04-17 L3 SLE Flashcards
(19 cards)
1
Q
What is the def of SLE
A
- it is both a type II and type III hypersensitivity rxn in which bound antibody antigen pairs (immune complexes precipitate and cause further immune response.
- autoimmunity based on interplay b/c genetic predisposition hormonal and environmental triggers that result in reduced tolerance to self tissues.
- Immune response anomalies, alltered antigen presentation, abnormal B-cell responses, increase func of T-helper cells, abnormal cytokine production, exaggerated effector response loss of regulator T-cells or B-cells
2
Q
SLE genetics
A
- >40 genes have been implicated
- Def of C1q, C2, C4
- mutatino w/in MHC complex HLA-DR3
3
Q
International society of n/r pathology
Class 1-6
A
- Class I: minimal mesangial lupus nephritis
- Class II: mesangial proliferative lupus nephritis
- Class III: Focal lupus nephritis (<50%)
- Class IV: Diffuse lupus (>50%)
- Class V: membranous lupus nephritis (global or segmental subepithelial depositis)
- Class VI: Advanced sclerosis lupsu nephritis (>90%)
4
Q
Lupus nephritis
which class has the worse prognosis
treatment
A
- Prognosis
- Class 4 w/high activity index has worse prognosis
- Treatment
- induction: cellcept 2-3 grams or CYc
- Maintainence: cellcept or Imuran
- Refractory: Rituxan, tacrolimus
5
Q
Neuropsychiatric lupus
A
- Neurological syndromes of CNS PNS, ANS and psychiatric disorders in which other causes have been ruled out.
6
Q
Cardiovascular disease
A
- 50 times higher risk of CVD
- women with SLE vs normal
7
Q
Pulmonary disease
A
- acute lupus pneumonits
- diffuse avleolar hemmohage, hemoptysis, falling hct, infiltrates dyspnea
- PH
- PE
- skrinking lung syndrome
8
Q
GI
A
- peritonities (least common serosal lingin involved)
- bowel vascultiis
- pancreatitis
- protein loosing enteropathy
9
Q
A
10
Q
Ocular
A
- cotton wool spots from focal ischemia (non-specific)
- MC-plaquenial toxicity
11
Q
Hematologic
A
- Penia: generally due to peripheral destruction
- Autoimmune hemolytic anemia
- Anemia of chronic disease
- Leucopenia
- Lymphophenia less than 1500
- thromboyctopenia
12
Q
What type of serologies and complements are seen in lupus
A
- ANA
- dsDNA
- low C3 & C4
- Anti sm-specific
- SSA/SSB
- AntiRNP,
- Antiribosomal P
- Antiphospholipid
13
Q
Name 4 treatment options for SLE
A
- Corticosteroids
- Topical agents
- Antimalarials
- Dapsone
14
Q
SLICC classification criterion (2012)
what are the two criteria
A
- pt statisfies 4 of teh critiera listed (including at least one clinical criterion and one immunologic criterion)
- Pt has biosy proven nephritis compatible with SLE and with ANA or anti-dsDNA antibodies
15
Q
What is the first line immunnomodulatory agent in mild SLE?
A
- **Hydroxychloroquine or ‘HCQ’ **(antimalarials)
16
Q
Pregnancy in women w/SLE
discuss contraception
factors to consider
A
- contraception
- need to plan pregnancy should be discussed regularly
- best time to plan pregnancy is when SLE is quiescent for at least 6 mons
- SLE pts are at higher risk of miscarriages, stillbirths, preeclampsia, eclamspia, IUGR, preterm labour, thrombotic and infection complications as well as have higher rate of C sectino post martum bleeding
17
Q
Pregnancy in women w/SLE
factors to consider
A
-
factors to consider
- SLE activity (hypocomplemenemia)
- Maternal hypertension
- Lupus nephritis/proteinuria/renal function
- SSA/SSB antibodies: monitoring for neonatal lupus
- anti-phospholipid antibodies
- Medications
18
Q
What are the 3 diagnosit criterion of
Antiphospholipid syndrome
A
-
elevated (moderate to high titers) of anticardiolipin or anti-beta 2 glycoprotein antibdies
- pos lupus anticoagulant
-
Prior pregnancy morbidity
- pregnacy loss of morphological normal fetus
- 3 consecutive pregnancy losses <10 w
- prior preterm birth (<34 w) for eclapmsia or severe pre-eclampsia or placental insufficiency
- prior thormbosis
19
Q
Which class c drug must you continue during pregnancy?
A
- Plaquenil
