Lupus Flashcards
What are some causes of lupus?
-No known specific cause.
-Genetics
-Start of menses, oral contraceptives, during or after pregnancy (worse immediately postpartum)
-Environmental factors: exposure to sunlight or UV light, stress, some chemicals or toxins
-Medications such as procainamide, hydralazine, quinidine
What are general manifestations of lupus?
General complaints include fever, weight loss, joint pain, excessive fatigue. May precede worsened disease activity.
What are dermatologic manifestations of lupus?
-Vascular skin lesions, mostly on sun-exposed areas
-Butterfly rash over cheeks and nose bridge
-Oral or nasopharyngeal ulcers
-Alopecia
What are musculoskeletal problems associated with lupus?
-Arthritis
-Pain in multiple joints (polyarthralgia) with morning stiffness FIRST COMPLAINT
-Diffuse swelling with joint/muscle pain and some stiffness
-Increased risk for bone loss and fracture
What are cardiopulmonary problems associated with lupus?
-Tachypnea and cough suggesting lung disease
-Pleurisy
-Dysrhythmias due to SA and AV node stenosis #1 cause of death
-Pericarditis, myocarditis, endocarditis
-Hypertension & hypercholesterolemia from steroid use
-Risk for secondary antiphospholipid syndrome, increases risk for stroke, gangrene, heart attack
What are renal problems associated with lupus?
-Mild proteinuria to rapidly progressive glomerulonephritis
-Scarring and permanent damage leading to ESRD
What are nervous system problems associated with lupus?
-Common in SLE
-Generalized-onset or focal-onset seizures
-Peripheral neuropathy leading to sensory and motor deficits
-Disordered thinking, disorientation, memory deficits
-Depression, anxiety, psychosis, headache
-Stroke or aseptic meningitis
What are hematologic problems associated with lupus?
-Anemia, leukopenia, thrombocytopenia, coagulation disorders
-Many patients benefit from high-dose warfarin treatment
What diagnostic studies are used with lupus?
-ANA titer: presence of antibodies
-Discoid rash: raised patches with scaling follicular plugging, scarring in older lesions
-CBC: anemia, leukopenia, lymphopenia, thrombocytopenia
-Immunologic disorder: antibody to Sm (SMITH) nuclear antigen or positive antiphospholipid antibodies
-Malar rash: butterfly rash
-Xray of affected joints
-ECG for cardiac involvement
-24 hour urine to assess for proteinuria or casts
What are antimalarial agents used for in lupus?
Manage fatigue and skin/ joint problems. Hydroxychloroquine most common, patients should have eye exams every 6-12 months due to risk of retinopathy.
What are corticosteroids used for in lupus?
Manage severe cutaneous SLE. Lowest dose possible for shortest amount of time.
What are immunosuppressants used for in lupus?
Used to suppress the immune system and reduce end-organ damage. Monitor closely to decrease risk of drug toxicity and side effects.
What is belimumab (Benlysta)?
B-lymphocyte stimulator that inhibits inflammation of SLE.
