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LES Flashcards

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1
Q

Etiologie - medicamente

A

HIPP

Hidralazina

Izoniazida

Procaindamida

Penicilamina

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2
Q

LES cu afectare cutanata si renala este caracterizat de prezenta

A

depozitelor de

complement

+

Ac de tip IgG

+

influx neutrofile + limfocite

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3
Q

Biopsiile altor tesuturi - rar efectuate, dar pot arata

A

modificari de tip vasculitic ce afecteaza

capilarele

arteriolele

venulele

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4
Q

Sinoviala articulara poate fi

A

edematoasa

+

contine complexe imune

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5
Q

In infiltratul inflamator pot fi identificati

A

corpi hematoxilinici = depozite omogene, rotunde, albastre in coloratia cu hematoxilina

rezulta din interactiune Ac anti-nucleari + nuclee celulare

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6
Q

Tablou clinic

A

mostly

Fatigabilitate

Artralgii

Leziuni cutanate

afectare organe vitale - rara, dar severa cand exista

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7
Q

Manifestari generale

A

Febra → exacerbari

Fatigabilitate

simptomele NU sunt corelate cu activitatea bolii / severitatea afectarii altor organe

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8
Q

Afectare articulara

A

cea mai frecventa >90%

simptome gen AR → artralgii simetrice la niv articulatiilor mici

articulatii dureroase, aspect clinic NORMAL

uneori tumefactie discreta la niv tesuturilor moi periarticulare

RAR

deformari cauzate de contractia capsulei articulare si a tendonului

deformare articulara importanta gen cea din AR = artropatia Jaccoud

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9
Q

Necroza avasculara ce intereseaza soldul / genunchiul

A

complicatie rara a bolii / tratamentului cu CS

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10
Q

Mialgia

A

50%

miozita adevarata → <5%

miozita importanta → poate avea BRA complexa + suprapunere (overlap) de polimiozita + LES

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11
Q

Tegumentul e afectat in

A

85% cazuri

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12
Q

Caracteristic LES

A

eritemul dispus in fluture la nivelul obrajilor + piramidei nazale

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13
Q

Pot fi intalnite si

A

PELea PULA

Pigmentari

Eruptii plantare + palmare

Livedo reticularis

Purpura

Urticaria

Leziuni vasculitice degete + periunghial

Alopecie

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14
Q

Fotosensibilitate

A

40-50%

in special la pacientii cu anticorpi anti-Ro +

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15
Q

Pot fi intalnite si

A

Livedo reticularis

Eruptii plantare + palmare

Pigmentari

Alopecie

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16
Q

Alopecia cicatriciala poate duce la

A

pierderea focala ireversibila a parului

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17
Q

Fenomenul Reynaud

A

comun

poate aparea cu multi ani inaintea altor manifestari clinice

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18
Q

Afectare pulmonara

A

50%

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19
Q

Cele mai frecvente manifestari pulmonare

A

Pleurezii recurente

Revarsate pleurale (exudate)

adesea BILATERALE

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20
Q

Pneumonita

Atelectazia

→ unii pacienti pot sa dezvolte si

A

disfunctie respiratorie restrictiva

asociata cu

⇓ volume pulmonare

ascensionari hemidiafragmatice

= SINDROM DE PLAMAN MICSORAT

poate avea o baza neuromusculara

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21
Q

Rareori apare

(mai frecvent in sindroamele OVERLAP)

