B3.020 - Lupus Flashcards
What joints does RA spare
DIPs
What can lupus cause in the lymph nodes
inflammation
On an H&E stain what would indicate lupus
Mesangial proliferation
What is full house staining
Indirect immunofluorescence for IgG, IgA, IgM, C3, C1q, Kappa, and lambda
What is the most common presenting symptom for lupus
joint pain
What disease feature non destructive arthritis
Lupus
What is jaccouds arthropathy
Ligament laxity, looks like a deformity but can correct on exam
What can constitute serositis
Pleural effusion
Pericardial effusion
Pleurisy/pleuritic chest pain
What is something unique about oral ulcers associated with lupus
Can involve hard palate and typically not painful
What are the 3 types of rash associated with lupus
Butterfly
Subacute cutaneous lupus rash
Discoid lupus rash
Differentiate between the 3 types of rash
- butterfly is due to photosensitivity, appearing days after exposure
- Subacute cutaneous is ornate and not due to photosensitivity
- Discoid is scarring that doesnt heal fully
What are hematologic manifestations of lupus
Anemia
Thrombocytopenia
Leukopenia
What are the renal manifestations of lupus
Glomerulonephritis, aka lupus nephritis
What are symptoms of lupus nephritis
Hematuria, proteinuria, hypertension, edema
What type of hypersesitivity leads to lupus nephritis
3 - antibody/antigen complexes form in blood and deposit in tissues
What can be measured to loo for lupus nephritis and why
C3 and C4, because IgG containin immune complexes activate complement in tissues leading to damage
What are the cardiac manifestations of lupus nephritis
Pericarditis
Libman-sacks endocarditis (noninfectious vegetations)
What neurologic clinical manifestations are there for lupus
Seizures
Psychosis
What is Antinuclear antibody
Antibody with specificity to components of nucleus
How do you test for antinuclear antibodies and what does it test for
ANA - indirect immunofluorescence
Reflects dilution
What are limitations of ANA
False positives
Variability in results
quantitative value doesn’t have clinical significance
What is a positive of ANA diagnostics for lupus
Its sensitive
What are anti double stranded DNA antibodies
Specific to lupus, felt to be pathogenic, trend with disease activity
What are specific antinuclear antibodies
Anti-Smith
Anti-RNP
Anti-SSA
Anti-SSB
What are antiphospholipid Abs
Anti cardiolipin Ab IgM and IgG
Anti beta 2 glycoprotein 1 IgM and IgG
Activation of which complement pathway is associated with Lupus flares and what Cs does it lead to a decline in
Classical - C1, C2, C3, C4
Which Igs participate in the classical pathway
IgM and IgG
What are Anti-Histone Antibodies associated with
Drug induced lupus
What are common medications that can cause drug induced lupus
Hydralazine
Procainamide
Isoniazid
Minocycline
How long before disease clinically do autoantibodies present
5 years
What is the mnemonic for diagnosing lupus
SOAP MD BRAIN Serositis Oral Ulcers Arthritis Photosensitivity Malar rash Discoid rash Blood abnormalities Renal abnormalities Positive ANA Immunologic abnormalities Neurologic
what age is lupus most commonly diagnosed
16-55
What are the 3 general steps leading to lupus
- Inefficient clearance of apoptotic debris
- Breach of tolerance
- Immune complex deposition and complement activation
What is the increase in mortality of lupus patients
3 fold
What does Hydroxychloroquine do
Interferes with antigen processing as a result of peptide-MHC protein complexes
What does Belimumab do
Blocks binding of soluble B Cell activating factor
What does Azathioprine do
Inhibits purine synthesis leading to inhibition of DNA and RNA leading to reduced cellular proliferation
What does Mycophenolate mofetil do
Inhibits inosine monophosphate dyhedrogenase which leads to reduced B and T cell proliferation
What does cyclophosphamide do
Attaches to an alkyl group to DNA which leads to apoptosis
Classic chemo drug
What are consequences of corticosteroids like prednisone
Weight gain Bone health DM Infection Mood
What drugs are contraindicated for pregnancy
Cyclophosphamide
mycophenolate mofetil
