Chapter 6- SLE Flashcards
Epidemiology of SLE
women of african american and hispanic descent
What organs are involved in SLE (4)
skin, joints, kidney, serosal membrane
What autoantibodies are always present in SLE
antinuclear autoantibodies (ANAs) *these are not specific to SLE
Mechanism of injury in SLE
deposition of immune complexes and binding of antibodies to cells and tissues
11 Common Criteria for SLE
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
Most common autoantibodies in SLE
double-stranded DNA antigen
anti-smith antigen
ANA
Most common autoantibodies in Sjogren syndrome
Ro/SS-A
La/SS-B
4 categories of antinuclear antigens (ANA)
antibodies against DNA, histones, nonhistone proteins bound to RNA, and nucleolar antigens
How to detect ANAs
indirect immunofluorescence that shows 4 basic patterns
4 basic immunofluorescent patterns for ANAs
diffuse, speckled, anti-centromeric, nucleolar
SLE and Antiphospholipid antibodies
cause false-positive test result for syphilis
can interfere with clotting tests (PTT)
PTT test and SLE
+ 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
Genetic factors of SLE (4)
increased risk in family members, monozygotic twins, HLA-DQ allele, inherited complement deficiency
SLE and MHC molecule involvement
has implications with MHC and non-MHC genes
Result of susceptible loci in SLE
proteins involved in lymphocyte signaling are at risk
Environmental factors of SLE (4)
Exposure to UV light, gender bias (X chromosome), drugs, microbiome
UV light and SLE
exacerbates disease
stimulate keratinocytes to produce IL-1 and cause inflammation
Drugs that influence SLE
hydralazine, procainamide, and D-penicillamine
Morphology of SLE
blood vessels, joints, and kidneys*
Blood vessel morphology and SLE
acute necrotizing vasculitis of capillaries, small arteries, and arterioles
Joint morphology and SLE
non-erosive synovitis with little deformity
Kidney morphology and SLE
renal involvement
6 patterns
glomerular lesions from immune complex deposition
Most common glomerular disease in SLE
Class IV- diffuse lupus nephritis
Least common glomerular disease in SLE
Class I- minimal mesangial lupus nephritis
Skin morphology in SLE
butterfly rash
exposure to sunlight accentuates the erythema
deposition of immunoglobulin and complement along dermal-epidermal junction
Serosal Involvement and SLE
inflammation of serosal lining membranes
acute and chronic stages
pleuritis and pericarditis may be present
Acute stage in serosal involvement in SLE
mesothelial surfaces covered with fibrinous exudate
Chronic state in serosal involvement in SLE
thickened, opaque and coated with fibrous tissue
Cardiovascular system and SLE
any layer of the heart can be damaged
myocarditis, coronary artery disease, valvular abnormalities, and valvular endocarditis
Myocarditis in SLE
leads to tachycardia and ECG abnormalities
Coronary artery disease in SLE
angina and myocardial infarction
Valvular abnormalities in SLE
mitral and aortic involvement
stenosis and/or regurgitation
Valvular endocarditis in SLE
Libman-Sacks
big lesions of the heart where bacteria is not present
CNS and SLE
neuropsychiatic symptoms
Spleen and SLE
splenomegaly, capsular thickening, follicular hyperplasia
Lungs and SLE
pleuritis
chronic interstitial fibrosis
secondary pulmonary hypertension
Signs of renal involvement in SLE (4)
hematuria, red cell casts, proteinuria, classic nephrotic syndrome
Why do SLE patients have increased numbers of infection?
underlying immune function and treatment with immunosuppressive drugs
How to treat disease flares for SLE
corticosteroids and immunosuppressive drugs
Causes of death in SLE (3)
renal failure, infection, coronary artery disease
Primary characteristic of Chronic Discoid Lupus Erythematosus
skin manifestations on face and scalp
skin plaques to varying degrees- edema, erythema, scaliness, skin atrophy surrounded by elevated erythematous border
*rarely systemic
Subacute Cutaneous Lupus Erythematosus
mild version of lupus
predominant skin involvement
mild systemic symptoms consistent w SLE
How to distinguish subacute cutaneous lupus erythematosus from systemic lupus erythematosus?
skin rash tends to be widespread, superficial and nonscarring
Drugs that induce Drug Induced Lupus occur?
hydralazine, procainamide, isoniazid, and D-penicillamine
anti-TNF therapy
What organs does drug induced lupus not affect?
renal and CNS
How can drug induced lupus be resolved?
withdrawal of the drug
