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SLE Flashcards

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1
Q

SLE is a ___ autoimmune disorder associated with the production of ______

A

multi system

production of multiple antibodies

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2
Q

cause of SLE?

A

unknown

(in bold)

pts are genetically predisposed coupled with stimuli/trigger

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3
Q

SLE MC affects

A

Women
Women of Color (AA, Asian)
Young (20-30)*

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4
Q

SLE risk factors

A
  1. Immune system dysregulation
  2. Genetics (MC in daughter/mom)
  3. Hormonal (sex hormones)
  4. Environmental (geographic clusters)
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5
Q

characteristic manifestations of SLE

A

periods of active disease and periods of remission are

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6
Q

SLE flares caused by

A

illness, stress, or no identifiable cause

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7
Q

pathophysiologic mechanisms of SLE (2)

A
  1. trapping of immune complexes

2. direct autoimmune attack

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8
Q

trapping of immune complexes in SLE + symptoms

A

complexes in small blood vessels get trapped

causes plugging of the small capillaries that limit blood supply

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9
Q

direct autoimmune attack in SLE

A

direct attack - cell dysfunction and death

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10
Q

classic triad of SLE (+who gets it?)

A

Fevers
Rash
Joint pain

women of child bearing age

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11
Q

lupus mainly involves which systems

A 
Skin 
joints 
kidney 
blood cells
nervous system
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12
Q

constitutional symptoms of SLE

A
  1. fever (low grade)
  2. fatigue/diminished exercise tolerance
  3. myalgias
  4. weight changes
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13
Q

pt is classified as SLE IF

A
  1. biopsy proven lupus nephritis + ANAN or anti-dsDNA Abs

2. satisfies 4 of 11 diagnostic criteria (1 clinical and 1 immunologic)

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14
Q

diagnostic criteria of SLE

A

4/11 - SOAP BRAIN MD

Serositis
Oral Ulcers
Arthritis
Photosensitivity

Blood disorders 
Renal involvement 
Antinuclear ABs
Immunologic phenomena 
Neurologic disorder

Malar rash
Discoid rash

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15
Q

derm manifestations of lupus

A

malar rash
discoid rash
photosensitivity rash
oral nasal ulcerations

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16
Q

malar rash

A

“butterfly” pattern of fixed erythema of cheeks (malaria eminences) and bridge of nose

SPARES nasolabial folds

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17
Q

discoid lesions

A

erythematous raised patches with thick adherent KERATOTIC scaling

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18
Q

how to distinguish malar rash from rosacea

A

scaling in malar rash

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19
Q

photosensitivity rash

A

reaction to sunlight

face and hands

occurs AFTER sun exposure

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20
Q

arthritis in SLE

A

non erosive, non derforming arthritis of two or more peripheral joints with tenderness, swelling, effusion

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21
Q

where is arthritis MC in SLE

A

MCP, PIP, wrists

migratory and fleeting

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22
Q

positive ANA

A

> 1:160

speckled centromere pattern is most specific

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23
Q

renal manifestations of lupus

A 
proteinuria (0.5gm/day)
cellular casts (red cell casts)
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24
Q

