MDTI - ALL OF RHEUMATOLOGY

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Can you name the MDTI - ALL OF RHEUMATOLOGY?

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PromptsDiseases
Inflammasomes
Belimumab (1)
cells express Bax, lymphocytes express BCLxl
interferon signature connects viral infection to lymphocyte invasion
Occurrence linked to ingestion of purine/pyrimidines, endogenous production of urate, and breakdown of tissues
Schirmer's test
environmental triggers are UV exposure/DNA or RNA viruses/Medication
treat acute flair up with NSAIDs, colchicine, corticosteroids
environmental influence of vinyl plastics, hair dyes
two causal reasons: highly vascularized synovium, no basement membrane
slow progression over time
Characterized by immune dysregulation/vascular dysfunction/fibrosis
3 stages, last one develops B cell Lymphoma
focus
karryohexis
Blys
Can be caused by increase in enzyme PRPP
Allopurinol
4:1 female to male ratio
75% of people get this
associated with previous damage (RA, OA), diabetes mellitus, immunosuppression
Can be caused by deficiency of HGPRT
fibrillations
estrogen and prolactin cause activation/proliferation of lymphocytes
Cytokines Involved: IL-1, IL-6, IL-17, TNFalpha
Genetic defect in COL1A2, TGFb, Fibrillin 1
200-2000 white cells in joint fluid
IFN-g/TNFa both inhibit SMAD activity
problems in the WNT pathway
cartilage fragments mediate inflammation
Vital Dye test
anti-ANA are first important sign
antibiotic resistant arthritis possibly due to mimcry between OspA and LFA
fibroblasts turn to myofibroblasts
Comes in both diffuse/limited versions
cytoplasmic and perinuclear antibodies
ANA test involves permeabilizing cells
Fibrosis leading to ischemia and organ damage
30% associated with HepB infection
increase vascularization of cartilage which allows cytokine spread
PromptsDiseases
Pyrazinamide, Nicotinate, Lactate all stimulate URAT1
Can be caused by increase in enzyme XO
fibrinoid kidney necrosis causes hypertension
Raynaud's Phenomenon precedes it
Sex hormones/chromosomes are important
Uric Acid Kidney Stones
subchondral sclerosis
anti-ssa/ssb (not lupus)
Acute Uric Acid nephropathy (especially in cancer patients with chemo drugs)
polymorphisms in C2/C4 genes
cholinesterase
HLADRB1 association
transmural inflammation
Heberden's Node
Alcohol increases conversion of ATP to AMP; produces lactate that acts on URAT1
monoarthritic arthritis, usually 1st MTP/Knee/Ankle
sialadenitis
2000-100,000 white cells in joint fluid
20-200 white cells in joint fluid
lymphepithelial lesion
Anti-Smith, Anti-dsDNA, Anti-SSB
cppd
40% twin concordance
Possible mimicry between retroviruses and anti-SCL70
BAFF
URAT1
Pathway: Nalp3 -> IL-1b -> NfkB -> attracting of neutrophils
CXCL 12 - T-cells
6% concordance among MZ twins
treat with physical therapy, braces, NSAIDs
anti-M3
Cytokines Involved: IL-1, IL-6, IL-17, TNFalpha, with TNF-alpha being the boss
discoid rash
African Americans have particularly high anti-SCL70, bad prognosis
Tophi in olecranon bursa
Can be caused by increase in enzyme APRT
CXCL 13 - B-cells
early, early disseminated, late disseminated spread
cells inappropriately express both MHC1 and 2
Vascular injury may be initiating factor
PromptsDiseases
Interferon Signature (1)
hypertrophy of chondrocytes, but decrease in collagen production
osteophytes
NALP3
msu crystals
TGFb/CTGF sensitize fibroblasts and increases collagen production
fibroblasts upregulate PDGFr in response to TGFb
lack of DHEA
cast nephritis
ectopic lymphoid follicles in salivary glands
Interferon Signature (2)
spares lung/kidneys
Belimumab (2)
90% male, correlated with obesity and alcohol use
CREST
Anti-SCl-70 (Topoisomerase 1)
HLA DQ7/DR5 associated
IFNalpha upregulates TLR7/IRF7 to help uptake of DNA/RNA containing complexes
Febuxostat
>50,000 cells, >95% PMN's
Oxypurinol
A20 mutation leads to too much NfKb
Probenecid
renal hypertension due to medium vessel closure
polymorphisms in HLA DR2/DR3
Cytokines: IL-6, IL-17, IFN-alpha
crescentic glomerulonephritis
Mainly affects DIP, Knee, and 1st MCP joints
Type I/III collagen production
Anti-centromere antibodies seen in limited version
TGFb/SMAD signaling
IFN signal induced by DNA/RNA containing complexes
cytokines: TGFb, CTGF, PDGF(r)
sicca
Defect in Complement Receptor 1, FCyR
TGFb downregulated metalloproteinase release
Defect in clearance of apoptosis
Bouchard's Node
malar rash

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