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IM IMMUNO/RHEUMA > SLE 2 > Flashcards

SLE 2 Flashcards

1
Q

Patients with dangerous proliferative forms of glomerular damage (ISN Ill and IV) usually have microscopic hematuria and proteinuria

A

(>500 mg per 24 h)

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2
Q

20% of individuals with lupus diffuse proliferative ‘
glomerulonephritis (DPGN) die or develop ESRD within

A

10 years of dx

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3
Q

Approximately 20% of SLE patients with proteinuria (usually nephrotic) have ____changes without
proliferative changes on renal biopsy

A

membranous glomerular

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4
Q

For most people with lupus nephritis, ____ becomes important after several years of disease

A

accelerated atherosclerosis

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5
Q
  • most common manifestation of diffuse CNS lupus
  • difficulties with memory and reasoning
A

Cognitive dysfunction

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6
Q

When excruciating, they often indicate SLE flare

A

Headaches

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7
Q

caused by focal occlusion or by embolization from carotid artery plaque or from fibrinous vegetations
of Libman-Sacks endocarditis

A

Ischemia in the brain

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8
Q

are primarily manifestations of accelerated atherosclerosis

A

myocardial infarctions

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9
Q

The increased risk for vascular events is 3-to tenfold overall, and is highest in women aged

A

<49 years

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10
Q
  • most common pulmonary
    manifestation of SLE
  • when mild, may respond to treatment with nonsteroidal
    anti-inflammatory drugs (NSAIDs); when more. severe, patients require a brief course of glucocorticoid therapy
A

Pleuritis w/ or without pleural effusion

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11
Q

Life-threatening pulmonary manifestations include

A
  • interstitial inflammation leading to fibrosis,
  • shrinking lung syndrome,
  • intraalveolar hemorrhage
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12
Q
  • most frequent cardiac manifestation;
  • usually responds to anti-inflammatory therapy and infrequently leads to tamponade
A

Pericarditis

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13
Q

More serious cardiac manifestations

A
  • myocarditis
    >fibrinous endocarditis of Libman-Sacks
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14
Q

most frequent hematologic manifestation of SLE

A

Anemia

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15
Q

can be rapid in onset and severe, requiring high-dose glucocorticoid therapy, which is effective in most patients

A

Hemolysis

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16
Q

common and almost always consists of npnopenia, not granulocytopenia; lymphopenia rarely predisposes to infections and by itself usually does not require therapy

A

Leukopenia

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17
Q
  • a recurring problem
A

thrombocytopenia

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18
Q

If the platelet counts are ___ and abnormal bleeding is ___, therapy may not be required

A
  • > 40000/uL
  • absent
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19
Q

SLE flare

A
  • Nausea,
  • vomiting,
  • diarrhea
20
Q

d/t autoimmune peritonitis or intestinal vasculitis

A

Diffuse abdominal pain

21
Q

Gastrointestinal Manifestation that is common when active

A

Increase in AST and ALT

22
Q

Intestinal vasculitis — LIFE THREATENING; may lead to:

A
  • ischemia
  • bleeding
  • sepsis
23
Q

5 EYE PROBLEMS ASSOCIATED WITH LUPUS

A
  • Dry eye disease
  • eyelid disease
  • retinal disease
  • scleral disease
  • nerve disease
24
Q

MOST IMPORTANT to detect; positive in >95% of patients, usually at the onset of symptoms

A

ANA

25
Q

SPECIFIC for SLE TEST

A

High titer IgG antibodies to dsDNA

26
Q

Also specific test and assist in diagnosis

A

Antibodies to Sm

27
Q

not used for diagnosis, but indicates increased risks for neonatal lupus, sicca syndrome, and SCLE

A

Anti —Ro/ SS-A

28
Q

not specific for SLE ; if (+) — increased risk for venous or arterial clotting & thrombocytopenia

