Specificity and Sensitivity
ANA has what sensitivity for SLE (assuming titers =/> 1:160)?
What is >95%?
Poor specificity
Also assoc with Sjögren syndrome, MCTD
What antibody has the highest specificity for SLE?
anti-smith (does not correlate with disease activity)
A 63-year-old woman is evaluated for chronic painful arthritis.
Hand findings are shown.
What is tophaceous gout?
Photo 1
What is Dermatomyositis?
Anti histone antibodies are associated with what?
what is drug induced lupus?
What is the sensitivity of RF in RA?
What is 70% senisitivity? limited specificity, esp because of many atypical presentations
What antibody is associated with GPA?
What is c-ANCA?
correlation with disease activity is unclear. High specificity in classic presentations, 90% sensitive when disease is active
A 55-year-old man is evaluated for the recent onset of muscle weakness and facial rash.
Skin findings are shown (see ppt slide).
what is dermatomyositis?
Photo 2
what is discoid lupus rash (SLE)
Atypical p-anca is also associated with what?
What is IBD and drug-induced vasculitis?
What is the sensitivity and specificity of Anti-CCP in RA?
What is 70% sens, 95% spec?
Antibody associated with polymyositis?
What is Anti-Jo-1?
Associated with antisynthetase syndrome, which may include mechanic's hands, Raynaud phenomenon, and lung inflammation
A 57-year-old woman is evaluated for a 2.5-year history of pain and swelling in the hands and wrists. She also has joint stiffness for over an hour after awakening.
On physical examination, vital signs are normal. She has swelling and tenderness of the following: second, third, and fourth proximal interphalangeal joints of the right hand and third and fourth proximal interphalangeal joints of the left hand; the left second and right third metacarpophalangeal joints; and both wrists.
Laboratory evaluation reveals a blood C-reactive protein level of 4.8 mg/dL (48 mg/L) and positive results on tests for serum rheumatoid factor and anti–cyclic citrullinated peptide antibodies.
Radiographs of the hands show periarticular osteopenia and joint-space narrowing of the proximal interphalangeal joints, periarticular osteopenia and marginal erosions at the second proximal interphalangeal and metacarpophalangeal joints of both hands, and radiocarpal joint-space narrowing.
What is her diagnosis? Also, do we need further imaging for appropriate diagnosis?
What is RA? No, we do not.
Photo 3
what is systemic sclerosis?
RF is common in multiple other diseases than RA. What is one other disease RF is common in?
What are Hep C, endocarditis, SLE?
What is the sensitivity of Anti-Scl-70 in diffuse cutaneous systemic sclerosis?
10-30%, no specificity data given
Antibody associated with Sicca syndrome?
What is/are Anti-Ro/SSA, anti-La/SSB?
Sicca symptoms; in SLE, associated with photosensitive rash; offspring of mothers who are positive for anti-Ro/SSA or anti-La/SSB are at increased risk for neonatal lupus erythematosus (rash and congenital heart block)
An 85-year-old woman is evaluated for a 10-day history of right knee pain and swelling, which is impairing her ability to walk and climb stairs. She has a history of similar symptoms over the past 2 years. Each episode has lasted about 3 weeks and resolves with rest and ice.
On physical examination, vital signs are normal. She has moderate swelling of the right knee, with warmth and tenderness, and decreased range of motion related to pain. No skin lesions or tophi are noted.
ESR 65, other lap work normal. Xray available if needed.
What is CPPD?
Photo 4
what is osteoarthritis
What is an antibody that follows SLE disease activity and can be used for clinical monitoring?
anti-dsDNA
Found in more severe disease, especially kidney disease; antibody levels commonly follow disease activity and are useful to monitor
What is the sensitivity and specificity of anti-dsDNA for SLE?
What is 50-60% sensitive, > 95% specificity?
What antibody has a high sensitivity for MCTD?
What is anti-u1-RNP?
A 62-year-old woman is evaluated for joint pain. She has a 10-year history of psoriasis and a 3-year history of arthritis. Her psoriasis has been controlled with adalimumab, but joint symptoms persist. She has stiffness in the affected joints for less than 30 minutes every morning, and pain increases with activity. There is no dactylitis. Current medication is adalimumab.
On physical examination, there are small psoriatic plaques on the left elbow and right knee. She has bony enlargement, without swelling, of most distal and proximal interphalangeal joints of the hands. The left knee has a small effusion. The remainder of the examination is normal.
Radiographs of the hands show joint-space narrowing and osteophytes at the distal and proximal interphalangeal joints of both hands. Radiographs of the knees show medial joint-space narrowing and subchondral sclerosis of the left medial compartment.
What is the most likely cause of this patient's joint pain?
What is osteoarthritis?
photo 5
what is PsA
What antibody is associated with lupus hepatitis and CNS lupus?
What is antiribosomal P?