Lupus

Question 1

What is the most common autoimmune disease?

Answer 1

Rheumatoid arthritis

Question 2

What is the second most common autoimmune disease?

Answer 2

Systemic Lupus Erythematosus

Question 3

What areas of the body are affected by Lupus?

Answer 3

• multiple organ systems
• primarily skin, joints, kidneys

Question 4

Lupus is more prevalent in females from ____ descent groups

Answer 4

African

Question 5

What sex is Lupus more common in?

Answer 5

F>M (9:1)

Question 6

What age group is primarily affected by Lupus?

Answer 6

onset from late teens to 40 yrs
(peak = 20-40yrs)

Question 7

Lupus is often over-diagnosed as what other condition?

Answer 7

fibromyelgia

Question 8

What is the etiology of Lupus?

Answer 8

probably genetic (doesn’t have to be)

Question 9

What factors may trigger Lupus?

Answer 9

• medications
• pain killers & antibiotics
• exposure to UV light

Question 10

What are the general clinical manifestations of Lupus?

Answer 10

• gradual onset
• fever & malaise
• anorexia & weight loss
• alopecia (spotty hair loss)
• pain & swelling like RA
• acute necrotizing vasculitis

Question 11

What are the effects of Lupus on joints?

Answer 11

• polyarthralgia (“everything hurts”)
• often self-limiting
• non-erosive synovitis/tenosynovitis
• deformity (tendon rupture) without arthropathy (non-erosive)
• ^instability eventually results in arthritis

Question 12

Lupus is characterized as a ____-____ disease

Answer 12

collagen-vascular

Question 13

What is acute necrotizing vasculitis?

Answer 13

• deposition of immune complexes & fibrinoid materials in small aa and arterioles
• thickening & narrowing of small BVs

Question 14

How does acute necrotizing vasculitis affect organs?

Answer 14

organ fibrosis

Question 15

acute vasculitis of serosal membranes may lead to ____

Answer 15

ulceration

Question 16

What are the effects of Lupus on the kidney?

Answer 16

Acute necrotizing vasculitis causes:
- glomerular damage
- renal failure

Question 17

What is the term for the effect of Lupus on the skin?

Answer 17

Erythema
(caused by acute vasculitis)

Question 18

What is erythema?

Answer 18

painful skin rash caused by acute necrotizing vasculitis

Question 19

Where are the common locations of erythema seen in Lupus?

Answer 19

• bridge of nose & cheeks (butterfly/malar rash)
• neck
• elbows
• hands (palms)

Question 20

The butterfly rash of systemic lupus erythematosus is also known as ____

Answer 20

malar rash

Question 21

What sign may be seen in a patient with Lupus if there are small temperature changes in the environment?

Answer 21

Raynaud phenomenon
(acute necrotizing vasculitis causes hyperreactivity of BVs)

Question 22

____ is one of the number one causes of death from Lupus

Answer 22

renal failure

Question 23

When do the skin effects of Lupus occur in relation to other symptoms?

Answer 23

flare up at same time

Question 24

What can worsen erythema in a patient with Lupus?

Answer 24

sunlight (UV exposure)

Question 25

What are the radiographic characteristics of Lupus?

Answer 25

- BL symmetric jt involvement - reversible subluxations in hands (deformity w/out arthropathy) - swan neck, boutonniere, hitch-hiker deformities - atlanto-axial instability - soft tissue necrosis & calcifications - osteonecrosis

Question 26

What radiographic characteristics of Lupus are caused by vasculitis?

Answer 26

- soft tissue necrosis & calcifications - osteonecrosis

Question 27

What deformities may be caused by Lupus?

Answer 27

(reversible subluxations) - swan neck - boutonniere - hitch-hiker thumb - ulnar drift

Question 28

What is the radiographic latency period of Lupus?

Answer 28

2-5 years (late stage, would already have Dx)

Question 29

What imaging test is required before any treatment to the neck in a patient with any autoimmune condition?

Answer 29

cervical radiographs with flexion/extension

Question 30

What joints are primarily affected by Lupus?

Answer 30

- hands - wrists - knees - shoulders

Question 31

How does soft tissue calcification in Lupus appear radiographically?

Answer 31

diffuse (tiny white dots everywhere)

Question 32

What does radiographic soft tissue calcification in Lupus represent?

Answer 32

areas of necrosis

Question 33

What are the 3 radiographic findings for osteonecrosis in order of occurrence?

Answer 33

- sclerosis - flattening - fragmentation

Question 34

In a patient with a diagnosis of Lupus, what areas would you be concerned about avascular necrosis?

Answer 34

areas of poor blood supply (hips, ankles, shoulders, knees)

Question 35

How would a patient who is unaware that they have Lupus (no diagnosis) present?

Answer 35

complains of bone pain (not jt pain), unable to recreate pain with ortho

Question 36

What are the relevant lab findings for Lupus?

Answer 36

- ^ESR/CRP - anemia of chronic dz - RF neg. - Anti-double-stranded DNA (dsDNA) - Anti-nuclear antibodies (ANA) pos. in 95% (not specific) - ^creatinine in urine (reduced renal function)

Question 37

Patients with late stage Lupus will have (localized/systemic) avascular necrosis

Answer 37

systemic (multiple *sites* of involvement)

Question 38

What does bone marrow fibrosis caused by Lupus result in?

Answer 38

anemia of chronic dz

Question 39

What are the possible treatments for Lupus?

Answer 39

(refer to rheumatology) - corticosteroids (acute) or other drug therapy (DMARDs) - anti-inflam. diet - education - soft tissue work - low impact activity - do **not** adjust unstable jts