serositis

A

inflammation of any serial membrane

pleuritis, pleural/pericardial effusion or pericarditis

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25
symptoms of pericardial effusion
feels better when patient leans forward friction rub on exam
26
heme criteria
1. hemolytic anemia 2. leukopenia (<4k) 3. lymphopenia (<1.5k) 4. thrombocytopenia (<100k)
27
hemolytic anemia in SLE
elevated LDH bilirubin decreased haptoglobin USUALLY Coombs +
28
immunologic abnormalities of SLE
anti-DNA antibodies antibodies to Sm presence of antiphospholipid antibodies
29
neuro criteria of SLE
seizures or psychosis
30
diagnostic imaging
Joint radiographs CT scan of chest/abdomen/pelvis MRI of brain
31
where to start with SLE lab evaluation
quantitative ANA if > 1:160+ get more
32
secondary SLE labs
1. ssDNA and dsDNA (HIGH specificity) 2. Anti Sm 3. Lupus anticoagulant 4. anti-cariolipin antibodies 5. anti-Ro and anti-La 6. complement 7. ESR, CRP
33
urinalysis and SLE
microscopy + spot CR to protein ratio
34
goals of SLE tx
1. immunosuppression 2. reduction of inflammation 3. ID and reduce new onset of disease
35
tx considerations
disease and treatment causes morbidity and mortality early rheumatology referrals and close management
36
behavioral tx of SLE
healthy diet, avoid tobacco, exercise, annual CV risk assessment, family planning sunscreen and protective clothes vitamin D and Ca supplementation low dose aspirin routine immunizations
37
why must SLE pts have routine immunizations
aggressive tx pts are immunosuppressed non live vaccines are given during stable dz
38
all medications used to treat lupus cause
bone marrow suppression worsen hematologic abnormalities on CBC
39
what drugs don't cause bone marrow suppression?
hydroxychloroquine (Plaquenil)
40
categories of drugs used to treat SLE
1. anti-malarials 2. NSAIDs 3. Glucocorticoids 4. DMARDs
41
antimalarials
mainstay of tx decrease flares and prolong life
42
anti-malarials are most useful for
fevers arthritis muco-cutaneous symptoms
43
anti-malarials example
hydroxychloroquinalone (Plaquenil)
44
NSAID use in therapy
anti-inflammatory control of arthritis, HA, serositis systems monitor for renal and liver toxicities
45
glucocorticoids use in therapy
main agent for flares (high dose)
46
ADRs in glucocorticoids
toxicities obesity, DM, osteoporosis, AVN, ocular dx, increased infection risk
47
non biologic DMARDs when?
symptoms of dz are severe OR they are not well controlled to allow for discontinuing steroids
48
non biologic DMARDs list
Azathioprine (imuran) Mycophenolate mofetil (cellcept, myfortic) methotrexate (arthritis)
49
biologic DMARDs list
Belimumab (Benlysta) | Rituximab (Rituxan)
50
when do you use biologic DMARDs
SLE is refractory to other tx
51
family planning SLE
Intact fertility pregnancy may worsen SLE and meds used to tx SLE are teratogens appropriate contraception is essential in these patients
52
safe family planning methods SLE
IUDS | Non hormonal barrier methods
53
unsafe family planning SLE
estrogen products, Depo Shot risk of osteoporosis
54
pregnancy and SLE
causes SEVERE flares in patients higher rates of spontaneous abortion and prematurity (Esp. at time of pregnancy)
55
CVD in SLE
substantially increased risk of coronary artheriosclerotic disease ESP. accelerated sclerotic disease
56
leading cause of death in SLE
CV mortality
57
when is CVD risk highest in pts?
prior to or within a few years of diagnosis
58
cause of renal disease
occurs insidiously from dz or result of medications
59
when should we preform a renal biopsy in SLE?
1. increasing Cr w/o cause 2. greater than 1 g proteinuria/24 hrs 3. greater than 0.5 g proteinuria/24 hrs on hematuria or cellular casts on UA
60
what symptoms/signs might occur in a flare?
new AKI or psychosis/seizure elevated fevers worsen joint
61
treatment of an SLE flare
corticosteroid
62
heme disease in SLE
have some at baseline + medications worsen it must determine if infection or flare
63
SLE infection heme abnormalities
1. high fever 2. leukocytosis 3. thrombocytosis 4. both ESR and CRP elevated 5. Stable complement and dsDNA levels
64
SLE disease flare or meds heme abnormalities
1. afebrile/low grade 2. lymphopenia 3. thrombocytopenia 4. ESR elevation, CRP normal 5. hypocomplementemia, increased dsDNA
65
life threatening SLE (4 main manifestations)
1. lupus nephritis 2. lupus cerebritis 3. pulmonary hemorrhage 4. vasculitis of small vessels
66
drugs to avoid in SLE
sulfa drugs and estrogens
67
pts with SLE are also at an increased risk for
CAD
68
dx of lupus requires
CAD screening
69
early causes of death in pts with SLE (5-10 yrs from diagnosis)
opportunistic infection severe disease
70
later cause of death in pts with SLE
MI or CVA 2/2 accelerated arteriosclerosis
71
pts who survive long term must be monitored for
CAD Cancer AVN
72
what must be excluded in pts with SLE diagnosis
drug induced lupus
73
how does drug induced lupus present
mild arthritis, serositis, skin and constitutional symptoms rare CNS or renal involvement
74
drug induced lupus epi
individuals 50-70s M=F caucasians MC
75
tx of drug induced lupus
withdrawal of drug

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