Multi-system - SLE

Question 1

Diagnostic criteria for SLE

Answer 1

4 out of 11
1. Malar rash
2. Discoid rash
3. Photosensitivity
4. Oral or vaginal ulcers (painless)
5. Arthritis (2+ peripheral joints)
6. Serositis
7. Renal involvement
8. Neurologic disorder
9. Hematologic disorder
10. Immunologic disorder (anti-dsDNA, anti-Smith, antiphospholipid Ab)
11. positive ANA

Question 2

What is the major complication of SLE?

Answer 2

Renal involvement - HTN, CKD, nephrotic syndrome, or ESRD

Question 3

How is lupus nephritis treated?

Answer 3

Immunosuppressants, high-dose corticosteroids

Question 4

What are the most common causes of death in SLE?

Answer 4

1. Infection, often related to use of immunosuppressants
2. Vascular disease (MI)

Question 5

Most common form of chronic cutaneous lupus erythematosus

Answer 5

discoid lupus erythematosus

Question 6

Erythematous, inflammatory scaly plaques typically on the face, neck and head that are painful to remove; when the plaques heal they cause scarring alopecia, atrophy, peripheral hyperpigmentation and central depigmentation

Answer 6

discoid lupus erythematosus

Question 7

What test can help distinguish SLE from DLE?

Answer 7

Lupus band test (direct immunofluorescence)

Question 8

Autoantibodies associated with SLE

Answer 8

1. positive ANA ( > 1:80)
2. anti-dsDNA Ab (positive in 60-70% but highly specific for SLE)
3. anti-Smith Ab (only positive in 30% but highly specific for SLE)
4. antiphospholipid antibodies

Question 9

Complement labs associated with SLE

Answer 9

Decreased C3 and C4 in patients with active disease

Question 10

CBC results in SLE

Answer 10

• leukopenia (decreased WBC)
• thrombocytopenia
• autoimmune hemolytic anemia
• anemia of chronic disease

Question 11

What antibodies have the highest sensitivity but low specificity for SLE?

Answer 11

ANA

Question 12

What are the most specific antibodies for SLE?

Answer 12

• anti-dsDNA
• anti-Smith

Question 13

A direct immunofluorescence staining technique used to detect Ig and complement deposits along the dermoepidermal junction

Answer 13

Lupus band test (LBT)

Question 14

What risk assessment should be completed in patients with SLE?

Answer 14

ASCVD risk assessment - patients with SLE have double the cardiovascular risk and CVD is one of the most common causes of death in patients with SLE

Question 15

How is SLE treated for all patients regardless of disease activity?

Answer 15

Hydroxychloroquine

Question 16

What antibody is present in drug induced lupus?

Answer 16

anti-histone Ab

Question 17

Classic findings in neonatal lupus?

Answer 17

1. skin lesions
2. cardiac abnormalities (AV block, Transposition of the great vessels)
3. Valvular and septal defects

Question 18

What is endocarditis in SLE called?

Answer 18

Libman-Sacks endocarditis

Question 19

What immunizations should patients with SLE receive?

Answer 19

Influenza
Pneumococcal

Question 20

Why do patients with SLE on hydroxychloroquine need ophthalmologic screening?

Answer 20

Hydroxychloroquine has been associated with retinal toxicity

Question 21

How often do patients with SLE need ophthalmology screenings?

Answer 21

At baseline, at 5 years, and annually after

Question 22

SOAP BRAIN MD

Answer 22

1. serositis
2. oral/nasal ulcers
3. arthritis
4. photosensitivity
5. blood disorders
6. renal involvements
7. ANA
8. Immunological (anti-dsDNA, anti-Smith, antiphospholipid antibodies)
9. Neurological disorders
10. Malar rash
11. Discoid rash

Question 23

Flat or raised fixed erythema over the malar eminences, sparring the nasolabial folds

Answer 23

Malar (butterfly) rash

Question 24

Well defined erythematous plaques with adherent keratotic scaling and follicular plugging which may lead to scarring, pigmentation, atrophy and alopecia

Answer 24

Discoid rash

Question 25

Treatment of cutaneous lupus erythematosus

Answer 25

1. Hydroxychloroquine 2. Topical glucocorticoids and/or topical calcineurin inhibitors

Question 26

Mesangial and/or sub endothelial deposition of immune complexes leading to expansion and thickening of mesangium, capillary walls and or glomerular basement membrane

Answer 26

Lupus nephritis

Question 27

Clinical features of lupus nephritis

Answer 27

- hypertension - edema - hematuria

Question 28

Urinalysis of lupus nephritis

Answer 28

- proteinuria - hematuria - cellular casts (RBC, hemoglobin, granular, tubular or mixed)

Question 29

Findings of kidney biopsy in lupus nephritis

Answer 29

immune complex-mediated glomerulonephritis

Question 30

Drugs with increased risk of drug induced lupus

Answer 30

hydralazine, procainamide

Question 31

Drugs with low risk of drug induced lupus

Answer 31

sulfa drugs, isoniazid, methyldopa, minocycline, phenytoin, TNF alpha inhibitors

Question 32

Antibodies associated with increased risk of neonatal lupus

Answer 32

Anti-Ro/SSA and Anti-La/SSB

Question 33

Antibodies found in antiphospholipid syndrome

Answer 33

anticardiolipin, lupus anticoagulant

Question 34

Diagnosis of neonatal lupus syndrome

Answer 34

1. antibodies (anti-Ro/SSA or anti-La/SSB) 2. heart block, characteristic periorbital or diffuse rash, hematologic involvement, hepatic involvement with no identifiable cause

Question 35

Poor prognosis is associated with

Answer 35

damage to kidneys or nervous system