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PHM702 > Exam 4 - Systemic Lupus Erythematosus > Flashcards

Exam 4 - Systemic Lupus Erythematosus Flashcards

1
Q

What are potential risk factors for the development of SLE? (7)

A

ultraviolet light, stress, smoking, medications, viruses, hormones, genetics

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2
Q

Explain the pre-clinical phase of SLE?

A

autoimmune proliferation as overactive B/T-cell activation and impaired tolerance and immune complex clearance (Type III hypersensitivity)

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3
Q

How does SLE most commonly present? (3)

A

fever, arthralgias, and rash in a woman of childbearing age

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4
Q

What are the ACR diagnostic criteria for SLE? (11)

A

serositis, oral ulcers, arthritis, photosensitivity, blood disorders, renal involve/impairment, antinuclear Ab, immunology, neurologic disorder, malar rash, discoid rash

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5
Q

What are the serologic tests for SLE? (3)

A

antinuclear, anti-dsDNA, and anti-Sm (Smith proteins) Abs

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6
Q

What constitutes antiphospholipid syndrome in SLE?

A

antiphospholipid antibody (aPL) positive and a thrombotic event

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7
Q

What constitutes lupus nephritis? (2)

A

persistent proteinuria and/or cellular casts and renal biopsy and histology

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8
Q

How does lupus NEPHRITIS commonly present (3)

A

foamy urine, peripheral edema, concomitant hypertension

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9
Q

What are nDMARDs for SLE? (4)

A

topical corticosteroids, calcineurin inhibitors, acetaminophen, NSAIDs

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10
Q

What is the DMARD for SLE?

A

hydroxychloroquine

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11
Q

How long does hydroxychloroquine take to work?

A

2-4 months

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12
Q

What are glucocorticoids reserved for in adjunctive treatment of SLE? (4)

A

moderate-severe initial presentation, organ/life-threatening SLE, inadequate response to hydroxychloroquine or NSAIDs, poor QoL without

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13
Q

What is the MOA of belimumab (Benlysta)?

A

B-lymphocyte stimulator antagonist

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14
Q

What is belimumab (Benlysta) reserved for in adjunctive treatment of SLE? (3)

A

non-active-CNS Ab+ SLE, unresponsive to hydroxychloroquine/NSAIDs/steroid, lupus nephritis III-V

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15
Q

How long does belimumab (Benlysta) take to work?

A

2-4 months

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16
Q

What are AEs of belimumab (Benlysta)? (5)

A

GI, hypersensitivity reactions, infusion reactions, suicidality, PML

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17
Q

What is the MOA of anifrolumab (Saphnelo)?

A

interferon antagonist

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18
Q

What are contraindications for anifrolumab (Saphnelo)? (2)

A

active lupus nephritis, CNS disease

19
Q

When is methotrexate indicated in SLE? (2)

A

concomitant RA or primary presentation of arthritis

20
Q

When is azathioprine indicated in SLE?

A

second-line (after steroids) for more moderate disease

21
Q

When is mycophenolate mofetil indicated in SLE? (2)

A

proliferative (II-IV) lupus nephritis, second-line for membranous (V) lupus nephritis

22
Q

Why is cyclophosphamide use in SLE controversial?

A

positive long-term evidence but incredibly toxic

23
Q

When is cyclosporine indicated in SLE?

A

membranous (V) lupus nephritis

24
Q

When are calcineurin inhibitors indicated in SLE?

A

membranous (V) lupus nephritis

25
Q

What is an off-label last-line treatment for SLE?

A

rituximab

26
Q

What are clinical pearls for voclosporin (Lupkynis)? (3)

A

boxed warning for infections and malignancies, eGFR <45 cutoff, 3A4 interactions

27
Q

What are first-line treatments for skin disease in SLE? (3)

A

topical steroids, calcineurin inhibitors, hydroxychloroquine

28
Q

What are treatments for refractory skin disease SLE? (7)

A

systemic steroids, methotrexate, mycophenolate, belimumab, anifrolumab, retinoids, dapsone

29
Q

What is initial treatment for lupus nephritis (III-IV)?

A

mycophenolate mofetil or cyclosporine plus steroid

30
Q

What is remission therapy for lupus nephritis?

A

tapered steroid

31
Q

What can be added to steroid + mycophenolate mofetil combos in lupus nephritis (III-IV) treatment?

A

tacrolimus

32
Q

When should lupus nephritis (III-V) treatment be reassessed?

A

3-12 months

33
Q

If lupus nephritis (III-IV) is responsive to treatment? If not?

A

mycophenolate mofetil or azathioprine with tapered steroid; alternative induction therapy or add tacrolimus or rituximab

34
Q

What is initial treatment for lupus nephritis (V) with a UPr <3?

A

RAAS blockade (ACEi/ARB)

35
Q

What are initial treatments for lupus nephritis (V) with a UPr >3? (2)

A

RAAS blockade (ACEi/ARB), mycophenolate mofetil plus steroid

36
Q

If lupus nephritis (V) is responsive to treatment? If not?

A

continue same treatment with tapered steroid; calcineurin inhibitor (monotherapy or add-on to mycophenolate mofetil) or cyclosporine or rituximab

37
Q

What are the indications for ACE-i/ARBs in SLE? (2)

A

persistent proteinuria (>0.5 g/24hr) and/or HTN

38
Q

What is the indication for statin therapy in SLE?

A

LDL >100 mg/dL

39
Q

Explain pregnancy with regards to SLE medications? (4)

A

hydroxychloroquine = good, NSAIDs = unsafe in 3rd trimester (use APAP), topical steroids must be low-potency and non-fluorinated, azathioprine is the only safe immunosuppresant

40
Q

What is the treatment for aPL+ and not pregnant? Pregnant?

A

low-dose aspirin; low-dose aspirin +/- low molecular weight heparin (enoxaparin)

41
Q

What is the treatment for APS and pregnant?

A

low-dose aspirin +/- low molecular weight heparin (enoxaparin)

42
Q

What is the treatment for APS with an arterial manifestation?

A

warfarin (INR 3-4)

43
Q

What is the treatment for APS with a venous manifestation?

A

warfarin (INR 2-3)

44
Q

What is treatment for lupus nephritis in pregnant patients?

A

hydroxychloroquine with azathioprine

PHM702 (19 decks)

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