SLE

Question 1

what is SLE

Answer 1

systemic lupus erythematosus

autoimmune disease that cause inflammation in various organs

Question 2

risk factors of SLE

Answer 2

more common in women
diagnose bw ages of 15-45
SLE more common in African-Americans, Hispanics and Asian-American
external: sun exposure, hormonal and reproductive factors, viruses, drugs, smoking

Question 3

describe photosensitivity in SLE

Answer 3

exposure to UVA, UVB, artificial lighting can increase disease activity
UV light on epidermal DNA –> inflammation and production of cytokines and oxygen free-radicals

Question 4

describe role of hormones in SLE

Answer 4

OCPs and postmenopausal hormone therapy may have potential negative side effects for women with SLE

Question 5

describe role of viruses in SLE

Answer 5

EBV sero-positivity is much higher in patients with SLE

no association w HPV vaccination and autoimmune disease

Question 6

smoking role in risk for SLE

Answer 6

increased risk of SLE among current smokers

Question 7

what can trigger SLE?

Answer 7

L-canavanine in alfafa sprouts

also certain drugs

Question 8

MSK manifestations of SLE

Answer 8

Arthritis

Jaccoud’s arthropathy- ulnar deviation, swan next and boutonniere deformity

Question 9

skin manifestations of acute SLE

Answer 9

butterfly (malar) rash that spares nasolabial folds

sun exposed skin

Question 10

skin manifestations of subacute SLE

Answer 10

annular configuration with raised red borders

or

papulosquamous (eczematous or psoriasiform appearance)

Question 11

skin manifestations of chronic SLE

Answer 11

discoid LE
confined to skin above neck
red, inflamed, coin-shaped lesions

Question 12

mucosal manifestations of SLE

Answer 12

buccal mucosa most involved

palate and tongue less frequently involved

Question 13

testing for renal involvement includes:

Answer 13

urinalysis
protein and creatinine excretion
serum creatinine
serology (c3, c4, anti-ds-DNA)

Question 14

Hematologic abnormalities of lupus

Answer 14

ACD, MAHA, leukopenia, lymphopenia, ITP, TTP

Question 15

ocular manifestation of SLE

Answer 15

dry eye, keratoconjuctivities sicca as a result of secondary Sjorgren
retinal vasculopathy as cotton wool spots

Question 16

what does ANA test for

Answer 16

autoantibodies targeting components of cell nucleus

not specific - 10% normal people have it

Question 17

what does anti-dsDNA test for

Answer 17

autoantibody against DNA
found in 70-80% patients w SLE
levels vary with disease activity
don’t order IgM anti-dsDNA or anti-ssDNA

Question 18

what does anti-Sm test for

Answer 18

smith antigens are part of ENA (extractable nuclear antigen)
HIGHLY specific for SLE
does not change in titer, need not be monitored
don’t repeat ENA

Question 19

what are levels of complement proteins in patients with lupus?

Answer 19

diminished serum levels of c3 and c4; complement activation

hereditary deficiency strongly associated with development of SLE

Question 20

complications from NSAID use in lupus patients include:

Answer 20

transaminitis 
sun-induced rash 
edema 
HTN
PUD
aseptic meningitis

Question 21

Rx for lupus

Answer 21

glucocorticoids has been frontline therapy
antimalarials
hydroxychloroquine