A

fibroza pulmonara

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22
Q

Complicatie rara, dar amenintatoare de viata

A

hemoragia intrapulmonara + vasculita

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23
Q

Inima este afectata in

A

25% cazuri

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24
Q

Este frecventa

A

pericardita

cu mici colectii pericardice detectabile ecocardiografic

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25
Poate sa apara si o miocardita usoara
→ aritmii
26
Mai rar intalnite
leziuni valve aortice cardiomiopatia
27
Apare foarte rar
**endocardita non-infectioasa interesand valva mitrala = sindromul Libman-Sacks)**
28
Pot aparea mai ales in asociere cu **sindromul antifosfolipidic**
fenomen Raynaud vasculite tromboze arteriale + venoase
29
Incidenta crescuta a
BCI AVC datorata **partial** f de risc comuni (HTA, dislipidemii) contributie: prezenta **inflamatiei cronice**
30
Afectare renala clinica apare in
30% din cazuri postmortem modif histologice f frecvente
31
Tuturor pacientilor li se efectueaza periodic
sumar de urina → hematurie / proteinurie
32
Un pacient **asimptomatic + proteinurie**
**stadiu incipient de nefrita lupica** \*initiere tratament → previne evolutia catre IR
33
Proteinuria si hematuria
**proteinuria** → cuantificata **hematuria** → identificarea cilindrilor celulari / hematii fragmentate → **GLOMERULONEFRITA** **biopsie renala → tip + severitate nefrita**
34
**Tromboza venei renale** poate aparea in
**sd nefrotic** asociere cu **anticorpii antifosfolipidici**
35
SN
60% simptomele fluctueaza depresie usoara → ocazional tulburari psihice mai severe
36
Pot fi intalnite
epilepsie migrene ataxie cerebeloasa meningita aseptica leziuni n. cranieni boli cerebrovasculare polineuropatii
37
Leziunile pot fi datorate
vasculitei depunerilor de complexe imune trombozei microvasculopatiei non-inflamatorii
38
Lupus neurologic
infectii excluse / **tratate** in PARALEL cu adm de **CS + imunosupresoare**
39
Vasculita retiniana
→ infarcte = exudate dure + hemoragii
40
Pot fi intalnite
episclerita conjunctivita nevrita optica CECITATEA NEOBISNUITA
41
Sindromul Sjogren secundar
15%
42
GI - sunt frecvente si pot fi o caracteristica de debut
ulceratiile bucale nedureroase / suprainfectate → dureroase
43
Vasculita mezenterica poate cauza
leziuni inflamatorii - intereseaza intestinul subtire (infarct / perforatie)
44
Rare TGI
afectare ## Footnote **hepatica** **pancreatita**
45
Investigatii HLG completa
**leucopenie** **limfopenie** **trombocitopenie** anemie (af cronica) anemie hemolitica autoimuna **VSH ⇑** in raport cu activitatea bolii **PCR N** **⇑ pleurezie lupica** **peritonita** **artrita** **infectie coexistenta**
46
Ureea si creatinina cresc doar cand
boala renala e avansata
47
Indicatori timpurii ai nefritei lupice
**⇓ albumina serica** **⇑ RAC** (rap alb / creat urinara)
48
AutoAc - cei mai semnificativi
ANA anti-ADNdc anti-Ro anti-Sm anti-La **Ac antifosfolipidici → 25-40%** nu toti dezvolta sindrom antifosfolipidic
49
Complement seric
**⇓ C3, C4** in cursul bolii active
50
Poate anunta un puseu de boala combinatia
**⇑** VSH **⇑** Ac anti-ADNdc **⇓** C3 toti markerii revin la normal pe masura ce puseul dispare Ac anti-ADNdc ramane ridicat si in cursul remisiunii clinice
51
Histologie
depozite IgG + complement → biopsii renale si cutanate
52
CT
infarcte hemoragii cu semne de atrofie cerebrala
53
IRM
**leziuni substanta alba** care nu sunt decelate pe CT \*DIFICIL DE DISTINS vasculita reala - tromb mic
54
**artralgia** **artrita** **febra** **serozita** raspund bine la
dozele standard de AINS
55
Lupus cutanat
CS topici
56
Medicamentele antimalarice (clorochina / hidroxiclorochina)
**formele usoare de afectare cutanata** **fatigabilitate** **artralgii** care NU raspund la AINS + CONSULT OFTALMO periodic (potential toxic retinian)
57
Modificari retiniene sub medicatie antimalarica apar in
**7,5%** → pacienti tratati pe termen lung cu hidroxiclorochina risc mai mare la ncei care iau mai mult de **5mg / kgc / zi**
58
CS + medicamente imunosupresive Trat pusee severe de **artrita** **pleurezie** **pericardita**
injectii IM in priza unica de CS cu durata de actiune lunga cure scurte de CS orali \*unele cazuri pot fi controlate doar cu CS orali pe termen lung
59
Afectarea renala / neurologica Anemia hemolitica severa Trombocitopenia
doze mari CS orali **afectarea renala / neurologica → IN PLUS + imunosupresoare**
60
Afectarea renala / neurologica
doze mari CS orali + imunosupresoare **CICLOFOSFAMIDA** → inloc cu **MICOFENOLAT DE MOFETIL** (mai putine ef adverse) pt obtinerea remisiunii **AZATIOPRINA** agenti noi - cazuri refractare **RITUXIMAB** **BELIMUMAB** = Ac monoclonali indreptati impotriva lf B
61
Decesele timpurii in evolutia bolii sunt cauzate in special de
afectare renala neurologica infectii ulterior → boala coronariana AVC
62
RAR, **progresia cronica a distructiei articulare**, cum se obs in AR si artroza
o mica parte din pacienti → deviatie ulnara
63
Pacientii cu LES → risc crescut pe termen lung de a dezvolta unele **neoplasme** gen
LIMFOM
64
Safe in sarcina
Hidroxiclorochina Azatioprina doze mici de CS
65
Au risc de **2%** de a naste copii cu **sindrom lupic neonatal** ERUPTII HEPATITA BLOC CARDIAC FETAL
femeile cu **Ac anti-Ro + anti-La**

Reumato (13 decks)

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