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Old 03-23-2012
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Immunology Antinuclear Antibodies Test

A 57-year-old woman with a history of hypertension and arthritis is referred to a rheumatologist for evaluation. A complete blood count (CBC) is normal, and a mini-chem panel shows no electrolyte abnormalities. Her erythrocyte sedimentation rate (ESR) is elevated, and an antinuclear antibody test (ANA) is positive. Further antibody studies are performed, and the results are shown below.

Anti-histones - high titer
Anti-double stranded DNA - not detected
Anti-single stranded DNA - not detected
Anti-SSA - not detected
Anti-SSB - not detected
Anti-SCI-70 - not detected
Anti-Smith - not detected
Anti-centromere - not detected
Anti-RNP - not detected

Which of the following diseases is suggested by these results?

A) CREST syndrome
B) Diffuse form of scleroderma
C) Drug-induced lupus
D) Sjögren syndrome
E) Systemic lupus erythematosus (SLE)


** This might be an easy question but let's see if you guys can explain all the diseases where you find the above mentioned Antinuclear Antibodies! **
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It's C - Antihistone -> Drug induced lupus like hydralazine/ procainaminde...


Anti-double stranded DNA -> SLE
Anti-single stranded DNA - not specific - Mostly in SLE
Anti-SSA - Sjrogen
Anti-SSB - Sjrogen
Anti-SCI-70 - I.e. Antitopoisomerase I -> systemic scelorsis
Anti-Smith - SLE
Anti-centromere - CREST
Anti-RNP - MCTD
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Its HIPP to have lupus =)

drug induced lupus:

Hydralazine
INH
Procainamide and something else i forgot (Phenytoin?)
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Quote:
Originally Posted by DocSikorski View Post
Its HIPP to have lupus =)

drug induced lupus:

Hydralazine
INH
Procainamide and something else i forgot (Phenytoin?)
this is waht wikipedia says:

High risk:

Procainamide (antiarrhythmic)
Hydralazine (antihypertensive)


Moderate to low risk:

Isoniazid (antibiotic)
Minocycline (antibiotic)
Pyrazinamide (antibiotic)
Quinidine (antiarrhythmic)
D-Penicillamine (anti-inflammatory)
Carbamazepine (anticonvulsant)
Oxcarbazepine (anticonvulsant)
Phenytoin (anticonvulsant)
Propafenone (antiarrhythmic)

i only remember bold ones
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Quote:
Originally Posted by beka-CTS View Post
this is waht wikipedia says:

High risk:

Procainamide (antiarrhythmic)
Hydralazine (antihypertensive)


Moderate to low risk:

Isoniazid (antibiotic)
Minocycline (antibiotic)
Pyrazinamide (antibiotic)
Quinidine (antiarrhythmic)
D-Penicillamine (anti-inflammatory)
Carbamazepine (anticonvulsant)
Oxcarbazepine (anticonvulsant)
Phenytoin (anticonvulsant)
Propafenone (antiarrhythmic)

i only remember bold ones
Definitely saw Pyrazinamide to have SLE-like symptoms in questions...

But Quinidine is associated with cynchonism on step 1 (I think...)

Because both Procainamide and Quinidine are Class IA antiarrythmics, it would make more sence to make 2 good questions from them then just one... I dunno.

Btw these to (or just one of them) can lead to torsades, cuz they also increse action potential duration...
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Default Its eeeeeez

It's C....drug induced lupus
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Old 03-24-2012
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The correct answer is C. The single finding of high autoantibody titers to histones, without any other autoantibodies, is characteristic of drug-induced lupus. The most commonly implicated drugs are procainamide, hydralazine (given for hypertension), and isoniazid. Patients typically have milder disease than in systemic lupus erythematosus (SLE) and tend to have arthritis, pleuropericardial involvement, and, less commonly, rash. CNS and renal disease are not usually observed.

CREST syndrome (choice A) is a milder variant of scleroderma characterized by calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia. Anti-centromere antibodies are diagnostic.

The diffuse form of scleroderma (choice B), also known as systemic sclerosis, causes fibrosis of the skin and internal viscera. This disorder is characterized by anti-SCI-70 and often low titers of many other autoantibodies.

Sjögren syndrome (choice D) is characterized by dry eyes and dry mouth. Sjögren syndrome in isolation is characteristically positive for anti-SS-A and anti-SS-B. If it accompanies rheumatoid arthritis, anti-RNP will be positive as well.

SLE (choice E) is a multisystem disorder that is distinguished from drug-induced lupus by the presence of a wide variety of autoantibodies, including anti-double stranded DNA (Anti dsDNA).
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