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Senior - Rhuem Chart > 7 - Lupus > Flashcards

7 - Lupus Flashcards

1
Q

MC pt for Lupus?

A

Black women

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2
Q

What is lupus?

A

Inflammatory autoimmune disorder affecting multiple organ systems

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3
Q

Lupus pts need to worry about?

A

Sever renal disease early in life

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4
Q

Lupus is multifactorial, what are some of the factors suspected to be involved?

A

Genetic - monozygotic twins, HLA DR2 and DR3

Abnormal immune system - autoantibodies (ANA)

Endocrine - Menarche, HRT, OCPs

Environmental - tobacco, UV light, EBV

Drugs - procainamide, hydralazine, INH

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5
Q

Classification for lupus?

A

4/11 of the following:

  1. Malar rash
  2. Discoid rash
  3. Photosensitivity
  4. Oral ulcers
  5. Arthritis
  6. Serositis
  7. Renal (>0.5 proteinuria or cell casts)
  8. Neurologic (seizure, psychosis)
  9. Hematologic disorders
  10. Immunological abnormalities
  11. POS ANA
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6
Q

95-100% of lupus pts have?

A

Positive ANA

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7
Q

Immunological abnormalaties seen with Lupus?

A

Anti-dsDNA
Anti-Sm
Antiphospholipid antibodies

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8
Q

Hematologic disorders with lupus?

A

Hemolytic anemia
Leukopenia
Lymphopenia
Thrombocytopenia

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9
Q

Important Labs for lupus

A

Depressed serum complement (C3, C4, CH50)

Anti-phospholipid antibody

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10
Q

Labs for lupus

A 
C3, C4, CH50
ANA
Anti-smith
Ds-DNA
Anti-phospholipid antibody

UA = hematuria
CBC = anemia, leukopenia, thrombocytopenia
Chemistry = hyperkalemia, renal
LFT - multiple cases of test abnormalitis
CK elevated in associated mytosis
Skin biopsy

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11
Q

CT Imaging studies for lupus?

A

CT chest:

  • lupus pneumonitis
  • alveolar hemorrhage
  • fibrosis
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12
Q

Endocardiogram for lupus?

A

Pericardial effusions
Valvular lesions
Screening for pulm HTN

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13
Q

CXR for lupus?

A

Initial eval of pleuritic chest pain

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14
Q

Lupus non-pharmacologic tx?

A 
PT education
Photoprotection
Tobacco cessation
Exercise
Healthy diet
Vaccine (flu, pneumococcal)
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15
Q

Pharmacologic cutaneous tx for lupus

A

Initially: low potency topical steroids

Truncal lesions: medium potency topical steroids

Severe hypertrophic regions: high potency topical steroid

Tacrolomus/pricrolimus: 2nd line agent

Retinoids: 2nd line

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16
Q

Systemic pharmacological agents for lupus

A

Hydroxychloroquine (plaquenil) - 1st line

Cloroquine - 2nd line
Corticosteroids - short term only
ACE/ARB - control B/P and Renal manifestations

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17
Q

If youre treating with hydroxychloroquine (plaquenil) you cannot give?

A

Chloroquine

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18
Q

You can but should never give lupus pts?

A

Corticosteroids

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19
Q

Systems effected by lupus

A 
Constitutional
Ocular
Arthritis
Osteonecrosis (avascular necrosis)
Cardiovascular
Pulmonary 
Hematologic
Neurologic
Renal
Gastrointestinal
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20
Q

Occular lupus symptoms?

A

Keratoconjunctiva sicca

SLE retinopathy

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21
Q

Arthritic symptoms of lupus

A

Transient symmetric arthritis of:

  • hands
  • writsts
  • knees

Seldom

  • Deforming
  • Non-erosive

Less severe than RA

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22
Q

MC presenting of SLE?

A

Arthritis

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23
Q

Lupus pts can have ___ w or w/o hx of steroid therapy?

A

Osteonecrosis (avascular necrosis)

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24
Q

Cardiovascular symptoms of lupus?

A 
Raynauds
Pericarditis
Valvular heart dz
Libman-sacks endocarditis
CAD
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25
Q

Pulmonary features of lupus?

A 
Serositis
Plueral effusions
Pleuritis
Intersititial lung disease (restrictive)
Pulmonary HTN
Shrinking lung syndrome 
PE

PFT’s: restrictive, low diffusion

26
Q

Hematologic presentation of lupus?

A

Anemia of chronic disease
- MOST COMMON

Lymphadenopathy (common)
Leukopenia
Thrombocytopenia
Hemolytic anemia 
Coombs test +
27
Q

Neurologic presentation of lupus?

