Chapter 6- SLE

Question 1

Epidemiology of SLE

Answer 1

women of african american and hispanic descent

Question 2

What organs are involved in SLE (4)

Answer 2

skin, joints, kidney, serosal membrane

Question 3

What autoantibodies are always present in SLE

Answer 3

antinuclear autoantibodies (ANAs)
*these are not specific to SLE

Question 4

Mechanism of injury in SLE

Answer 4

deposition of immune complexes and binding of antibodies to cells and tissues

Question 5

11 Common Criteria for SLE

Answer 5

IM DAMN SHARP
immunologic disorder
malar rash
discoid rash
antinuclear antigens 
mucositis (oral or nasal ulcers)
neurologic disorder
serositis (pleuritis or pericarditis)
hematologic  disorder
arthritis
renal disorder
photosensitivity

Question 6

Most common autoantibodies in SLE

Answer 6

double-stranded DNA antigen
anti-smith antigen
ANA

Question 7

Most common autoantibodies in Sjogren syndrome

Answer 7

Ro/SS-A

La/SS-B

Question 8

4 categories of antinuclear antigens (ANA)

Answer 8

antibodies against DNA, histones, nonhistone proteins bound to RNA, and nucleolar antigens

Question 9

How to detect ANAs

Answer 9

indirect immunofluorescence that shows 4 basic patterns

Question 10

4 basic immunofluorescent patterns for ANAs

Answer 10

diffuse, speckled, anti-centromeric, nucleolar

Question 11

SLE and Antiphospholipid antibodies

Answer 11

cause false-positive test result for syphilis

can interfere with clotting tests (PTT)

Question 12

PTT test and SLE

Answer 12

+ PTT test should mean the person has a problem clotting but with SLE it is actually the opposite and the person is prone to more clots

Question 13

Genetic factors of SLE (4)

Answer 13

increased risk in family members, monozygotic twins, HLA-DQ allele, inherited complement deficiency

Question 14

SLE and MHC molecule involvement

Answer 14

has implications with MHC and non-MHC genes

Question 15

Result of susceptible loci in SLE

Answer 15

proteins involved in lymphocyte signaling are at risk

Question 16

Environmental factors of SLE (4)

Answer 16

Exposure to UV light, gender bias (X chromosome), drugs, microbiome

Question 17

UV light and SLE

Answer 17

exacerbates disease

stimulate keratinocytes to produce IL-1 and cause inflammation

Question 18

Drugs that influence SLE

Answer 18

hydralazine, procainamide, and D-penicillamine

Question 19

Morphology of SLE

Answer 19

blood vessels, joints, and kidneys*

Question 20

Blood vessel morphology and SLE

Answer 20

acute necrotizing vasculitis of capillaries, small arteries, and arterioles

Question 21

Joint morphology and SLE

Answer 21

non-erosive synovitis with little deformity

Question 22

Kidney morphology and SLE

Answer 22

renal involvement
6 patterns
glomerular lesions from immune complex deposition

Question 23

Most common glomerular disease in SLE

Answer 23

Class IV- diffuse lupus nephritis

Question 24

Least common glomerular disease in SLE

Answer 24

Class I- minimal mesangial lupus nephritis

Question 25

Skin morphology in SLE

Answer 25

butterfly rash exposure to sunlight accentuates the erythema deposition of immunoglobulin and complement along dermal-epidermal junction

Question 26

Serosal Involvement and SLE

Answer 26

inflammation of serosal lining membranes acute and chronic stages pleuritis and pericarditis may be present

Question 27

Acute stage in serosal involvement in SLE

Answer 27

mesothelial surfaces covered with fibrinous exudate

Question 28

Chronic state in serosal involvement in SLE

Answer 28

thickened, opaque and coated with fibrous tissue

Question 29

Cardiovascular system and SLE

Answer 29

any layer of the heart can be damaged | myocarditis, coronary artery disease, valvular abnormalities, and valvular endocarditis

Question 30

Myocarditis in SLE

Answer 30

leads to tachycardia and ECG abnormalities

Question 31

Coronary artery disease in SLE

Answer 31

angina and myocardial infarction

Question 32

Valvular abnormalities in SLE

Answer 32

mitral and aortic involvement | stenosis and/or regurgitation

Question 33

Valvular endocarditis in SLE

Answer 33

Libman-Sacks | big lesions of the heart where bacteria is not present

Question 34

CNS and SLE

Answer 34

neuropsychiatic symptoms

Question 35

Spleen and SLE

Answer 35

splenomegaly, capsular thickening, follicular hyperplasia

Question 36

Lungs and SLE

Answer 36

pleuritis chronic interstitial fibrosis secondary pulmonary hypertension

Question 37

Signs of renal involvement in SLE (4)

Answer 37

hematuria, red cell casts, proteinuria, classic nephrotic syndrome

Question 38

Why do SLE patients have increased numbers of infection?

Answer 38

underlying immune function and treatment with immunosuppressive drugs

Question 39

How to treat disease flares for SLE

Answer 39

corticosteroids and immunosuppressive drugs

Question 40

Causes of death in SLE (3)

Answer 40

renal failure, infection, coronary artery disease

Question 41

Primary characteristic of Chronic Discoid Lupus Erythematosus

Answer 41

skin manifestations on face and scalp skin plaques to varying degrees- edema, erythema, scaliness, skin atrophy surrounded by elevated erythematous border *rarely systemic

Question 42

Subacute Cutaneous Lupus Erythematosus

Answer 42

mild version of lupus predominant skin involvement mild systemic symptoms consistent w SLE

Question 43

How to distinguish subacute cutaneous lupus erythematosus from systemic lupus erythematosus?

Answer 43

skin rash tends to be widespread, superficial and nonscarring

Question 44

Drugs that induce Drug Induced Lupus occur?

Answer 44

hydralazine, procainamide, isoniazid, and D-penicillamine | anti-TNF therapy

Question 45

What organs does drug induced lupus not affect?

Answer 45

renal and CNS

Question 46

How can drug induced lupus be resolved?

Answer 46

withdrawal of the drug