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PHM702 > Systemic Lupus Erythematosus > Flashcards

Systemic Lupus Erythematosus Flashcards

1
Q

SLE - Environmental Risk Factors

A

UV light
stress
smoking
drugs
viruses

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2
Q

SLE - Hormonal Risk Factors

A

estrogen
prolactin

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3
Q

SLE - Pre-Clinical Phase Pathophysiology

A

B-cell & T-cell overactivation
elevated CD4:CD8 ratio
dysregulation of cellular apoptosis

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4
Q

SLE - Clinical Phase Pathophysiology

A

autoantibody production -> immune complexes form and deposit in vasculature and tissues -> Type III hypersensitivity reaction -> inflammation -> organ involvement

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5
Q

SLE - Diagnostic Criteria

A

4/11 needed to diagnose
serositis
oral ulcers
arthritis
photosensitivity
blood disorders
renal involvement
antinuclear antibodies
immunology
neurologic disorder
malar rash
discoid rash

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6
Q

SLE - Signs & Symptoms

A

fatigue
fever
weight loss
myalgia
Raynaud’s syndrome
dyspepsia, abdominal pain
alopecia
dry eyes

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7
Q

SLE - Antibodies Involved

A

antinuclear
anti-dsDNA
anti-Sm
antiphospholipid

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8
Q

Antiphospholipid Syndrome

A

aPL (+) and thrombotic event

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9
Q

Lupus Nephritis

A

kidney inflammation due to deposition of immune complexes in either glomeruli or glomerular basement membrane

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10
Q

Lupus Nephritis - Diagnostic Criteria

A

persistent proteinuria or cellular casts
renal biopsy to confirm

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11
Q

Lupus Nephritis - Clinical Presentation

A

foamy urine
peripheral edema
concomitant hypertension

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12
Q

SLE - Maintenance Drug of Choice

A

hydroxychloroquine 200-400 mg QD

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13
Q

Hydroxychloroquine - Adverse Reactions

A

flu-like symptoms
ocular toxicity
allergic skin eruptions
hematological changes
GI upset
cardiomyopathy

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14
Q

SLE - Glucocorticoids’ Role in Therapy

A

adjunctive treatment for moderate-to-severe initial presentation / organ- or life-threatening SLE / inadequate response to hydroxychloroquine / poor QOL

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15
Q

SLE - Belimumab’s Role in Therapy

A

adjunctive treatment - to be used in combination with standard
B-lymphocyte stimulator antagonist
preferred in: non-active-CNS, LN III / IV / V

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16
Q

Belimumab - Adverse Reactions

A

NVD
infusion reactions
depression / CNS effects
PML
infections

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17
Q

SLE - Anifrolumab’s Role in Therapy

A

adjunctive treatment - to use in combination with standard
interferon antagonist
NOT in active LN or CNS disease

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18
Q

SLE - Immunosuppressants’ Role in Therapy

A

refractory disease
organ-threatening SLE (mainly LN)

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19
Q

SLE - Immunosuppressants

A

azathioprine
cyclophosphamide
cyclosporine
methotrexate
mycophenolate
rituximab
tacrolimus

20
Q

SLE - Methotrexate Indications

A

concomitant RA or primary presentation of arthritis

21
Q

SLE - Azathioprine Indications

A

second line after steroids for a moderate disease course
safest in class in pregnancy

22
Q

SLE - Mycophenolate Indications

A

mainly proliferative LN
second line in membranous LN

23
Q

SLE - Cyclosporine Indication

A

membranous LN

24
Q

SLE - Rituximab Indications

A

off-label severe renal / psychiatric / hematologic disease
last line

25
Q

SLE - Tacrolimus Indications

A

proliferative LN
may be used with MMF

26
Q

SLE - Voclosporin Indications

A

adjunctive to other immunosuppressants in active LN (except cyclosporine)

27
Q

Voclosporin - BBWs

A

infections
malignancies

28
Q

Voclosporin - eGFR Cut-Off

A

45 mL/min

29
Q

SLE Skin Disease - First-Line Agents

A

topical steroids
topical CNIs
hydroxychloroquine

30
Q

Mild SLE - First-Line Agents

A

hydroxychloroquine
PO glucocorticoids

31
Q

Mild SLE - Refractory Agents

A

first-line plus methotrexate / azathioprine

32
Q

Moderate SLE - First-Line Agents

A

hydroxychloroquine
PO glucocorticoids
methotrexate / azathioprine
CNIs
MMF

33
Q

Severe SLE - First-Line Agents

A

hydroxychloroquine
PO glucocorticoids
MMF
cyclosporine

34
Q

Severe SLE - Last Line

A

rituximab

35
Q

SLE - Glucocorticoid Dosing

A

prednisone 20-60 mg per day with 10% taper every 5-7 days

36
Q

Lupus Nephritis III-IV - Treatment

A

induction: MMF or cyclosporine PLUS steroid
remission: taper steroid, switch immunosuppressant as needed

37
Q

Lupus Nephritis III-IV - No Response to Treatment

A

add tacrolimus or rituximab

38
Q

Lupus Nephritis III-IV - Treatment-Responsive

A

continue MMF or switch to azathioprine after 3-12 months

39
Q

Lupus Nephritis V - Treatment

A

RAAS blockade
steroid
MMF

40
Q

SLE - RAAS Blockade Indications

A

glomerular disease and
persistent proteinuria or hypertension

41
Q

SLE - Statin Indication

A

LDL > 100 mg/dL

42
Q

SLE - Pregnancy Treatment Options

A

hydroxychloroquine
acetaminophen instead of NSAIDs
low-potency, non-fluorinated topical steroids

43
Q

Lupus Nephritis - Pregnancy Treatment Options

A

mild: hydroxychloroquine / azathioprine
clinically active: non-fluorinated PO steroid
highly active: pre-term delivery (28 wks)

44
Q

SLE - Pregnancy Options with aPL(+)

A

low-dose aspirin +/- LMWH

45
Q

SLE - aPL(+), No Event, Not Pregnant

A

low-dose aspirin

46
Q

SLE - Antiphospholipid Syndrome, Not Pregnant

A

warfarin
arterial: INR 3-4
venous: INR 2-3

PHM702 (20 decks)

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