7 - Lupus Flashcards by michael english

MC pt for Lupus?

Black women

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What is lupus?

Inflammatory autoimmune disorder affecting multiple organ systems

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Lupus pts need to worry about?

Sever renal disease early in life

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Lupus is multifactorial, what are some of the factors suspected to be involved?

Genetic - monozygotic twins, HLA DR2 and DR3

Abnormal immune system - autoantibodies (ANA)

Endocrine - Menarche, HRT, OCPs

Environmental - tobacco, UV light, EBV

Drugs - procainamide, hydralazine, INH

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Classification for lupus?

4/11 of the following:

Malar rash
Discoid rash
Photosensitivity
Oral ulcers
Arthritis
Serositis
Renal (>0.5 proteinuria or cell casts)
Neurologic (seizure, psychosis)
Hematologic disorders
Immunological abnormalities
POS ANA

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95-100% of lupus pts have?

Positive ANA

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Immunological abnormalaties seen with Lupus?

Anti-dsDNA
Anti-Sm
Antiphospholipid antibodies

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Hematologic disorders with lupus?

Hemolytic anemia
Leukopenia
Lymphopenia
Thrombocytopenia

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Important Labs for lupus

Depressed serum complement (C3, C4, CH50)

Anti-phospholipid antibody

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Labs for lupus

C3, C4, CH50
ANA
Anti-smith
Ds-DNA
Anti-phospholipid antibody

UA = hematuria
CBC = anemia, leukopenia, thrombocytopenia
Chemistry = hyperkalemia, renal
LFT - multiple cases of test abnormalitis
CK elevated in associated mytosis
Skin biopsy

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CT Imaging studies for lupus?

CT chest:

lupus pneumonitis
alveolar hemorrhage
fibrosis

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Endocardiogram for lupus?

Pericardial effusions
Valvular lesions
Screening for pulm HTN

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CXR for lupus?

Initial eval of pleuritic chest pain

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Lupus non-pharmacologic tx?

PT education
Photoprotection
Tobacco cessation
Exercise
Healthy diet
Vaccine (flu, pneumococcal)

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Pharmacologic cutaneous tx for lupus

Initially: low potency topical steroids

Truncal lesions: medium potency topical steroids

Severe hypertrophic regions: high potency topical steroid

Tacrolomus/pricrolimus: 2nd line agent

Retinoids: 2nd line

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Systemic pharmacological agents for lupus

Hydroxychloroquine (plaquenil) - 1st line

Cloroquine - 2nd line
Corticosteroids - short term only
ACE/ARB - control B/P and Renal manifestations

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If youre treating with hydroxychloroquine (plaquenil) you cannot give?

Chloroquine

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You can but should never give lupus pts?

Corticosteroids

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Systems effected by lupus

Constitutional
Ocular
Arthritis
Osteonecrosis (avascular necrosis)
Cardiovascular
Pulmonary 
Hematologic
Neurologic
Renal
Gastrointestinal

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Occular lupus symptoms?

Keratoconjunctiva sicca

SLE retinopathy

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Arthritic symptoms of lupus

Transient symmetric arthritis of:

hands
writsts
knees

Seldom

Deforming
Non-erosive

Less severe than RA

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MC presenting of SLE?

Arthritis

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Lupus pts can have ___ w or w/o hx of steroid therapy?

Osteonecrosis (avascular necrosis)

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Cardiovascular symptoms of lupus?

Raynauds
Pericarditis
Valvular heart dz
Libman-sacks endocarditis
CAD

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Pulmonary features of lupus?

``` Serositis Plueral effusions Pleuritis Intersititial lung disease (restrictive) Pulmonary HTN Shrinking lung syndrome PE ``` PFT’s: restrictive, low diffusion

Hematologic presentation of lupus?

Anemia of chronic disease - MOST COMMON ``` Lymphadenopathy (common) Leukopenia Thrombocytopenia Hemolytic anemia Coombs test + ```

Neurologic presentation of lupus?

``` HA Seiures Mood changes CVD Cognitive dysfunction ```

Renal presentation of lupus?

Lupus nephritis | - w/in 1st 36 mo

Hallmark of lupus nephritis?

Proteinuria Hematuria

GI lupus presntation?

Mesenteric vasculitis (abdominal pain)

Malar rash is aka?

Acute cutaneous lupus Butterfly rash

Describe malar rash

Fixed erythema flat or raised over the malar eminences tending to spare the nasolabial folds

Acne rosacea, seborrheic dermatitis and flushing syndromes are differentiated from malar rash by:

Rosacea: - telangiectasias and pustules may sting/burn - heat and etoh make it worse Seborrheic derm: - scaly erythematous plaques on eyebrows, sclap, ears - nasolabial folds common

If the rash dx is unclear?

Biopsy to differentiate SLE from other derm

Discoid rash is aka?

Chronic cutaneous lupus

Discouid rash is MC found:

Face Scalp Neck

S/s of discoid rash

Raised erythematous patches w adherent keratotic scaling and follicular plugging Discoid lupus lesions: - Typically expand w peripheral erythema and hyperpigmentation

Discoid rash can occur?

In the oral cavity PAINFUL

Discoid lupus lesions hallmark?

Atrophic central scarring Telangiectasia Hypopigmentation

What causes subacute cutaneous lupus?

Most often induced by meds - hydrochlorothiazide - terbinafine

Where does subacute cutaneous lupus present?

Located on torso, limbs Spares the face

Subacute cutaneous lupus is the most ___ of the lupus rashes?

Most photosensitive

Describe subacute cutaneous lupus rash

Papulosquamous or annular Scaly erythematous papules The most photosensitive rash

Diagnostic labs for subacute cutaneous lupus?

Anti-Ro | SSA antibodies

Neonatal lupus can present as?

Cardiac Cutaneous Or both

With neonatal lupus you need to worry about?

Heart block

Rash s/s of neonatal lupus?

Annular, Polycyclic skin plaques on face and scalp After UV exposure for the 1st 3-5 months of life

Suspect neonatal lupus if mom had?

SSA | SSB labs

With neonatal lupus you can tell the parents?

It will typically resolves by 6-8 months of age

Patient population for drug induced lupus?

Men = women

Drugs associated w drug induced lupus?

``` Hydralazine INH Procainamide Minocycline Interferon alpha Anti-TNF agents Methyldopa Chloropromazine Quinidine ```

Hydrochlorthiazide is associated with?

Subacute cutaneous lupus

S/s of drug induced lupus?

``` Polyarthritis Myalgia Fever Serositis Nephritis CNS abnormalities rare ```

Diagnosis of drug induced lupus?

Anti-histone antibodies frequently present

Tx for drug induced lupus

Stop the drug!!! It gets better once you do that If systemic tx is needed in the interim than do that too

What is APS?

Antiphospholipid antibody syndrome Hypercoagulability with recurrent thrombosis of either venous or arterial circulation

APS causes?

DVT PE Stroke Renal injury

Clinical criteria for APS?

``` Vascular thrombosis Or 1+ pregnancy loss > 10 wks 1+ premature birth < 34 wks 3+ spontaneous abortion <10 wks ```

What antiphospholipid antibodies are included in APS?

False pos RPR (neg FTA) Lupus anticoagulant (increased PTT) Anticardiolipin antibodies (IgG/IgM) Anti-beta-2 glycoprotein 1 antibodies

Tx for APS?

Warfarin or heparin Lifelong anticuagulation w coumadin or heparin Smoking cessation

If woman has hx of preg-associated complication (APS) the tx is?

aspirin (preeclampsia) and heparin/LMWH

7 - Lupus Flashcards

(61 cards)