8- Connective Tissue Diseases Flashcards
Young adults
Dull red macules/indurated plaques with adherent scale—evolve with atrophy, scarring, pigment changes
Usually above the neck (scalp, nose, malar, lower lip ears)
Generalized- thorax, upper extremities, head and neck, may have alopecia
95% will remain confined to skin
Discoid LE
[Chronic cutaneous LE]
Large lesions, atrophic, hypopigmented, red or pink patches and plaques
Fine telangiectasia and scaling
Extensor/midline back usually affected
Prominent palmoplantar involvement
Lupus erythematosus-lichen planus overlap
Evolve as polycyclic annular lesions or psoriasiform plaques
Scale is thin and easily detached
Follicles not involved
Transient/migratory; no scarring
Tend to occur in sun exposed areas-face and neck, chest and back
3/4 have arthritis (+) anti Ro/SSA
Subacute cutaneous LE (SCLE)
Drug induced SCLE is most often related to what drug
Hydrochlorothiazide
Also: ACE inhibitors, CCB, interferon, anticonvulsant
SLE must have how many of the criteria to diagnose
4/11
At least 1 clinical and 1 immunologic
or must have biopsy proven lupus nephritis in the presence of ANA or anti-dsDNA antibodies
SLE criteria
SOAP BRAIN MD
Serositis (pleuritis/pericarditis)
Oral ulcers
Arthritis
Photosensitivity
Blood low (leuko, thrombo, anemia) Renal (protein >0.5g/day or casts) ANA positive Immunologic- dsDNA, anti-Sm Neurologic- seizures, psychosis
Malar rash
Discoid rash
Difference between bullous lesions of lupus erythematosus (BLE) and epidermolysis bullosa acquisita
Dapsone effective in BLE and not in EBA
Earliest changes that may be noted in SLE
May remain the sole symptom for some time
Transitory or migratory arthralgia
Most common cause of death in SLE DURING the first 5 years
Inflammatory lesions and infections
Most common cause of death in SLE AFTER the first 5 years
Thromboses
Most frequent cardiac manifestation in SLE
Pericarditis
This sign is a marker for SLE patients at risk for CNS lesions (Sneddon Syndrome)
Livedo reticularis
Implicated causes of drig induced LE
HIP SPAM
Hydralazine
Isoniazid
Procainamide
Sulfonamides
Penicillin
Anticonvulsants
Minocycline
This test is positive in 95% of cases of SLE
ANA
This is specific but not sensitive to SLE
Indicates high risk of renal disease
Anti-dsDNA
Immunologic test for SLE that has 10% sensitivity but specificity is very high
Anti-Sm
Immunologic test that is common in SCLE and Sjögren
Anti-La
(Immunologic test)
More commonly positive in SCLE, neonatal LE, late onset and Asian LE
Anti-Ro
Single most effective local treatment in SLE
Triamcinolone acetonide 2.5-10mg/mL at 4-6 weeks interval
Safest class of systemic agent for SLE
Antimalarials
Drug of choice for bullous systemic LE
Dapsone
First line systemic therapy in most forms of cutaneous LE
Hydroxychloroquine 6.5mg/kg/day
WOF this side effect of hydroxychloroquine
Ocular toxicity