007. Systemic lupus erythematosus Flashcards
What is lupus?
Multisystem autoimmune disease.
Antibodies are made against a variety of autoantigens which form immune complexes. This leads to tissue inflammation and damage
What subpopulation tend to present with lupus?
Typically woman of childbearing age
Commoner in african-carribeans, asians
What can be said about the clinical features of lupus?
Relapsing and remitting illness of variable presentation and course.
Non specific (malaise, fatigue myalgia and fever)
What are the symptoms listed in the classification criteria for lupus?
Need 4 for diagnosis or biopsy proven lupus nephritis
Malar rash
Discoid rash (three stage rash that looks scabby)
Non scarring alopecia
Oral/nasal ulcers
Snovitis
Serositis
Proteinurua
Sezures, psychosis, mononeurotitis multiplex
Heamolytic anaemia
Leucopenia
Thrombocytopenia
What is the laboratory criteria for lupus?
+ve antinuclear antibodies
anti double stranded DNA antibodies
Anti smith antibodies
Anti-phospholipid antibosies
Low complement (C3, C4 or C50)
+ve coombs test
What are the features of antiphospholipid syndrome?
How is it treated?
CLOT
coagulation defect
Livedo reticularis (mottled skin)
Obstetric (recurrent miscarriage)
Thrombocytopenia (thrombotic tendencies)
Anticoagulation
What are the three best tests for lupus?
Anti-dsna antibody
Complement (C3 and C4)
ESR
Also- urinalysis and BP
What is a major cause of lupus?
Medications
Lupus like symptoms will resolve when the medications are stopped
What are the general measures taken to combat lupus?
High factor suncream
Hydroxychloroquine
Screen for co-morbidities
Topical steroids for skin flares
What maintenance medications are given in lupus?
NSAIDS
hydroxychloroquinone for joint and skin symptoms
Azathioprine, methotrexate and mycophenolate are all used as steroid sparing agents
Benlimumab is a monoclonal amtibody used for add on therapy
What is the treatment for a mild flare of lupus?
What is the treatment for a moderate flare of lupus?
Hydroxychloroquine or low dose steroids
May require DMARDS or Mycophenolate (atypical DMARD)
How do you treat a severe flare of lupus?
Urgent high dose steroids
Mycophenolate
Rituximab
Cyclophosphamide
What are the principles of treatment for lupus nephritis?
Steroids and cyclophosphamide or mycophenolate
BP control vital (ACE-I)
Renal replacement therapy if all fails
