A 20-year-old woman is reviewed in the rheumatology clinic. She has been referred due to a three month history of arthralgia, lethargy, muscle pains and Raynaud's phenomenon. On examination she is noted to have slightly swollen hands but no significant synovitis. A number of blood tests are ordered:
Given the likely diagnosis, which other antibodies are most likely to be present?
Correct Answer E: Anti-ribonuclear protein (anti-RNP) = mixed connective tissue disease.
This patient has typical features of mixed connective tissue disease (e.g. arthralgia, myositis and Raynaud's). To confirm the diagnosis anti-RNP antibodies need to be detected.
Mixed connective tissue disease:
A 62-year-old man with lung cancer is suspected of having dermatomyositis.
Which one of the following antibodies is most likely to be positive?
Correct Answer A: Dermatomyositis antibodies: ANA most common, anti-Mi-2 most specific.
Dermatomyositis: investigations and management:
Investigations:
Management:
A 50-year-old woman complains of pain in her right elbow. This has been present for the past four weeks and is maximal around 4-5cm distal from the lateral aspect of the elbow joint. The pain is made worse by extending the elbow and pronating the forearm.
What is the most likely diagnosis?
Correct Answer B:
Elbow pain:
The table below details some of the characteristic features of conditions causing elbow pain:
Which one of the following antibodies is most specific for systemic lupus erythematous?
Correct Answer C: SLE: ANA is 99% sensitive - anti-Sm & anti-dsDNA are 99% specific.
SLE: investigations: Immunology:
Monitoring:
Which one of the following is most recognized as a potential complication in a patient with ankylosing spondylitis?
Correct Answer A:
Ankylosing spondylitis: features:
Ankylosing spondylitis is a HLA-B27 associated spondyloarthropathy. It typically presents in males (sex ratio 5:1) aged 20-30 years old.
Features:
Clinical examination:
Other features - the 'A's:
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