SLE

Question 1

Etiology of SLE

Answer 1

• unknown..
• Hormonal Factors: Estrogen and Androgens
• Genetic factors: Polymorphism
• Environmental Triggers

Question 2

What are some Environmental triggers for SLE

Answer 2

Diet - Alfalfa Sprouts; Saturated Fats
Hydrazines (aka aromatic amine exposure) - like hair dyes and tobacco smoke
UV light - Natural or Artificial

Question 3

Pathophysiology of SLE:
\_\_\_\_\_\_\_\_\_\_\_\_\_ Abnormalities
and
\_\_\_\_\_\_\_\_\_\_\_ shift
overall will lead to \_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 3

immunological; T Helper Cell; increase in auto-antibodies

Question 4

Presentation of SLE:

same for every patient or can vary a lot?

Answer 4

varies hella much - even within a patient (a flare up from before may not cause a flare anymore…)

Question 5

Clinical Features seen in SLE:

Constitutional Sx

Answer 5

fatigue/fever/weight loss

Question 6

Clinical Features seen in SLE:

Cutaneous

Answer 6

MALAR RASH (aka butterfly rash); Photosensitivity; oral ulcers; alopecia; Discoid Rash; Raynaud’s Phenomenon

Question 7

Clinical Features seen in SLE:

Renal

Answer 7

Lupus Nephritis (v severe); Hematuria/Proteinuria

Question 8

Clinical Features seen in SLE:

GI

Answer 8

N/V; Anorexia; Abdominal pain

Question 9

Clinical Features seen in SLE:

Neurologic

Answer 9

Psychosis, seizures, depression, anxiety

Question 10

What is Raynaud’s Phenomenon?

Answer 10

vessels in extremities contract - less blood flow - discoloration seen in tips of fingers

Question 11

Clinical Features seen in SLE:

Cardiovascular

Answer 11

Pericarditis/ CAD / HTN / Valvular disease

Question 12

Clinical Features seen in SLE:

Pulmonary

Answer 12

Coughing/Dyspnea/Pelurisy

Question 13

Clinical Features seen in SLE:

Hematologic

Answer 13

Hemolytic anemia; Leukopenia; Thrombocytopenia; ANTIPHOSPHOLIPID Abs

Question 14

Clinical Features seen in SLE:

Immunologic

Answer 14

Autoantibody Production

Question 15

ACR Diagnostic Criteria for SLE - what is their mnemonic for it?

Answer 15

DOPAMINE RASH

Question 16

What does DOPAMINE RASH stand for

Answer 16

its how to diagnose SLE - need 4/11 
D - discoid rash
O - Oral ulcers
P - Photosensitivity
A - Arthritis
M - Malar rash
I - Immunologic Involvement
NE - neurologic involvement

R - Renal involvement
A - Antinuclear Ab +
S - Serositis
H - Hematologic Involvement

Question 17

ACR uses DOPAMINE RASH for SLE Diagnosis - is SLE related to dopamine?

Answer 17

nah

Question 18

ACR guidelines - how many symptoms are needed to be diagnosed with SLE

Answer 18

4 (out of the possible 11)

Question 19

What is the SLICC Criteria to be diagnosed with SLE

Answer 19

need 4/17 criteria
- at least 1 immunologic crterion
and
- at least 1 clinical criterion

Question 20

If don’t use 4/17 criteria for SLICC - you can diagnose with this criteria - Biopsy proven ________ –> Systemic Lupus w/ ________

Answer 20

Nephritis; + ANA and + Anti-dsDNA

Question 21

Non-Pharm treatment options for SLE:

Answer 21

• Limit sun exposure
• Nutrition (balanced diet during remissions; may need more calories during flares)
• Immunizations (NO LIVE VACCINES in immunocompromised/caution during flares)
• Smoking Cessation (smoking can increase flares)
• Exercise (exercise can control flares)

Question 22

5 main groups of Pharmacological treatment for SLE

Answer 22

• NSAIDs
• Antimalarial Agents
• Corticosteroids
• Cytotoxic Agents
• Biologic Agents

Question 23

when using NSAIDs in SLE patients - what ADR is more of a concern in SLE pts over the normal population

Answer 23

Greater incidence of HEPATOTOXICITY can be seen in SLE pts when taking NSAIDs

Question 24

What are the antimalarial agents used in SLE

Answer 24

hydroxychloroquine and Chloroquine

Question 25

when to use the antimalarial agents in a SLE pt

Answer 25

if NSAIDs did not work/ there are cutaneous symptoms

Question 26

what is the first line agent to use in SLE pts and when to use it?

Answer 26

NSAIDs! use for mild arthritis/fever/muscoskeletal pain

Question 27

Antimalarial ADRs

Answer 27

- RETINAL TOXICITY - Dermatologic - CNS - GI

Question 28

Biggest thing to monitor for Antimalarial Agents

Answer 28

Ophthalmologic

Question 29

Corticosteroids - Topical Agents - are ______ line therapy for cutaneous symptoms

Answer 29

second (may be used adjunctively to NSAIDs or anti-malarials)

Question 30

which medication option can lead to Telangiecatasias

Answer 30

topical corticosteroids can lead to this (its aka "spider veins")

Question 31

which agent do you have to check bone mineral density - due to the risk of osteoporosis

Answer 31

SYSTEMIC corticosteroids

Question 32

what are cytotoxic agents that can be used for SLE

Answer 32

- cyclophosphamide - Azathioprine - Mycophenolate mofetil

Question 33

which agent should decrease its dose if the pt is also taking allopurinol or Febuxostat

Answer 33

Azathioprine

Question 34

MOA of Azathioprine

Answer 34

inhibits purine synthesis and DNA replication

Question 35

MOA of Mycophenolate

Answer 35

inhibits proliferation and differentiation of lymphocytes

Question 36

which drug needs to test for TPMT enzyme before use?

Answer 36

Azathioprine (that enzyme metabolizes the drug - know levels of TPMT - makes dosing more effective)

Question 37

which cytotoxic drug do you need to test/do urinalysis monitoring?

Answer 37

Cyclophosphamide (bc of bladder cancer risk)

Question 38

Which cytotoxic drug do you have to chest x-rays for?

Answer 38

Mycophenolate (bc of pulmonary risk)

Question 39

Antiphospholipid syndrome - importance to SLE pts?

Answer 39

if they have this syndrome they are at a greater risk for clotting

Question 40

which agent used for SLE - is the drug of choice for pregnant women

Answer 40

Hydroxychloroquine

Question 41

caution of SLE pt on estrogen containing contraceptives?

Answer 41

if pt with SLE has antiphospholipid syndrome AND on estrogen containing contraceptives (BIG RISK FOR CLOTTING!)

Question 42

Most Common Drugs that cause Drug Induced Lupus

Answer 42

- Procainamide - Hydralazine - Chlorpromazine