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Untitled_7
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- 1Rasburicase: acts on soluable urate and monosodium urate crystals and cause rapid reduction in tophi. Allopurinol block xanthine oxidase and prvent production.SLE: 1 clinical and immunological for dx. e.g lupus nephritis + ANA or Anti dsDNA.
Anti smith(sm) antibody more suggestive of SLE than antiphosphoplipid ab.
low C3,4, + direct coomb's test.
** ANA negative lupus may have SCLE(subcutaneous lupus), musculoskeletal complaints, SSA+-good prognosis - 2Jaccoud's arthritis: non-erosive but can be deforming and corrected. common in SLE. Hydroxychloroquine is the mainstay Rx for mild SLE; specially with mainly skin involvement.Treatment in young female with lupus nephritis is high dose steroids and mycophenolate; not cyclophosphamide?- urine protenin and RBC cast.
Renal disease major determinant of prognosis. biopsy if proteinuria >1g/24hrs.
Class 4:advanced sclerosing lupus nephrits; most common and most severe. haem. and proteinuria. low C3/4, high dsDNA. - 3Proliferative lupus nephritis: Cycolophosphamide and high dose steroids are the standart treatment. Switch to azathioprine for maintenance. Low dose cyclo induction as effective and safer than high dose cyclo.Mycophenolate pus steroids as effective and less side effects than IV cyclo and steroids.
Preferred in young women due to less amenorrhoea and leucopenia comparing with cyclo.
maintenance with Azathioprine if pregnancy contemplated. - 4ACE/ARB: any one with proteinuria, BP >130/80 hydroxychloroquine asboulute baseline Rx. bone protection; steroids. In pregnancy- not active not Rx. mild disease activity- hydrochloroquine. active lupus: prednisolone, AZA if necessaryLupus anticoagulant strongest predictor of thrombosis.
Antiphospholipid more associated with CVA and thrombosis as well.
Neonatal lupus: SSA, SSB and ENA antibodies most helpful. child can have complete heart block. 18% recurrence rate in subsequent pregnancies.
neonatal subacute cutaneous lupus: SSA/SSB antibiodies.
Anti-histone ab >90% positive but not specific.
Anti-Ribosomal P antibodies specific for SLE. but found in 10-20 percent.
CRP not elevated in SLE; if elevated look for infection - 5Recurrent miscarriage, levida reticualris; lupus syndrome- anticardiolipin antibodies the most helpful to diagnose the problem. If previous DVT and/or PE, prior pregnancy loss: ASA 100mg daily and SC heparin throughout the pregnancy.Recurrent TE: warfarin 3-4 plus Aspirin
- 6Diffuse scleroderma: lung 30%(Scl-70), poor prognosis. Limited Scleroderma: pulmonary hypertension 10%, good prognosis, CREST: clacinosis, Raynaud;s, Esophogeal dysmotility, sclerodactyly, telangiectasia.Anti-centromere ab positive.Systemic sclerosis: face; mouse-like appearance, acrosclerosis and terminal digit resorption.
Pulmonary involvement can happen in both limited and diffuse forms; cause PHT, poor prognosis.
Risk factors for ILD: Scl-70(but not severity), African American, men, But anti-centromere protective.NSIP most common, UIP poorer prognosis. - 7Pulmonary HT in diffuse and limited Systemic sclerosis: 12%, suspect if DLCO <50%(normal lung volumes), poor prognosis 2yrs without Rx <50%.systemic sclerosis with renal involvement ACE inh. improve the survival NO role for IV steroids like in Lupus.
1 year survival 15%-----76%with ACE inhibitors.
PHT the commonest cause of disease-related death in limited SSc.
ILD/PHT the commonest cause of scleroderma related death.
Anti-topoisomerase Ab(Scl-70) 40% with diffuse. - 8High dose steroids is not recommended in renal crisis in SSc. Bosentan/ambrisentan-Endothelin-1 receptor antagonist- vasodilatation in PHT.alternative; sildenafil, iloprostMCTD; characteristic ENA:U1RNP(high titre), ESR elvated 70% RF positive.
Important: dsDNA, Sm negative. - 9Sjogren's syndrome: anti Ro(SSA) and/or La(SSB). 44 x high RR of developing lymphoma c/w general population-primary b ell origin.extractable nuclear antigens includes: Ro (SS-A), La (SS-B), RNP, Scl-70(anti-topoisomerase), Sm, Jo-1
- 10The most common cause of SJS is Allopurinol, antigout meidcations, antibioitcs Sulfonamide(sulfamathazazole,dapsone)>penicillin> cephalosporin. Antipsychotic and antiepileptics. NSAIDs especially PiroxicamThe most common OTC inducer in St john wort her: induce P450 (3A4); Tacrolimus, cyclosporine.
e.g decrease the level of phenytoin, carbamazapine
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- Rheumatology FlashCards sobre Untitled_7, criado por naserduhair em 17-09-2013.
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