Flashcards in SLE Deck (19)
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)
-what is this?
-MC in which gender? Age?
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
-genetics; Chromosome 6; HLA-DR3
-endocrine: sex hormones; develops after menarche and before menopause.
-Drug induces: procainamide, hydralazine
-sx that might not be so common
-Systemic: low grade fever, photosensitivity
-mouth and nose ulcers
-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)
-nail fold infarcts (like hang nail..kinda)
Renal Features of SLE
-describe characteristics of lupus nephritis
-what is seen on bx of lupus nephritis?
-nephrotic syndrome (proteinuria and hyaline casts)
Bx lupus nephritis:
Ocular Manifestations of SLE?
transient or permanent monocular blindness
cotton wool spots on retina
Musculoskeletal features of SLE
Transient symmetric polyarthritis in small and large joints.
--no signs of inflammation
Osteonecrosis of hips
Pulmonary features of SLE
Transient basilar pneumonic infiltrates = lupus pneumonitis
Restrictive lung dz
(RARE) Alveolar hemorrhage with massive hemoptysis and death
Cardiac Features of SLE
Increased Muscle enzymes (MB or CPK)
-V. surface vegetations on valves
-vegetation break off may allow colonization
Serositis of SLE
Vascular features of SLE
Arterial or venous thrombosis
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.
CNS features of SLE
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)
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.
-findings of CBC
-findings of ESR & CRP
-findings of UA
which abys are we looking for?
--normocytic, normochromic, hemolytic
-Prolonged PTT (from antiphospholipid abys)
ESR and CRP are both elevated.
-cellular or hyaline casts.
Dx of SLE
dx is clinical, no one test of feature is fully diagnostic.
-characteristic rash across the cheek
-discoid lesion rash
-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.
**Pt must experience 4 of the criteria before a doc can classify condition as SLE.
-typical PE and Lab findings of pt being newly dx
-ANA, dsDNA, anti-SM
--WBC, RBC, proteinuria, hyaline casts
-pt education about dz flare ups
Tx: incurable but treatable
-reduce inflamm, suppress immune system
-Plasmapheresis (lupus nephritis)
-Belimumab (fully human monoclonal aby)
-sunscreen and protective clothing
-avoidance of vasoconstrictive drugs
Drug Induced Lupus Syndrome:
-discuss how labs differ from SLE
-MC drugs causing this, others
-musculoskeletal, pulmonary, and polyserositic sx
-abys are not harmful
-ANA present but return to normal with withdrawal of drug
Tx: d/c medication
-hydralazine and procainamide
* = definite association