inclusion body myopathy
common type(封入体筋炎)
(myocytes led to apoptosis by autoimmune process)
sporadic(quadriceps are affected)is more common than hereditary(tibialis anterior are affected) rheumatology May 10, 2019, 8:18 AM HirotoShishido
Felty syndromerheumatoid arthritis
splenomegaly
neutropenia rheumatology May 10, 2019, 6:53 AM HirotoShishido
extraarticular manifestation of RAskin→rheumatoid nodules
lung→interstitial lung disease,pleuritis,pleural effusion
heart→pericarditis
kidney→AA amyloidosis
nerve→carpal tunnel syndrome rheumatology May 10, 2019, 6:52 AM HirotoShishido
3 specific defromities to rheumatoid arthritisulnar finger deviation (MCP joints)
swan neck (MCP joints)
boutonniere=buttonhole deformity(PIP joints) rheumatology May 10, 2019, 6:46 AM HirotoShishido
how the citrullination cause rheumatoid arthritistype Ⅱ collagen and vimentin can be
modyfied when arginine convert into citrulline
immune cells are sometimes not clever enough to recognize these proteins as self antigens(due to gene susceptibility) rheumatology May 10, 2019, 6:37 AM HirotoShishido
treatment→corticosteroids,pilocarpine(to increase the exocrine secretions) rheumatology May 10, 2019, 3:40 AM HirotoShishido
primary and secondary Sjögren syndromeprimary→sicca syndrome
secondary→occurs with other autoimmune disease (e.g. RA) rheumatology May 10, 2019, 12:56 AM HirotoShishido
types of dermatomyositis with poor prognosisclinically amyopathic dermatomyositis(CADM) rheumatology May 9, 2019, 2:10 PM 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 May 9, 2019, 2:02 PM HirotoShishido
Evans syndrome
Which autoimmune disease is this associated with?warm autoimmune hemolytic anemia(warm weather is Great→IgG)+immune thrombocytopenic purpura
common age/ treatment for fibromyalgia, polymyalgia rheumaticafibromyalgia→ 20〜50yo TCAs, SNRIs, gabapentin
☆Normal lab values
polymyalgia rheumatica→ 50yo〜 (☆)rapid response to low dose glucocorticoid therapy
↑ ESR, specifically > 50 mm/h
↑ CRP
Leukocytosis rheumatologymedic media模試 May 9, 2019, 2:25 AM HirotoShishido
how to distinguish polymyalgia rheumatica and polymyositispolymyalgia rheumatica →CK
polymyosistis ↑CK rheumatology May 9, 2019, 2:18 AM HirotoShishido
fibromyalgia symptoms,diagnosis,treatment(線維筋痛症)
common in woman age 20-55
clinical history
-more than 3 mo
-widespread pain
-no other cause
sleep
regular exercise(incremental aerobic exercise)
medications
-anti depressants(TCAs,SNRIs)
-neuropathic pain agents(e.g.gabapentin) rheumatologyUWorld May 9, 2019, 1:51 AM 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 May 8, 2019, 11:51 PM HirotoShishido
lupus heart symptomsLibman-Sacks endocarditis (LSE in SLE)
non-bacterial thrombotic endocarditis (NBTE)
→can also be caused by ☆advanced malignancy(especially pancreatic adenocarcinoma= Trousseau syndrome), less commonly antiphospholipid syndrome, DIC, extensive burns
→ can affect left sided heart valves and are often asymptomatic, but ☆systemic embolization (eg stroke, acute limb ischemia) can occur and the most common presentation of NBTE rheumatologyUWorld May 8, 2019, 10:47 PM HirotoShishido
triggers/ treatment for Raynaud diseasecold temperature, stress, caffeine, nicotine, medication that affect sympathetic nervous system
common in pregnant woman or a job that requires vibration
(digital ulceration(severe ischemia) can be seen in secondary(syndrome))
calcium2+ channel blockers rheumatology May 8, 2019, 12:17 AM HirotoShishido
color change in Raynaud phenomenonvasospasm cause ischemia(white)→hypoxia(blue)→reperfusion(red) rheumatology May 8, 2019, 12:12 AM HirotoShishido
