Jeopardy. What s the rash? $100 $100 $100 $100 $100 $200 $200 $200 $200 $200 $300 $300 $300 $300 $300 $400 $400 $400 $400 $400

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1 Jeopardy Antibodies & more antibodies Aching joints What s the rash? Potpourri Image Challenge $100 $100 $100 $100 $100 $200 $200 $200 $200 $200 $300 $300 $300 $300 $300 $400 $400 $400 $400 $400 $500 $500 $500 $500 $500

2 Category 1 - $100 Q. Most specific antibody test for SLE? A. Anti-dsDNA

3 Category 1 - $200 Q. Most specific antibody seen in diffuse scleroderma (other than ANA which could be seen in 95% of SSc). A. Anti-topoisomerase I (anti-scl-70). It is 99.5% specific but only 20 to 50% sensitive. They are at a higher risk of developing ILD

4 Category 1 - $300 Q. This antibody is almost universally found Mixed Connective Tissue disease and is the sine qua non for this condition! A. Anti-U1-RNP (previously called anti-ena)

5 Category 1 - $400 Q. Name atleast two other conditions or diseases that can cause positive ANA other than systemic inflammatory conditions (SLE, Scleroderma, Sjogrens, PMR etc). A. Organ specific- Hashitmotos, Graves, AI hepaitis, PBC B. Infectious- viral- EBV, HIV, HCV, Parvo; Bact- Syphilis, SBE C. Malignancies- PNP, Lymphoproliferative disorders D. Misc: IBD, IPF

6 Category 1 - $500 Q. Sensitivity and Specificty for RF and anti-ccp for RA RF- Sensitivity 70 to 80% - Specificity 88 to 92% Anti-CCP- Sensitivty Same as RF - Specificty 95 to 98%

7 Category 2 - $100 Q. HLA-B27 associated diseases (seen in 80-90% cases) Name two of them. A. Ankylosing Spondylitis, Reactive Spondyloarthropathies: Reiter s syndrome, Yersinia, Shigella, and Salmonella arthropathy, Psoriatic arthritis

8 Category 2 - $200 Q. Name 2 conditions in Lyme s disease that require IV antibiotics therapy A. Meningitis, Encephalitis/Encephalomyelitis, Myocarditis (especially 3 rd degree heart block)

9 Category 2 - $300 Q. What two joints do the Seronegative spondyloarthropathis affect that RA does not? A. Spine and SI joints (Note: Sacroiliitis and Thoraco-Lumbar spine tenderness does NOT occur in RA!)

10 Category 2 - $400 Q. Osteoarthritis should be suspected in patients 40 years or older who have chronic joint pain without significant morning stiffness in the following joints (most commonly involved joints; name atleast 5 of them) Knee, Hip, Spine, PIP, DIP and MCP

11 Category 2 - $500 Q. Diagnostic criteria for Rheumatoid Arthritis Inflammatory arthritis involving 3 or more joints Positive RF and/or CCP Elevated levels of CRP or ESR Diseases with similar clinical features have been excluded (Psoriatic, acute viral, Polyarticular gout or CPPD) Duration of symptoms >6weeks

12 Q. Category 3 - $100 A. Erythema Migrans (Bull s eye rash/target lesions) from tick bite.

13 Q. Category 3 - $200 A. Psoriasis plaque. An erythematous plaque with coarse scale.

14 Q. Category 3 - $300 A. Shawl sign in dermatomyositis. Poikilodermatous changes are present on the upper back.

15 Q. Category 3 - $400 A. Papular sarcoidosis. Multiple round papules. Common cutaneous manifestation in sarcoidosis.

16 Q. Category 3 - $500 A. Discoid Lupus Erythematosus, seen in 25% patients of SLE( Discrete, erythematous, slightly infiltrated plaques covered by well formed adherent scale) Do not typically develop severe form of lupus if DLE is present

17 Category 4 - $100 Q. Name the key features of Limited Scleroderma (5) A. Calcinosis, Raynaud, Lower Esophageal dysfunction, Sclerodactyly, Telangiectasis.

18 Category 4 - $200 Q. What are the two pathognomic physical finding in Dermatomyositis? A. Gottren s papules (Erythematous or violaceous papules on MCP or IPJ) and Heliotrope eruption (on upper eyelids).

19 Category 4 - $300 Q. Name atleast 2 conditions A. Wegener Granulomatosis, Relapsing Polychondritis, Sarcoidosis, Churg-Strauss Syndrome

20 Category 4 - $400 Q. Name 3 of the 4 findings that establish the diagnosis of Polymyositis. A. Proximal muscle weakness and myalgias B. Markley elevated muscle enzymes (CPK) C. Abnormal Myopathic EMG D. Abnormal muscle biopsy showing cytotoxic cell infiltrate with myonecrosis.

21 Category 4 - $500 Q. Which combination drugs (2 drugs) are effective means to reduce rheumatoid arthritis symptoms and structural damage. A. Methotrexate in conjuction with TNF alpha inhibitors (Etanecerpt, Infliximab, Adalimumab etc)

22 Q. Category 5 - $100 A. Sausage digit (IP arthritis and flexor teno-synovitis) - seen in the reactive, Psoriatic arthritis, SSc, Ankylosing spondylitis

23 Q. Category 5 - $200 A. Pencil-in-cup deformity; associated with Psoriatic arthritis

24 Q. Category 5 - $300 A. Rheumatoid nodules. Firm painless subcutaneous nodule at the pressure points from antibody deposition.

25 Q. Category 5 - $400 A. Systemic sclerosis. Shiny taut skin of the hand distal to the metacarpophalangeal joints.

26 Q. Category 5 - $500 A. Left: Early relapsing polychondritis- redness and swelling of the auricle. B. Right: Late relapsing polychondritis showing loss of structural integrity of cartilage, resulting in floppy appearance

27 Final Jeopardy Q. ACR criteria for the classification for Fibromyalgia. a. Location b. Duration c. Name atleast 5 specific anatomical locations of tenderness A. Criterion 1. History of widespread pain. (Pain in R and L side of the body, and above and below the waist, and axial skeletal pain (cervical spine, thoracic spine, or low back). B. Criterion 2. Pain in 11 of 18 tender point sites on digital palpation (Occiput, Low cervical, Trapezius, Supraspinatus, 2 nd rib, Lateral epicondyle, Gluteal, Greater trochanter, Knee) Duration atleast 3 months. R/O secondary clinical disorder.

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