MDTI - ALL OF RHEUMATOLOGY

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Can you name the MDTI - ALL OF RHEUMATOLOGY?

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

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