually (~RF)
Specificity > 90% |
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ACR Criteria for Rheumatoid Disease Need ≥ 4
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Morning stiffness for > 1 hour*
Soft tissue swelling of a least 3 joints* PIP, MCP or wrist swelling (never DIP)* Symmetric joint swelling* Rheumatoid nodules Rheumatoid factor (seen in 80%) X–ray erosions, osteopenia in hands or wrist *must be present for 6 weeks |
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Rheumatoid Disease: Therapy
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Disease Modifying Antirheumatic Drugs (DMARDs)-This need to give early!
Glucocorticoids NSAIDs Anticytokine Therapy |
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Unique Side–Effects of Anticytokine Therapy
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Infections ex
-Tuberculosis -Opportunistic infections Malignancies Demyelination Autoimmune phenomena |
