Lec 10 SLE Flashcards
What is pathogenesis of SLE?
genetic component
breakfdown of self-tolerance -> pathogenic immune complexes, T and B cell dysregulation
Type II and type III hypersensitivity
What auti=antibodies seen in SLE?
- antinuclear antibodies = sensitive but not specific
- anti dsDNA = specific, poor prognosis
- anti-smith = specific but not prognostic
- antihistone = in drug induced
- anticardiolipin –> falst positive VRDL, long PTT
Who gets SLE?
females > males; black > white
What is prognosis of SLE?
5 yr survival > 90%
What is cause of death in early vs late SLE?
early = active disease or infection late = atherosclerosis or infection
What are 3 common causes of death in SLE?
- cardiovascular disease
- infections
- renal disease
What is role of estrogen in SLE?
decreased levels of androgens in pts with SLE
What are some environmental triggers of SLE?
virus [EBV]
bacterial infection
UV light
meds
What medicatsion induce lupus?
hydralazine
procainamide
isoniazid
What abnormalities of immune system in SLE?
- overactive B cells
- don’t have proper T cell regulation
- immune system less effective
What are the 11 ACR criteria for SLE?
- malar rash
- discoid rash
- photosensitivity
- oral ulcers
- non erosive arthritis
- pleuritis or pericarditis
- renal disorder [proteinuria]
- neuro disorder [seizure, psychosis]
- hematologic disorder [cytopenia]
- immuno disorder
- positive ANA
What are the constititutional symptoms of SLE?
fatigue
weight loss
fever
Where do you see immune complexes in SLE?
in skin and kidney
What is jacqoud’s arthropathy?
ulnar deviation of fingers
looks like RA except hand grip is normal [in RA it is not]
What type of synovial fluid in SLE?
- non inflammatory
- WBC < 3000
- normal glucose and protein
What does hot knee and WBC > 40,000 suggest?
septic arthritis
What signs of renal disease in lupus?
due to type 3 hypersensitivity –> have nephritic and nephrotic syndromes
–> hematuria, proteinuria, cellular casts, nephrotic syndrome
What is memrbanous glomerulonephritis?
architecture preserved but marked thickening of glomerular membranes
What is treatment for lupus if non-renal non-organ threatening?
- low dose steroids –> antimalarias [chloroquine]
- NSAIDS
- MTX
What is treatment for lupus if renal disease?
high dose steroids
immunosuppressive therapy –> cylophosphamide mycophenolate mofetil, azathiprine
What is treatment for lupus if organ threatening?
high dose steroids
immunosuppressants
What is treatment for lupus if ant-phospholipid syndrome?
means you will have recurrent clotting –> give high intensity anti-coagulation
