MDTI - ALL OF RHEUMATOLOGY

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Can you name the MDTI - ALL OF RHEUMATOLOGY?

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

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