A 
HA
Seiures
Mood changes
CVD
Cognitive dysfunction
28
Q

Renal presentation of lupus?

A

Lupus nephritis

- w/in 1st 36 mo

29
Q

Hallmark of lupus nephritis?

A

Proteinuria

Hematuria

30
Q

GI lupus presntation?

A

Mesenteric vasculitis (abdominal pain)

31
Q

Malar rash is aka?

A

Acute cutaneous lupus

Butterfly rash

32
Q

Describe malar rash

A

Fixed erythema
flat or raised
over the malar eminences
tending to spare the nasolabial folds

33
Q

Acne rosacea, seborrheic dermatitis and flushing syndromes are differentiated from malar rash by:

A

Rosacea:

  • telangiectasias and pustules may sting/burn
  • heat and etoh make it worse

Seborrheic derm:

  • scaly erythematous plaques on eyebrows, sclap, ears
  • nasolabial folds common
34
Q

If the rash dx is unclear?

A

Biopsy to differentiate SLE from other derm

35
Q

Discoid rash is aka?

A

Chronic cutaneous lupus

36
Q

Discouid rash is MC found:

A

Face
Scalp
Neck

37
Q

S/s of discoid rash

A

Raised erythematous patches w adherent keratotic scaling and follicular plugging

Discoid lupus lesions:
- Typically expand w peripheral erythema and hyperpigmentation

38
Q

Discoid rash can occur?

A

In the oral cavity

PAINFUL

39
Q

Discoid lupus lesions hallmark?

A

Atrophic central scarring
Telangiectasia
Hypopigmentation

40
Q

What causes subacute cutaneous lupus?

A

Most often induced by meds

  • hydrochlorothiazide
  • terbinafine
41
Q

Where does subacute cutaneous lupus present?

A

Located on torso, limbs

Spares the face

42
Q

Subacute cutaneous lupus is the most ___ of the lupus rashes?

A

Most photosensitive

43
Q

Describe subacute cutaneous lupus rash

A

Papulosquamous or annular
Scaly erythematous papules

The most photosensitive rash

44
Q

Diagnostic labs for subacute cutaneous lupus?

A

Anti-Ro

SSA antibodies

45
Q

Neonatal lupus can present as?

A

Cardiac
Cutaneous

Or both

46
Q

With neonatal lupus you need to worry about?

A

Heart block

47
Q

Rash s/s of neonatal lupus?

A

Annular, Polycyclic skin plaques on face and scalp

After UV exposure for the 1st 3-5 months of life

48
Q

Suspect neonatal lupus if mom had?

A

SSA

SSB labs

49
Q

With neonatal lupus you can tell the parents?

A

It will typically resolves by 6-8 months of age

50
Q

Patient population for drug induced lupus?

A

Men = women

51
Q

Drugs associated w drug induced lupus?

A 
Hydralazine
INH
Procainamide
Minocycline 
Interferon alpha
Anti-TNF agents
Methyldopa
Chloropromazine
Quinidine
52
Q

Hydrochlorthiazide is associated with?

A

Subacute cutaneous lupus

53
Q

S/s of drug induced lupus?

A 
Polyarthritis
Myalgia
Fever
Serositis
Nephritis
CNS abnormalities rare
54
Q

Diagnosis of drug induced lupus?

A

Anti-histone antibodies frequently present

55
Q

Tx for drug induced lupus

A

Stop the drug!!!

It gets better once you do that

If systemic tx is needed in the interim than do that too

56
Q

What is APS?

A

Antiphospholipid antibody syndrome

Hypercoagulability with recurrent thrombosis of either venous or arterial circulation

57
Q

APS causes?

A

DVT
PE
Stroke
Renal injury

58
Q

Clinical criteria for APS?

A 
Vascular thrombosis
Or
1+ pregnancy loss > 10 wks
1+ premature birth < 34 wks
3+ spontaneous abortion <10 wks
59
Q

What antiphospholipid antibodies are included in APS?

A

False pos RPR (neg FTA)
Lupus anticoagulant (increased PTT)
Anticardiolipin antibodies (IgG/IgM)
Anti-beta-2 glycoprotein 1 antibodies

60
Q

Tx for APS?

A

Warfarin or heparin

Lifelong anticuagulation w coumadin or heparin

Smoking cessation

61
Q

If woman has hx of preg-associated complication (APS) the tx is?

A

aspirin (preeclampsia)
and
heparin/LMWH

Senior - Rhuem Chart (10 decks)

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