MDTI - ALL OF RHEUMATOLOGY

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Can you name the MDTI - ALL OF RHEUMATOLOGY?

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

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