SLE Flashcards Preview

Rheumatology > SLE > Flashcards

Flashcards in SLE Deck (19)
Loading flashcards...
1

Describe hypersensitivity reactions I-IV

Type I = immediate (anaphalactic; atopic)

Type II = cytotoxic; target cell receptors; platelet-thrombocytopenia, Target fixed tissue ag; goodpastures

Type III = immune compex (vasculitis; SLE)***

Type IV: (delayed) cell mediated; Tuberculin rxn, cytotoxic cells destroy target cells (e.g allograft rejection)

2

SLE:
-what is this?
-MOA
-afffected areas
-MC in which gender? Age?
-cause

What; multisystem autoimmune disorder of unknown cause strongly associated with various autoabys.

MOA: deposition of ag-aby complexes along vascular and tissue basement membranes. Localized inflammatory responses occur: complement, neutrophil migration, cell-mediated tissue injury.

Affected areas: skin, joints, serosal surfaces, muscles, kidneys, heart, lung, CNS, red blood cells, and platelets.

MC in women, 20-40YO

Cause:
-genetics; Chromosome 6; HLA-DR3
-environmental factors:
--UV light
--bacterial/viral infections
--drugs
-endocrine: sex hormones; develops after menarche and before menopause.
-Drug induces: procainamide, hydralazine

3

SLE:
-MC sx
-sx that might not be so common

MC sx:
-Systemic: low grade fever, photosensitivity
-mouth and nose ulcers
-muscle aches
-arthritis (symmetrical but w/o articular destruction)
-psychological; fatigue and loss of appetite
-butterfly rash on face
-inflammation of pleura and pericardium
-poor circulation (fingers and toes)

Sx:
-alopecia
-fingertip lesions
-periungual erythema
-nail fold infarcts (like hang nail..kinda)
-splinter hemorrhages
-raynauds phenomenon

4

Renal Features of SLE
-describe characteristics of lupus nephritis
-what is seen on bx of lupus nephritis?

Nephritis:
-glomerulonephritis
-nephrotic syndrome (proteinuria and hyaline casts)
-HTN

Bx lupus nephritis:
-glomerulosclerosis
-fibrous crescents
-interstitial fibrosis
-tubular atrophy

5

Ocular Manifestations of SLE?

conjuncitivitis

photophobia

transient or permanent monocular blindness

Blurred vision

cotton wool spots on retina

6

Musculoskeletal features of SLE

Transient symmetric polyarthritis in small and large joints.
--no signs of inflammation

Osteonecrosis of hips

fibromyalgia

7

Pulmonary features of SLE

Transient basilar pneumonic infiltrates = lupus pneumonitis

Lupus pneumonitis:
-nonproductive cough
-dyspnea
-hypoxemia

Pleural effusions

Pleuritis

Bronchopneumonia

Restrictive lung dz

(RARE) Alveolar hemorrhage with massive hemoptysis and death

8

Cardiac Features of SLE

Pericarditis

Myocarditis
-tachycardia
-ventricular arrhythmia
-conduction problems
-CHF, cardiomyopathy

Increased Muscle enzymes (MB or CPK)

Libman-sacks endocarditis:
-V. surface vegetations on valves
-vegetation break off may allow colonization

9

Serositis of SLE

pleuritis

pericarditis

peritonitis

10

Vascular features of SLE

Raynauds phenomenon

Arterial or venous thrombosis

Lupus vasculitis

Livedo reticularis

11

GI tract sx of SLE

Transient nonspecific abd pain

increased incidence of primary biliary cirrhosis

Vasculitis of mesentery can cause infarction or perforation of bowel.

12

CNS features of SLE

very common

Confusion, memory deficits, disorientation, hypomania, delirium, and schizophrenia

grand mal seizures, temporal lobe seizures

Severe HA (MC)

Stroke (anti-phospholipid abys b/c of increased risk of clotting)

13

MC cause of death of SLE?

infectious complications related to active SLE and immunosuppressive tx is the MC cause of dealth in early active SLE.

14

SLE Labs
-findings of CBC
-findings of ESR & CRP
-findings of UA
which abys are we looking for?

CBC:
-anemia;
--normocytic, normochromic, hemolytic
-leukopenia
-thrombocytopenia (50-100K)
-Prolonged PTT (from antiphospholipid abys)


ESR and CRP are both elevated.

UA:
-proteinuria
-RBC/WBC
-cellular or hyaline casts.

Abys:
-ANA
-Anti-dsDNA
-Anti-SM

15

Dx of SLE

dx is clinical, no one test of feature is fully diagnostic.

Dx criteria:
-characteristic rash across the cheek
-discoid lesion rash
-photosensitivty
-oral ulcers
-arthritis
-inflammation of membranes in the lungs, heart, or abd
-evidence of kideny dz
-evidence of severe neurologic dz
-blood disorders, including low red, white blood cells, and platelet counts.
-Immunologic abnormalities
-positive ANA
**Pt must experience 4 of the criteria before a doc can classify condition as SLE.

16

SLE:
-typical PE and Lab findings of pt being newly dx

PE:
-butterfly rash
-hypertension
-alopecia
-discoid lesions
-ANA, dsDNA, anti-SM
-hypocomplementemia
-UA:
--WBC, RBC, proteinuria, hyaline casts

17

SLE:
-tx
-pt education about dz flare ups

Tx: incurable but treatable
-reduce inflamm, suppress immune system
-Glucocorticoids
-antimalarials
-immunosuppressants
-Iv Immunoglobulin
-Plasmapheresis (lupus nephritis)
-Belimumab (fully human monoclonal aby)

Pt education:
-sunscreen and protective clothing
-warm clothing
-avoidance of vasoconstrictive drugs
-psychological support
-routine immunizations

18

Drug Induced Lupus Syndrome:
-sx
-discuss how labs differ from SLE
-tx
-MC drugs causing this, others

Sx:
-musculoskeletal, pulmonary, and polyserositic sx

Labs:
-abys are not harmful
-no hypocomplementemia
-ANA present but return to normal with withdrawal of drug

Tx: d/c medication

MC drugs:
-hydralazine and procainamide

Others:
-Methyldopa*
-Quindine*
-Dilantin
-Zarontin
-Primidone
-Tegratol
-INH*
-sulfas
-Beta blockers
-PCN
* = definite association

19

Discoid Lupus:
-what is this?
-describe lesions.
-tx

What: chronic cutaneous lupus

Lesions:
-involves plaque-like lesions of head scalp and neck
-red, swollen patches w/ later scarring, depigmentation, plugging of hair follicles

Tx:
-sunscreen
-topical steroids
-antimalarial agents