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Simmons NURP 503 Exam 2 > 7: Lupus > Flashcards

7: Lupus Flashcards

1
Q

T/F SLE is an organ-specific disease like thyroiditis and diabetes.

A

False. It is a multisystem autoimmune disease that affects many organs.

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2
Q

Does SLE favor men or women?

A

Women (9:1)

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3
Q

When is the typical onset of SLE?

A

Reproductive years

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4
Q

T/F SLE has a strong minority representation.

A

True

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5
Q

What are constitutional symptoms of SLE (3)?

A
  1. Fatigue
  2. Fever
  3. Weight loss
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6
Q

What are SLE triggers (5)?

A
  1. Recent sun exposure.
  2. Emotional stress.
  3. Infection
  4. Drugs (sulfonamides, Hydralazine).
  5. Surgery
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7
Q

What is the criteria for diagnosing SLE (12)?

A 
Must meet 4:
Mucocutaneous:
1. Malar rash
2. Discoid lesions
3. Photosensitivity
4. Oral ulcers
Symptomatic Organs:
5. Arthritis
6. Serositis
7. Neuropsychiatric
8. Renal
Labs:
9. ANA
10. Hematological (lymphopenia, leukopenia, hemolytic anemia, thrombocytopenia)
11. Immunologic (anti-ds-DNA, anti-Smith, antiphospholipid)
12. Nephritis (RBC casts, proteinuria)
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8
Q

T/F SLE patients who die within 5 years usually have active disease.

A

True. Over 90% survive at least 2 years after diagnosis. Currently 80-90% survive 10 years. Late deaths are often d/t CVD.

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9
Q

T/F SLE is curable.

A

False. Remission is possible, but not a cure.

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10
Q

Which system is the most commonly affected?

A

Cutaneous (80-90%)

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11
Q

What are the 3 most common types of skin lesions with SLE?

A
  1. Acute
  2. Subacute
  3. Discoid (chronic)
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12
Q

What drugs can trigger SLE (6)?

A
  1. Clopidogrel
  2. Hydralazine
  3. Isoniazid
  4. Procainamide
  5. Ticlopidine
  6. Minocycline
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13
Q

Is a malar rash scarring?

A

No

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14
Q

What areas are important to inspect with SLE (6)?

A
  1. Scalp
  2. Pinnae
  3. Behind Ears
  4. Palate
  5. Fingertips
  6. Palms
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15
Q

T/F SLE can present with symmetrical arthritis just like RA.

A

True, but it can be brief or persistent, unlike RA.

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16
Q

The _____ is the signature organ affected by SLE.

A

Kidney

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17
Q

Studies all show _____ as key predictor of bad outcome.

A

Lupus nephritis

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18
Q

_____ affects 50-66% of patients.

A

Renal disease

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19
Q

What leads to diagnosis of renal disease in SLE?

A

Proteinuria

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20
Q

What is a very important test in SLE for health maintenance?

A

Urinalysis for protein

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21
Q

_____ manifestations in 66% of SLE patients.

A

Neuropsychiatric

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22
Q

Which psychiatric disorders are common SLE (3)?

A
  1. Mood disorders
  2. Anxiety
  3. Psychosis
23
Q

Which cognitive disorders are common in SLE (3)?

A
  1. Attention deficit
  2. Lack of concentration
  3. Impaired memory or word finding issues
24
Q

Which neurological complications are common in SLE (4)?

A
  1. Acute confusional state
  2. LOC or arousal issues
  3. Seizures/headaches that are non-responsive
  4. Visual defects, ptosis, nystagmus, vertigo, peripheral neuropathy
25
Q

_____ is the most frequent cardiac complication (6-45%).

A

Pericarditis

26
Q

T/F Primary myocardial involvement is rare.

A

True. Less than 10%.

27
Q

T/F There can be severe pain from pleuritis.

A

True. Seen in more than 30%. Not as deadly as cardiac and renal issues.

28
Q

_____ is pleuritic chest pain with cough, hemoptysis, and dyspnea and no infection is present.

A

Acute lupus pneumonitis

29
Q

_____ is the most important treatment.

A

Sunblock. Sunburns activate lupus.

30
Q

_____ is a key indicator of lupus.

A

Photosensitivity

31
Q

_____ alleviate pain from arthralgias and serositis.

A

NSAIDs.

32
Q

Kidney involvement and risk of thrombosis are associated with _____.

