7: Lupus Flashcards
T/F SLE is an organ-specific disease like thyroiditis and diabetes.
False. It is a multisystem autoimmune disease that affects many organs.
Does SLE favor men or women?
Women (9:1)
When is the typical onset of SLE?
Reproductive years
T/F SLE has a strong minority representation.
True
What are constitutional symptoms of SLE (3)?
- Fatigue
- Fever
- Weight loss
What are SLE triggers (5)?
- Recent sun exposure.
- Emotional stress.
- Infection
- Drugs (sulfonamides, Hydralazine).
- Surgery
What is the criteria for diagnosing SLE (12)?
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)
T/F SLE patients who die within 5 years usually have active disease.
True. Over 90% survive at least 2 years after diagnosis. Currently 80-90% survive 10 years. Late deaths are often d/t CVD.
T/F SLE is curable.
False. Remission is possible, but not a cure.
Which system is the most commonly affected?
Cutaneous (80-90%)
What are the 3 most common types of skin lesions with SLE?
- Acute
- Subacute
- Discoid (chronic)
What drugs can trigger SLE (6)?
- Clopidogrel
- Hydralazine
- Isoniazid
- Procainamide
- Ticlopidine
- Minocycline
Is a malar rash scarring?
No
What areas are important to inspect with SLE (6)?
- Scalp
- Pinnae
- Behind Ears
- Palate
- Fingertips
- Palms
T/F SLE can present with symmetrical arthritis just like RA.
True, but it can be brief or persistent, unlike RA.
The _____ is the signature organ affected by SLE.
Kidney
Studies all show _____ as key predictor of bad outcome.
Lupus nephritis
_____ affects 50-66% of patients.
Renal disease
What leads to diagnosis of renal disease in SLE?
Proteinuria
What is a very important test in SLE for health maintenance?
Urinalysis for protein
_____ manifestations in 66% of SLE patients.
Neuropsychiatric
Which psychiatric disorders are common SLE (3)?
- Mood disorders
- Anxiety
- Psychosis
Which cognitive disorders are common in SLE (3)?
- Attention deficit
- Lack of concentration
- Impaired memory or word finding issues
Which neurological complications are common in SLE (4)?
- Acute confusional state
- LOC or arousal issues
- Seizures/headaches that are non-responsive
- Visual defects, ptosis, nystagmus, vertigo, peripheral neuropathy
_____ is the most frequent cardiac complication (6-45%).
Pericarditis
T/F Primary myocardial involvement is rare.
True. Less than 10%.
T/F There can be severe pain from pleuritis.
True. Seen in more than 30%. Not as deadly as cardiac and renal issues.
_____ is pleuritic chest pain with cough, hemoptysis, and dyspnea and no infection is present.
Acute lupus pneumonitis
_____ is the most important treatment.
Sunblock. Sunburns activate lupus.
_____ is a key indicator of lupus.
Photosensitivity
_____ alleviate pain from arthralgias and serositis.
NSAIDs.
Kidney involvement and risk of thrombosis are associated with _____.
NSAIDs
_____ is used for skin and joint manifestations.
Plaquenil
_____ can occur and should be monitored on Plaquenil.
Retinal toxicity
_____ is topically used for skin rashes, except on face.
Corticosteroids
_____ is systemically used in low doses for skin rashes and joint involvement.
Corticosteroids
Moderate doses of corticosteroids combat aggressive skin disease, _____, and hematologic abnormalities.
Serositis
High doses of steroids are used for what (4)?
- Nephritis
- Cerebritis
- Vasculitis
- Life-threatening hematologic abnormalities
These drugs are superior to steroids alone and are shown to improve outcomes in severe lupus.
Immunosuppressants (Methotrexate, Cellcept, Azathioprine, Cytoxan)
_____ is the first FDA-approved treatment for lupus in 50 years.
Benlysta (Belimumab). Long-term effectiveness unknown.
What pharm category is Benlysta (Belimumab) and why is this important?
B-lymphocyte Stimulator Inhibitor. This is impotant b/c B lymphocytes are overexpressed.
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.
ANA
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.
Anti-dsDNA
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.
Anti-RNP
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.
Anti-RNP
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.
Anti-SSA/Ro
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.
Anti-SSB/LA
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.
Antiphospholipid
ANA, anti-dsDNA, anti-RNP, anti-SSA/Ro, anti-SSB/LA, antiphosholipid, anti-SM, or complements C3/4?
Presence almost always indicates SLE.
Anti-SM
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.
Complements C3/4
T/F Lupus is a constellation of diverse signs and symptoms that change over time. A butterfly rash means the disease is active.
True
What characteristics are most common in lupus?
- There is an overwhelming female predominance (approx. 9:1).
- The typical onset of lupus is during the reproductive years.
- There is a strong minority representation.
- All of the above.
- All of the above.
What lupus rashes cause scarring of the skin?
- All rashes/lesions cause scarring of the skin.
- Subacute lupus lesions cause scarring.
- Discoid or chronic lesions cause scarring.
- Acute butterfly lesions cause scarring.
- Discoid or chronic lesions cause scarring.
Monitoring lupus activity is important especially to watch for involvement of other systems. What autoantibodies should be monitored routinely?
- SSA and SSA
- dsDNA, C3, and C4
- Antiphospholipid antibody and ANA
- Anti Sm
- dsDNA, C3, and C4