types of dermatomyositis with poor prognosisclinically amyopathic dermatomyositis(CADM) rheumatology HirotoShishido
Dermatomyositis typical autoantibody①anti aminoacyl-tRNA synthetases(ARS) antibody
anti Jo-1 antibody(→antibody targetting synthetase which combines histidine and t RNA)
②anti MDA-5 antibody
positive in 20〜30% of DM
positive→50% are associated with negative→rarely associated with
rapidly progressive interstitial lung disease(RP-ILD)
③anti Mi-2 antibody
④anti transcriptional intermediary factor-1(TIF-1) antibody
positive in 20% of DM
50%〜75% of the individuals are associated with malignant tumor rheumatology HirotoShishido
Picturecalcinosis cutis→ CREST syndrome
calcinosis cutis,Raynaud's phenomenon,esophageal dysfunction(←atrophy and fibrous replacement of the muscularis in the lower esophagus) ,sclerodactylia, telangiectasia rheumatologymusculoskeletalUWorld HirotoShishido
Evans syndrome
Which autoimmune disease is this associated with?warm autoimmune hemolytic anemia(warm weather is Great→IgG)+immune thrombocytopenic purpura
IgA vasculitis(Henoch Schonlein purpura, HSP)
triad+1・skin (palpable purpura on the buttocks and lower extremities, 下腿伸側左右対称隆起性紫斑)
・GI (intermittent severe abdominal pain, upper and lower GI bleeding, intussusception)
・joints (migratory arthralgias and arthritis in large joints of the lower extremities)
・kidneys (IgA nephropathy)
symptoms and joint findings of osteoarthritis and rheumatoid arthritisOA
no swelling,sharp ache
morning stiffness less than an hour(come back at the end of the day)
☆synovial fluid noninflammatory, dislodged pieces of cartilage and subchondral bone, joint space narrowing
RA
painful swelling
morning stiffness more than an hour
improve with use(Lambart Eaton)
increased synovial fluid(inflammtory) rheumatologymusculoskeletal HirotoShishido
scleroderma
histopathological findings☆dermal layer expansion due to diffuse deposition of collagen (eosinophilic connective tissue), resulting in ☆atrophy of the intradermal adipose tissue and dermal appendages (ie, hairfollicles, glands). dermatologyrheumatologyUWorld HirotoShishido
Picture
symptomsgiant cell(temporal) arteritis
→focal ☆granulomatous inflammation of the media
≒ Takayasu arteritis
common cause of myopathy・glucocorticoid induced myopathy
(glucocorticoid favors catabolism and proteolysis to provide subtrates for gluconeogenesis and glycogenesis in the liver→ ☆increase liver enzymes)
progressive proximal muscle weakness without pain(-CK)
・polymyalgia rheumatica(-CK)
・inflammatory myopathy
・statin induced myopathy
・☆hypothyroid myopathy musculoskeletalrheumatologyUWorld HirotoShishido
histology of buerger disease
in what races does it have a propensity to occur?(thromboangiitis obliterans)
segmental vasculitis(= ☆inflammatory intraluminal thrombi) extending into contiguous veins and nerves
short term treatment for rheumatoid arthritisNSAIDs, glucocorticoids can provide rapid symptom relief in the interim
disease-modifying agents (eg, methotrexate, sulfasalazine, hydroxychloroquine, minocycline), biologic agents (eg, TNF-α inhibitors)
→alleviate pain and inflammation and reduce long term joint destruction (the response typically takes weeks) rheumatologypharmacologyUWorld HirotoShishido
