Autoimmune Rheumatologic Disorders Flashcards Preview

Clin Med IV - Ortho > Autoimmune Rheumatologic Disorders > Flashcards

Flashcards in Autoimmune Rheumatologic Disorders Deck (31):
1

Demographics for typical SLE pt

- Women of childbearing age
- African, Caribbean, Hispanic descent

2

When might you be suspicious of SLE in a pt?

Young woman presenting with multiple clinical problems but otherwise no significant PMH

3

Hallmark of SLE labs are _______?

Auto-antibodies to nuclear proteins

4

Describe the pathophysiology of SLE

Auto-antibodies to nuclear proteins damage tissues through immune activation and deposition of immune complexes

5

Besides auto-antibodies, what else is present in SLE?

- C3/C4 deficiencies
- Increased B-lymphocyte stimulator (BlyS)

6

Clinical presentation of newly diagnosed SLE pt

Young pt with multiple problems:
- Glomerulonephritis → edema, HTN, hematuria, foamy urine, oliguria
- Hematologic disorders → anemia, thrombocytopenia
- Arthritis
- Mucucutaneous lesions → butterfly rash, livid reticularis
- Raynaud phenomenon
- Serositis → pleuritic pain, pericarditis

7

Clinical presentation of pt with established SLE

- Hospital admission due to flare
- Hematologic changes (d/t SLE or meds)
- Neuropsychiatric dz
- Premature CVD

8

What do you need to diagnose SLE?

Clinical presentation PLUS supporting labs

9

What labs should you get if you are suspicious for SLE?

- Elevated ANA
- CBC w/ diff → anemia, thrombocytopenia
- UA → proteinuria, urinary sediment
- Anti-dsDNA
- C3/C4 complement deficiency

10

Dx lupus nephritis

- Proteinuria → >0.5g/day or 3+
- Urinary sediment → >5 RBC or WBC/HFP
- Kidney bx

11

What should you do to treat SLE flare?

- Don't need to get ANA levels if established dx
- R/o lupus nephritis via Cr, UA, urine sediment
- Anti-dsDNA, ESR/CRP, C3/C4
- Consult rheumatology

12

The mainstay of SLE treatment is _______

Glucocorticoids

13

Treatment of SLE includes

- Glucocorticoids!
- Hydroxychloroquine → reduces flares & improves survival
- Belimumab → binds to and inhibits BlyS
- IVIG if heart block

14

Indications for belimumab in SLE

- Higher disease activity
- Steroid use
- Elevated anti-dsDNA
- Low complement

15

Clinical manifestations of Sjogren's syndrome

Xerophthalmia
Xerostomia

16

Pts with Sjogren's also tend to develop ______

Malignant lymphoma

17

Labs for Sjogren's will show _______

- Autoantibodies to Ro/SSA and La/SSB
- Antimuscarinic antibodies

18

Why are xerophthalmia and xerostomia concerning?

- High risk for corneal ulcer or perforation (consult ophthalmology)
- Susceptible to dental caries

19

What test can you use to help diagnose Sjogren's, specifically xerophthalmia?

Schirmer's test

20

What can you do if you're suspicious for Sjogren's but all the tests are inconclusive?

Labial biopsy

21

Tx Sjogren's

Symptomatic relief
- Artificial tears, drink more water
- Propionic gels for vagina
- Corneal ulcer → eye patch, boric acid ointment
- Monoclonal antibody to CD20, add CHOP if lymphoma
- Hydroxychloroquine for arthrlagias
- Sodium bicarb for renal tubular acidosis
- Glucocorticoids only indicated for systemic vasculitis

22

What meds do Sjogren's pts want to avoid?

Avoid diuretics, anti-HTN, anticholinergics, antidepressants

23

What happens in scleroderma?

Fibrosis of skin & internal organs

24

Name the 2 types of scleroderma.
Which is more common?

- CREST syndrome (limited disease) → 80% pts
- Diffuse disease

25

Presentation of limited scleroderma disease

CREST - limited to face, neck, distal extremities
- Calcinosis cutis (calcification of skin)
- Raynaud phenomenon
- Esophageal dysmotility
- Sclerodactyly (sausage fingers)
- Telangiectasia

26

Presentation of diffuse scleroderma dz

- Widespread fibrosis in skin and internal organs
- Shorter period b/w Raynaud's & onset of other sx's (weeks to months)
- Polyarthralgia, weight loss, malaise
- Early "edematous" phase w/ hyperpigmentation, carpal tunnel, muscle weakness, fatigue, decreased joint motility; Clinically silent organ involvement

27

Most rapidly evolving pulmonary & renal damage in scleroderma pts occurs when?

Initial 4 years

28

______ and _______ are present in almost all scleroderma pts

Raynaud phenomenon
Antinuclear antibodies

29

_______ antibodies are found in 50% CREST pts

Anticentromere

30

Tx severe Raynaud syndrome in scleroderma pt

CCB (e.g. nifedipine) or losartan

31

What kind of counseling can you give scleroderma pt with esophageal involvement?

- Take meds in liquid or crushed form
- Avoid late-night meals and eating in supine/reclined position
- PPIs
- Prokinetics for hypomotility (erythromycin, metoclopramide, cisapride)
- Delayed gastric emptying → small/frequent meals, remain upright 2 meals s/p meals