Lupus/autoimmune Flashcards
(13 cards)
SLE
Autoimmune
Genetics
Drug induced-hydrazine, procainamide, methyldopa, quinidine, chlorpromazine, isoniazid resolves when stopped
Disease induced-infections like EBV, UV light, estrogen
SLE S/S
Many
Fatigue; fever,arthralgia, weight loss, anemia, thrombocytopenia, leukopenia, lymphadenopathy, morning stiffness, butterfly shaped rash, glomerulonephritis, pericarditis, pericardial effusion, pleurisy, chest pain, interstitial fibrosis, pulmonary HTN; shrinking of lung, alveolar hemorrhage, HA, psychosis, SZ, stroke, vasculitis, GI, hair loss, oral lesions
Diagnosis for SLE
Clinical judgement
CBC, CMP, serologic testing, ANA, sed rate, UA
Need to meet two criteria based on guidelines best to be done by expert clinician
Refer to rheumatology
R/O RA, systemic sclerosis, sjogrens, vasculitis, fibromyalgia, MS, CA, EBV or CMV, TTP
Young person with serosisits and decrease renal disease*** high suspicion
Reasons for hospitalize SLE
Acute desquamsting rash-Burning pain and vesicles
Cytopenia- less than 50,000 platelets or neutropenia
Pericarditis that progresses to tamponade
Large pleural effusion
Accelerated HTN
TX SLE
Exacerbation- steroids, hydroxychloroquine
- ophthalmology referral for baseline eval and follow up form due to eye ADE
Avoid UV light
Avoid smoking
Immunizations
Avoid drugs with sulfas
NSAIDs
Immune suppressive agents
Poor prognosis factors
Renal disease
Males
HTN
Young age
Older age at presentation
Low socioeconomic
Presence of ANA
High overall disease activity
Complications of SLE
CHF, CM, CAD, ACS, PE, pulmonary hemorrhage, myocarditis, glomerulonephritis, endocarditis, SZ, CVA
RA
Increased risk for CAD and non Hodgkin’s lymphoma, infection
Autoimmune, genetic, HLADRB1 gene
Stop smoking
Morning stiffness, wide spread and last about an hour, better with activity, joint swelling, sponginess, pain, bilaterally
DX- ANA, arthrocentesis, sed rate, CRP, CBC, LFT, renal function, rheumatoid factor, anti CCP antibodies, x rays
Symptoms longer than 6 weeks
Complications of RA
Pleural effusions
Pulmonary fibrosis
Rheumatoid vasculitis
Uveitis, sjogrens, conjunctivitis
Fever
Joint damage and septic joint
PNA
CAD
Carpal tunnel
Erosive changes in spinal cord
Death
Drug toxicity
RA TX
DMARDs by rheumatology
Screen for hepatitis B, C, TB
Methotrexate
Leflunomide
Sulfasalazine
Biological and biosimilars
Tetrogenic, Myelosuppresion ADE
Exacerbation- joint steroid infections or increase or start steroids
Vasculitis
Inflammation of blood vessels
Can cause vascular damage, stenosis, or occlusions, end organ damage, can cause aneurysm
Unknown etiology
Large cell, medium vessel, small vessel, variable vessel, single organ vessel, associated with systemic disease, associated with probable cause
Usually chronic
Fever, fatigue, weight loss, arthralgia, single or MOD, scleritis, foot or wrist drop, limb claudication, hemoptysis, purpura, bruits, absent pulses BO discrepancies
Vasculitis DX/TX
CBC, CMP, liver, ESR, CRP, hepatitis serology, serum cryoglobulins, UA, blood cultures, ANA, CXR, biopsy MRA, CTA, LP
Steroids and other immunosuppressants
Giant cell arteritis (temporal arteritis)
Inflammation of aorta, aortic branches, extra cranial branch of carotid arteries
HA, scalp tenderness, jaw claudication, vision changes, stroke, neuropathy, asymmetric BP, UE claudication
DX- ESR, CRP, CBC, LFT, gold standard of temporal artery biopsy, CTA, MRA, PET
TX-steroids start even without biopsy
Consult rheumatologist, TX for 1-2 years post if not longer