A

NSAIDs

33
Q

_____ is used for skin and joint manifestations.

A

Plaquenil

34
Q

_____ can occur and should be monitored on Plaquenil.

A

Retinal toxicity

35
Q

_____ is topically used for skin rashes, except on face.

A

Corticosteroids

36
Q

_____ is systemically used in low doses for skin rashes and joint involvement.

A

Corticosteroids

37
Q

Moderate doses of corticosteroids combat aggressive skin disease, _____, and hematologic abnormalities.

A

Serositis

38
Q

High doses of steroids are used for what (4)?

A
  1. Nephritis
  2. Cerebritis
  3. Vasculitis
  4. Life-threatening hematologic abnormalities
39
Q

These drugs are superior to steroids alone and are shown to improve outcomes in severe lupus.

A

Immunosuppressants (Methotrexate, Cellcept, Azathioprine, Cytoxan)

40
Q

_____ is the first FDA-approved treatment for lupus in 50 years.

A

Benlysta (Belimumab). Long-term effectiveness unknown.

41
Q

What pharm category is Benlysta (Belimumab) and why is this important?

A

B-lymphocyte Stimulator Inhibitor. This is impotant b/c B lymphocytes are overexpressed.

42
Q

ANA, anti-dsDNA, anti-RNP, anti-SSA/Ro, anti-SSB/LA, antiphosholipid, anti-SM, or complements C3/4?
Frequency is greater than 90%. Nonspecific. Diagnostic only.

A

ANA

43
Q

ANA, anti-dsDNA, anti-RNP, anti-SSA/Ro, anti-SSB/LA, antiphosholipid, anti-SM, or complements C3/4?
Frequency is 40-60%. Found in nephritis. May predict flare.

A

Anti-dsDNA

44
Q

ANA, anti-dsDNA, anti-RNP, anti-SSA/Ro, anti-SSB/LA, antiphosholipid, anti-SM, or complements C3/4?
Frequency is 30-40%. Found in Raynaud’s. Not related to SLE activity.

A

Anti-RNP

45
Q

ANA, anti-dsDNA, anti-RNP, anti-SSA/Ro, anti-SSB/LA, antiphosholipid, anti-SM, or complements C3/4?
Frequency is 30-40%. Found in MSK disease. Not related to SLE activity.

A

Anti-RNP

46
Q

ANA, anti-dsDNA, anti-RNP, anti-SSA/Ro, anti-SSB/LA, antiphosholipid, anti-SM, or complements C3/4?
Frequency is 10-45%. Associated with dry eye/mouth, SCLE, neonatal lupus, and photosensitivity. Not related to SLE activity.

A

Anti-SSA/Ro

47
Q

ANA, anti-dsDNA, anti-RNP, anti-SSA/Ro, anti-SSB/LA, antiphosholipid, anti-SM, or complements C3/4?
Frequency is 10-15%. Associated with dry eye/mouth, SCLE, neonatal lupus, and photosensitivity. Not related to SLE activity.

A

Anti-SSB/LA

48
Q

ANA, anti-dsDNA, anti-RNP, anti-SSA/Ro, anti-SSB/LA, antiphosholipid, anti-SM, or complements C3/4?
Frequency is 30%. Associated with clotting issues. Varied relationship to SLE activity.

A

Antiphospholipid

49
Q

ANA, anti-dsDNA, anti-RNP, anti-SSA/Ro, anti-SSB/LA, antiphosholipid, anti-SM, or complements C3/4?
Presence almost always indicates SLE.

A

Anti-SM

50
Q

ANA, anti-dsDNA, anti-RNP, anti-SSA/Ro, anti-SSB/LA, antiphosholipid, anti-SM, or complements C3/4?
Inflammation from SLE severely reduces these. Low numbers may indicate active SLE.

A

Complements C3/4

51
Q

T/F Lupus is a constellation of diverse signs and symptoms that change over time. A butterfly rash means the disease is active.

A

True

52
Q

What characteristics are most common in lupus?

  1. There is an overwhelming female predominance (approx. 9:1).
  2. The typical onset of lupus is during the reproductive years.
  3. There is a strong minority representation.
  4. All of the above.
A
  1. All of the above.
53
Q

What lupus rashes cause scarring of the skin?

  1. All rashes/lesions cause scarring of the skin.
  2. Subacute lupus lesions cause scarring.
  3. Discoid or chronic lesions cause scarring.
  4. Acute butterfly lesions cause scarring.
A
  1. Discoid or chronic lesions cause scarring.
54
Q

Monitoring lupus activity is important especially to watch for involvement of other systems. What autoantibodies should be monitored routinely?

  1. SSA and SSA
  2. dsDNA, C3, and C4
  3. Antiphospholipid antibody and ANA
  4. Anti Sm
A
  1. dsDNA, C3, and C4

Simmons NURP 503 Exam 2 (17 decks)

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