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61 Cards in this Set
- Front
- Back
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T/F: You can order a screening test to help find out what is going on with a patient
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F. But you can use them to follow the course of a disease...
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If you get some lab tests back that don't fit in with the clinical picture, what should you think? What should you do?
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-false positive
-re-do the lab test |
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What are acute phase reactants?
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-proteins produced in the liver (hepatocytes) whose plasma concentration increases or decreases by at least 25% during inflammatory states
-change is in proportion to severity of tissue injury |
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What is the most important inflammatory cytokine induced by acute phase reactants?
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IL-6
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What is CRP a kind of surrogate marker for?
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IL-6
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Do acute phase reactants come down?
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Not if the inflammation is STILL present
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What are the POSITIVE acute phase reactants?
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CRP
Fibrinogen Alpha 1 antitrypsin haptoglobin complement components |
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What are the NEGATIVE acute phase reactants?
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albumin
transferring |
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Why are acute phase reactants useful?
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-frequently reflect the presence and intensity of an inflammatory process
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What are the most widely used indicators of the acute phase response?
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ESR
CRP |
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What kinds of things increase ESR?
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age
anemia pregnancy obesity chronic renal failure tissue damage high cholesterol |
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What things decrease ESR?
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sickle cell
microcytosis polycythemia extreme leukocytosis hypogammaglobulinemia |
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What is the CRP?
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a protein made by the liver AFTER tissue injury
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What is more reliable: ESR or CRP?
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CRP
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What are the advantages of CRP?
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rises faster than ESR
responds more quickly to change independent of factors that increase ESR |
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What are the acute phase reactants good for clinically?
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distinguish inflammatory from non-inflammatory
follows course of disease follows response to therapy prognostic (e.g. RA) |
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Why are autoantibodies useful?
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markers of chornic immunoinflammation and rheumatic diseases
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Are autoantibodies specific?
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some of them are
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What is rheumatoid factor?
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antibodies directed against the Fc portion of IgG
IgM is usually measured NOT specific for RA |
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If RF is positive then what kinds of things might you have?
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RA
Sjogren's mixed connective tissue disease SLE chronic infections (Hep, endocarditis, TB, chronic bronchitis) |
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What are the disadvantages of RF?
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not standardized
poor specificity |
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What is the clinical utility of RF?
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may precede onset of clinical RA
high titer supports diagnosis of RA |
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If you have a positive RF and you have RA, what does that mean for the prognosis of your disease?
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may have more severe disease including erosive arthritis and systemic manifestations
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T or F: the specificity of the rest for rheumatoid arthritis (RF) is very poor
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true
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T or F: serial testing of RF is useful
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False. Once you have it, you have it.
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What are the systemic manifestations of RA?
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nodules
vasculitis mononeuitis multiplex interstitial lung disease Felty's syndrome (big spleen, neutropenia) |
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T or F: RF fluctuates with disease.
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False.
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What is citrulline?
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a protein residue that occurs during inflammation induced apoptosis in the synovium
antibodies are produced to it |
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What is test for citrulline?
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anti-CCP
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T or F: the sensitivity and specificity of the anti-CCP test are both very high
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False: the specificity is high, but the sensitivity is only 50%
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What is the benefit of anti-CCP testing?
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may precede clinical onset of disease by 10 years
may help with diagnosis of early undifferentiated disease predicts later development of classic erosive RA |
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What are the ANAs?
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antibodies that react with antigens in nucleus
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In testing for ANA, what would be more significant: a 1:1600 titer or a 1:200 titer?
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the 1:1600
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What does the ENA panel include?
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Ro, La, Sm, RNP, Jo-1
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Which ANA is specific for SLE?
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anti dsDNA
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T or F: Do anti dsDNA levels vary with disease activity in lupus nephritis?
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True.
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T or F: someone with suspected SLE does NOT test positive for the anti-Sm antibody. We can therefore say that they DON'T have SLE.
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false. It is specific for lupus but not sensitive. Most people with Lupus will NOT have the antibody, but if they do it helps confirm the diagnosis
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Ro and La are associated with what syndrome and what neonatal problem?
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Sjogren's
neonatal lupus |
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What antibody is associated with the inflammatory muscle diseases?
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Jo-1
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Drug induced lupus is associated with what antibody?
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histone
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The bioplex is better because it results in fewer false ________ (positives/negatives)
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positives
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What are ANAs useful for?
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nearly always positive for SLE
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Diseases in what other organs will you get positive ANAs?
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thyroid
lung liver |
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Why are ANAs useful?
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in autoimmune of connective tissue disease:
-to confirm -to exclude -to subclassify -to monitor |
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Where else will you see ANAs?
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-chronic infectious disease
-lymph disease -certain drugs (antiTNFs, abx - sulfa, Ca channel blocks) -false positives in women, elderly, 1st degree relatives with disease |
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What is complement?
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consists of plasma and membrane proteins that mediate pathways of enzyme reactions in the immune response
-a "complement" to humoral, antibody triggered response |
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What happens when complement is activated?
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-deposits complement components on the pathologic targets
-liberates fragments that promote inflammatory and immune response -can be deliterious to the host |
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When is the classical pathway activated?
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when IgM or IgG binds to antigens
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When is complement elevated?
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during many inflamatory conditions
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Where does complement get created?
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the liver
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Are increased or decreased levels of complement more informative? In which disease?
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decreased: means that complement is being used up
-suggests that disease is more severe -SLE |
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What types of complement are we looking for in SLE?
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C3 and C4
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When might you suspect someone has an inherited deficiency of complement if they already have lupus?
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if you find C3 and C4 is low, and you treat them, and then their C3 and C4 doesn't increase
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T or F: low C3 and C4 levels increase the susceptibility of someone to getting lupus?
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True
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T or F: return to normal C3 and C4 levels are a good prognostic sign
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True
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What are the ANCAs? What are they associated with?
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they react with neutrophils
Wegner's vasculitis |
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What antibody is associated with Wegener's? What type of antibody is it?
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anti-PR3
ANCA |
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If you have limited Wegener's, what system(s) is affected? Will the antibody associated with it be activated?
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-upper airways, ears, eyes
-you will NOT get anti PR3 |
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What is Churg Strauss? T/F: It is MPO positive
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-history of worsening asthma
-eosinophilia that infilitrate organs -progresses to small vessel vasculitis --> MPO Positive -- YES |
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What are the two types of ANCA?
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PR3
MPO |
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What can look like Wegener's but WITHOUT ENT involvement? What systems are affected? What antibody will you see?
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microscopic polyangiitis
pulmonary, renal, skin, nerve anti-MPO |
