Systemic Lupus Erythematosus Flashcards
What is systemic lupus erythematosus?
SLE is a chronic inflammatory disease associated with production of antinuclear antibodies (also called ANF… antinuclear factor)
What are the most common symptoms of SLE?
most common are polyarthritis and dermatitis. malar rash (butterfly rash) in 1/3 of patients. renal disease occurs in over half and is the most common cause of death. (10-20% require dialysis). d\t increased vasculitis, these patients have increased risk of CNS disorders such as stroke, seizures, dementia, peripheral neuropathy, and psychosis. diffuse serositis results in pericardial effusion in over half of patients… tamponade is rare
What patient characteristics are linked to the highest incidence of SLE?
young women 20-30….. (1/1000 females)… most common in women of African and Asian decent
What drugs are used to treat SLE?
corticosteroids for moderate to severe SLE; antimalarials are effective in treatment of arthritis and dermatitis; immunosuppressants (azathioprine, methotrexate, cyclophosphamide, and cyclosporine) help reduce symptoms and reduce corticosteroid dose requirements
What conditions and drugs can precipitate an exacerbation of SLE?
infection, pregnancy, and surgical stress…. over 80 drugs can precipitate exacerbation: procainamide, hydralazine, captopril, enalapril, isoniazid, d-penicillamine, and methyldopa are most common
What are the pulmonary effects of systemic lupus?
prone to pleural effusion, pneumonitis, alveolar hemorrhage, and pulmonary HTN…. end result is a restrictive defect
What are airway implications of SLE?
~ 1/3rd with SLE exhibit cricoarytenoid arthritis and RLN palsy
A patient with SLE takes corticosteroids and cyclophosphamide. How might this alter your anesthetic plan?
may require additional corticosteroids during the peri-operative period. b\c cyclophosphamide (chemo drug that works by inducing death on certain T cells) inhibits plasma cholinesterase, the effects of ester local anesthetics and Sux may be prolonged
