Rheumatology

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    Rheumatology Serological Markers

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    Rheumatoid Factor

    • Antibody against an Fc portion of Ig (antibody against antibody)
    • Seen in RA (70%), Cryoglobulinemia (rheumatoid factors are cryoglobulins)
    • Seen 10% of population 

    DISH

    • Diffuse idiopathic skeletal hyperostosis (DISH)
    • Defined by the presence of flowing osteophytes involving the anterolateral aspect of the thoracic spine at ≥4 contiguous vertebrae with preservation of the intervertebral disk space (+ absence of apophyseal joint or sacroiliac inflammatory changes such as erosions.)
    • DISH may occur with osteoarthritis or inflammatory arthritis (or without) and represents a separate finding of calcification and ossification of spinal ligaments and the regions where tendons and ligaments attach to bone (entheses).
    • Unknown cause that is common in the elderly population.
    • Symptoms range from asymptomatic or may describe stiffness and reduced range of motion, mostly at the thoracic spine.

    Pulmonary Renal Syndrome

    • Young pt presents with hemoptysis, elevated creatinine.  On urinalysis has blood 3+ and proteins 2+.  Urine sediment 50-80 RBC/hpf.  2 RBC casts.
    • chestXrayPulmRenal.jpg
    • Pulmonary Renal Syndrome
      • Differential diagnosis:
        • Goodpastures
        • IgA nephropathy
        • ANCA-Related (MOST COMMON).  5 Types of ANCA positive syndromes:
          • 1. Granulomatosis with polyangiitis (GPA)
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