A

aPL

29
Q

Mainstay Tx for SLE

A

Analgesics and antimalarials

30
Q

analgesics/anti-inflammatories for arthritis/arthralgias

A

NSAIDs

31
Q

Often reduce dermatitis, arthritis and fatigue

A

Antimalarial (hydrochloroquine, chloroquine and quinacrine)

32
Q
  • reduces accrual of tissue damage, including renal damage over time
  • Because of potential retinal toxicity, patients receiving antimalarials should undergo ophthalmologic examinations annually
A

Hydroxychloroquine

33
Q
  • MAINSTAY FOR SEVERE SLE Proliferative Form of Lupus Nephritis
  • High doses are recommended for much shorter period
A

Systemic glucocorticoids

34
Q

In patients whose renal biopsies show ISN grade Ill or IV disease, early
treatment with combinations of ____ reduces progression to ESRD and death

A

glucocorticoids and cyclophosphamide

35
Q

multiple cellular crescents and/or fibrinoid necrosis on renal biopsy, or rapidly
progressive glomerulonephritis

A

Severe nephritis

36
Q

High-dose cyclophosphamide (500-1000 mg/m2 body surface area given monthly IV for

A

6 months, followed by azathioprine or mycophenolate
maintenance)

37
Q

Cyclophosphamide and mycophenolate responses begin ____after treatment is initiated, whereas glucocorticoid responses may
begin within ____

A
  • 3—16 weeks
  • 24 h
38
Q
  • For maintenance therapy, ____ probably are similar in efficacy and toxicity
  • both are safer than cyclophosphamide
A
  • mycophenolate
  • azathioprine
39
Q

common effect of high-dose cyclophosphamide therapy

A
  • ovarian failure
  • can be reduced by treatment with a gonadotropin-releasing hormone agonist prior to each monthly cyclophosphamide dose
40
Q

he number of SLE flares is reduced by maintenance therapy with

A
  • mycophenolate mofetil (1.5—2 g daily) or
  • azathioprine (1—2.5 mg/kg per day)
41
Q
  • Both cyclophosphamide and mycophenolate mofetil are potentially
  • atients should be off either medication for ___ before attempting to conceive
  • can be used if necessary to control active SLE in patients who are pregnant
A
  • teratogenic
  • at least 3 months
  • Azithioprine
42
Q
  • Good improvement occurs in 80% of lupus nephritis patients receiving either cyclophosphamide or mycophenolate at
  • Most patients with SLE of any type should be treated with ___ since it prevents damage in skin and kidney and reduces overall damage scores
  • Px w/ proteinuria >500mg daily should receive ___, as they reduce the chance for ESRD
A
  • 1-2 years of follow-up
  • hydroxychloroquine
  • ACE inhibitors or ARBs
43
Q
  • presence of cellular or fibrotic crescents in glomeruli with proliferative glomerulonephritis
  • indicates a worse prognosis than in patients without this feature
  • high-dose cyclophosphamide as the induction therapy of choice
A

Crescentic Lupus Nephritis

44
Q
  • Most SLE patients with it have proliferative changes and should be treated for proliferative disease
  • Treatment for this group is less well define
A

Membranous Lupus Nephritis

45
Q
  • In SLE patients with antiphospholipid antibodies and prior fetal losses, tx with ___ has been shown in prospective controlled trials to increase significantly the proportion of live births.
  • Aspirin alone may be used, although most consider it less effective
A

heparin (usually low-molecular-weight) plus low-dose aspirin

46
Q

Patients with SLE who have venous or arterial clotting and/or repeated fetal losses and at least two positive tests for antiphospholipid antibodies have APS and should be managed with

A

long-term anticoagulation

47
Q

POOR PROGNOSIS (50% mortality in 10 years)

A
  • High serum creatinine levels >1.4 mg/dL
  • Hypertension
  • Nephrotic syndrome (24hr urine protein excretion >2.6g)
  • Anemia (Hgb <12.4 g/dL)
  • Hypoalbuminemia
  • Hypocomplementemia
  • Male sex

IM IMMUNO/RHEUMA (9 decks)

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