Chapter 42 - Lupus Erythematosus Flashcards
What is the most important part of treatment of cutaneous lupus?
Sun protection
How often should an eye exam be performed in a patient on hydroxychloroquine or chloroquine?
At baseline and then every 6-12 months
True or false: in patients who are not responsive to hydroxychloroquine, chloroquine may be added.
False; both these drugs can cause retinal toxicity, and thus combining them dramatically increases the risk of this side effect. However, quinacrine, which doesn’t cause retinal toxicity, can be added to hydroxychloroquine
List the eleven criteria from the 1982 American College of Rheumatology (ACR) criteria for SLE. Hint: use the mnemonic “SOAP BRAIN MD”.
Serositis, Oral ulcers, Arthritis, Photosensitivity/Pulmonary fibrosis, Blood cells (decrease in any cell line), Renal/Raynaud’s, ANA, Immunologic (Anti-Sm, Anti-dsDNA), Neuropsychiatric, Malar rash, and Discoid rash
*Four out of 11 criteria are skin related!
Which autoantibody is often present in patients with drug-induced lupus?
Antihistone antibodies, although beware that these autoantibodies are non-specific and are also common in patients with SLE!
True or false: patients with drug-induced lupus often present with nephritis and CNS disease.
False; they almost never present with nephritis and CNS disease. They usually present with MSK-type symptoms, including arthralgias, myalgias, pleuritis, and fever
What is the biggest risk factor for LE?
Gender, women outnumber men by at least 6 to 1. Also, ethnicity plays a big role; there is a 4-fold higher prevalence of LE in African-American women than in Caucasian. Note: prevalence in Caucasians is similar to Asians and Latin Americans
What are some potential complications of babies born to mothers with anti-Ro autoAb?
3rd-degree heart block, subacute cutaneous lupus, hepatobiliary disease, thrombocytopenia, or some combination
What are the 4 subtypes of CCLE?
Discoid, LE tumidus, lupus panniculitis, chilblain lupus
What are the 3 main types of cutaneous LE?
Acute, subactue, chronic
What medications have been known to cause specifically SCLE?
HCTZ, terbinafine, CCBs (e.g. diltiazem), NSAIDs, griseofulvin and antihistamines
What mutation is associated with familial chilblain lupus?
TREX1
List the distribution of lesions in neonatal LE in descending frequency.
Face > periorbital skin > scalp > arms and legs > trunk and groin
What is the initial workup for a patient you suspect has cutaneous LE +/- SLE?
Hx, P/E, skin bx. Bloodwork includes CBCd, U/A, BUN/Cr, ANA, and SLE-specific autoAb (dsDNA, Sm, Ro especially if pregnant), ESR, C3, C4
What is the treatment for cutaneous LE?
Sunprotection, topical or intralesional corticosteroids, topical calcineurin inhibitors, PO antimalarial (with eye exams), PO retinoids/thalidomide/gold/immunosuppressants, ?PDL
