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N935 Advanced Pathophysiology > Systemic Lupus Erythematosus > Flashcards

Systemic Lupus Erythematosus Flashcards

1
Q

What is lupus?

A

complex multisystemic autoimmune disease characterized by presence of autoreactive B and T cells and the production of a broad, heterogenous group of autoantibodies

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2
Q

What is a common antibody that is produced in lupus?

A

antinuclear (anti DNA) antibody

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3
Q

Pathogenesis of lupus

A

genetic predisposition and environmental exposures
loss of self tolerance
immune activation

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4
Q

Risk factors for lupus

A

women 15-44 y/o
BIPOC
UV light, infection, virus, stress
estrogen?

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5
Q

Why might estrogen be associated with lupus?

A

lupus symptoms develop before menstruation and during pregnancy when estrogen levels are high

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6
Q

What does loss of self tolerance mean?

A

production of autoantibodies without regulation

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7
Q

What happens with immune activation?

A

T and B cells are hyperactive and the innate immune system is activated causing inflammation leading to tissue damage and clinical manifestation of the disease

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8
Q

How is lupus diagnosed?

A

CBC, antibody (ANA, anti dsDNA), complement test, blood clotting tests, urine test, biopsies

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9
Q

Criteria for diagnosis of lupus

A

need at least 4 serial or simultaneous from the classification list

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10
Q

Criteria for classification of lupus

A

malar rash, photosensitivity, oral or nasopharyngeal ulcers, discoid rash, renal disorder, serositis, neurologic disorders, hematologic disorders, immunologic disorders, nonerosive arthritis of at least 2 peripheral joints, presence of ANA

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11
Q

Signs and symptoms of lupus

A

Headaches, fever, hair loss, butterfly shaped rash across cheeks and nose, mouth or nose ulcers, abnormal blood clotting, sun or light sensitive, swelling (feet, leg, hands, around eyes), painful or swollen joints, anemia, pain in chest, fingers turning blue or white when cold (Raynaud’s)

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12
Q

What are the 4 types of lupus?

A

systemic lupus erythematous
drug induced lupus erythematous
cutaneous lupus erythematous
neonatal lupus

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13
Q

CNS effects of SLE

A

vasculitis, anxiety, depression, psychosis, seizures, stroke

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14
Q

Blood effects of SLE

A

thrombocytopenia, anemia, leukopenia, antiphospholipid syndrome leading to embolism

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15
Q

Heart effects of SLE

A

pericarditis, pericardial effusions, CHF, HTN

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16
Q

Joint effects of SLE

A

arthritis, avascular necrosis d/t steroid use leading to needing joint replacement

17
Q

Kidney effects of SLE

A

nephritis, proteinuria, hypoalbuminemia, hematuria, renal failure

18
Q

Lung effects of SLE

A

pleural effusions, restrictive lung disease, atelectasis

19
Q

Airway effects of SLE

A

mucosal ulceration, cricoarytenoid arthritis, recurrent laryngeal nerve palsy

20
Q

What are the 3 main culprits that cause drug induced lupus?

A

Hydralazine, Procainamide, and Isoniazid

21
Q

How does drug induced lupus differ from SLE?

A

Signs and symptoms usually disappear 6 months after stopping the drug
Doesn’t mimic parts of SLE that are more severe
More cutaneous manifestations

22
Q

Where does cutaneous lupus cause rashes and discoid lesions?

A

face, arms, neck, shoulders, trunk

23
Q

How is cutaneous lupus affected?

A

Affected by sunlight and fluorescent

24
Q

Pregnancy risks of activating lupus

A

pre-eclampsia, pre-term delivery, miscarriages, intrauterine growth restrictions

25
Q

How does neonatal lupus present?

A

skin rash, liver problems, low blood counts, congenital heart blocks potentially needing pacemakers

26
Q

What are two antibodies that can be screened for in women looking to get pregnant?

A

anti SSA - RO

anti SSA - LA

27
Q

Treatment for lupus includes

A

NSAIDs, tylenol, immunosuppressants, corticosteroids, antimalarials, anticoagulants, monoclonal antibodies, repository corticotropin injections

28
Q

Which agent is the only FDA approved treatment for lupus?

A

Belimumab which is a monoclonal antibody agent

29
Q

Our pre-anesthesia evaluation is influenced by

A

magnitude of organ system dysfunction, drugs used to treat SLE, and any airway involvement

30
Q

What kinds of questions may we want to ask or think about with a patient who has SLE?

A

When was the last flare?
What does their lupus attack look like?
What things do they worry about during a flare?
When was their last rheumatologist visit and lab work?
Was there any recent changes to medications?

N935 Advanced Pathophysiology (15 decks)

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