Flashcards in MKSAP 7: SLE Deck (20):
Provide a basic definition of SLE
characterized by multiorgan involvement and presence of autoantibodies including those directed at intranuclear antigens; loss of tolerance to self-antigens and active autoimmunity
What is the basic pathophysiology of SLE?
Abnormalities in how dying cells are handled by immune system. Nuclear material inadequately cleared, upregulating of autoreactive T and B cells and autoantibodies directed against nuclear and other antigens.
About ___% of SLE patients are women
Which ethnicities are more impacted
African American, Chinese and Hispanic
Name the 3 types of mucocutaneous involvement in SLE
- acute cutaneous SLE
- subacute cutaneous SLE
- chronic SLE
Describe findings in acute cutaneous SLE
malar or butterfly rash, 40-50% of patients.
Erythema/edema over the cheeks and bridge ofn ose and potentially forehead and chin, characteristically spares the nasolabial folds.
Generalized form can involve the dorsum of the arms and hands including areas between the fingers but sparing the knuckle pads
Describe subacute cutaneous SLE
Photosensitive rash over the arms, neck and face. Erythematous, annular, or polycyclic lesions often with fine scale. May leave postinflammatory changes but does not cause atrophy
Which autoantibodies are present in 70% of patients with SCLE?
What is the most common chronic cutaneous manifestation of LE?
Discoid LE; most do not go on to develop SLE; usually affects the scalp, face and presents as hypo - or hyperpigmented erythematous, patches or thin plaques. Can cause scarring, atrophy and permanent alopecia
What cutenous finding is a common feature of active SLE?
Nonscarring alopecia with hair regrowth a sign of disease control
Arterial vasospasm of the digits that happens in 60% of SLE patients
Joint involvement occurs in ___% of patients with SLE with inflammatory polyarthralgia the most common presentation. Frank arthritis occurs in 40% of patients with SLE.
Persistent periarticular inflammation can damage joints supporting soft tissue structures resulting in reducible subluxation of the digits, swan neck deformities and ulnar deviation, called ____
Pain or limitation of motion of large joints such as hips should raise concern for ___
Up to 37% of patients with SLE develop it by serial MRI but less than 10% become symptomatic
What are risk factors for osteonecrosis in SLE patients?
glucocorticoid use, Raynaud's, lupus vasculitis
Prednisone > 20mg and cushinoid features
Typical feature of the pain in patients with SLE and osteonecrosis?
Night pain and use pain meds
Lupus nephritis occurs in up to ___% of patients with SLE and presence of ___ abs is a marker for risk
How should all patients with SLE be evaluated for possible nephritis?
Baseline Scr, urine pro-cr ratio, urinalysis with microscopic evaluation
Signs and symptoms defining more severe lupus nephritis include:
HTN, LE edema, active urine sediment (proteinuria, hematuria, cellular casts) and elevated Scr
Indications for kidney biopsy are:
increased Scr without explanation, proteinuria ? 1000mg/24h, proteinuria >500mg/24h with hematuria, and proteinuria >500mg/24h with cellular casts