CTD part I Flashcards
autoimmune MHC I more common in
men
autoimmune MHC II more common in
women
AutoAb in SLE
+ ANA HLA B8 HLA DR2 and DR3 W>M black>white
what deficiencies are assoc with SLE
C1 C2 and C4
28 F arthralgias, chest pain dyspnea, malar rash on face, 2/6 systolic murmur scartchin sound L lower lung pedal edema elevated ESR troponin inc, moderate proteinuria
SLE
11 Criteria for SLE!!!!!
-hematologic disorder: pancytopenia -immunologic disorder: dsDNA or SmAg, APA or FPSTS -ANA -Oral ulcers -Renal disorder: protein or casts -Neurologic disorder: seizure or psychosis -malar rash -discoid rash -photosensitivty -arthritis -serostitis :pleuritis or pericarditis
ST elevations in every lead
pericarditis
ANA subtpes
Ro SS-A La SS-B Sm U1-RNP Scl70/topoisomerase 1 Jo-1
peripheral rim pattern cytology
SLE
speckled pattern cytology
SLE and sjogrens polymyositis and dermatomyositis PSS
anti centromere pattern cytology
PSS (CREST) progessive systemic sclerosis
nucleolar pattern cytology
SLE and PSS
telescoping urinary sediment
casts, WBC or RBC or protein etc.
urinary findings in SLE
casts proteinuria >500 mg in 24 hrs 3+ protein on dipstick
SLE CNS involvement
seizures psychoses
what makes SLE rashes worse
smoking
reversible swan neck deformtiies
SLE arthritis
cardiopulm involvement with sLE
alveolar hemorrhage (cough up blood) libman sacks endocarditis (not infectious)
Tx for SLE
hydroxychloroquine
what does hydroxychloroquine do in SLE Tx
reverse platelet activaiton by IgG antiphospholipid prevents flares reduces congenital heart block reduce DM risk
causes of splinter hemorrhages
nail truama SBE sntiphospholipid Ab syndrome hyper-eos syndrome
risk factors for libman sacks vegetations
lupus nephritis anticardiolipin Ab
what cause atypical verrucous vegetations with marantic non bacterial thrombotic endocarditis
aka: libman sack mitral regurg SLE causes this
What drugs can trigger autoimmunogenicity
hydralazine isoniazid procainamide methimazole propylthiouracil etanercept slow acetylators
inhibit DNA methylation in T helper cells
become autoreactive
what is an important screening test for pregnant woman with lupus
lupus anticoagulant because pregnancy is a prothrombotic state also La and antiphospholipid Ab, apolipoprotein H to exclude APS
pregnancy is most hazardous in what SLE patients
those with concurrent HTN and renal disease, APS and RO Ab
what drugs are safe in pregnancy for SLE
HCQ
what drugs are not safe for pregnancy in SLE
mycophenolate, cyclophosphamide, MTX azathrioprine
what indicates lupus flare and not preeclampsia
low C3 C4 uric acid levels normal in SLE flare
indications of preeclampsia
uric acid high abn LFTs
Hx deficiency Cā2 most likely Ab
Ro/SS-A
photosensitivty with Cā deficiency may have daughter with what
heart block
SCSLE rash
spares knuckles and face nonindurated non scaring erythematous plaques papulosquamous or annular lesions with cental hypopigmentation or telangiectasia sun exposed areas
SCLE rash also seen in
RA and SS
What drug can cause SCLE rash
HCTZ
screen for what when see the SCLE rash
anti Ro anti La Ab
neonatal lupus affect children born to mothers with what Ab
Anti-Ro SS-A or La SS-B
what is transient in neonatal lupus
rashes- SCSLE thrombocytopenia hemolytic anemia arthritis
what is permanent in neonatal lupus
complete heart block
Tx of neonatal lupus
HCQ
50 y.o with PMH + 2 spontaneous abortions and TIA fater + stroke DVT in L arm, abdominal ecchymosis from LMWH injections hemosiderin deposits visible in LE prolonged INR and PTT low platelet count Check what Ab?
lupus anticoagulnt
What is APS
antiphospholipid Ab syndrome
causes of secondary APS
CTDs malignancy infections (HIV) drugs: phenytoin, chlorpromazine
Dx of APS
1 clinical + 1 lab 3 mo apart
clinical criteria APS
spontaneous abortion vascular thrombosis
lab criteria APS
anticardiolipin Ab lupus anticoagulant Anti B2 glycoprotein 1 (ApoH) false + serologic test for syphilis
type of rash

discoid lupus erythema
what are these

splinter hemorrhages
assoc with SLE
identify rash

subacute cutaneous lupus erythematosus
RA SS and SLE
watch out for heartblock in daughter