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Reumato > LES > Flashcards

LES Flashcards

1
Q

Etiologie - medicamente

A

HIPP

Hidralazina

Izoniazida

Procaindamida

Penicilamina

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2
Q

LES cu afectare cutanata si renala este caracterizat de prezenta

A

depozitelor de

complement

+

Ac de tip IgG

+

influx neutrofile + limfocite

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3
Q

Biopsiile altor tesuturi - rar efectuate, dar pot arata

A

modificari de tip vasculitic ce afecteaza

capilarele

arteriolele

venulele

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4
Q

Sinoviala articulara poate fi

A

edematoasa

+

contine complexe imune

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5
Q

In infiltratul inflamator pot fi identificati

A

corpi hematoxilinici = depozite omogene, rotunde, albastre in coloratia cu hematoxilina

rezulta din interactiune Ac anti-nucleari + nuclee celulare

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6
Q

Tablou clinic

A

mostly

Fatigabilitate

Artralgii

Leziuni cutanate

afectare organe vitale - rara, dar severa cand exista

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7
Q

Manifestari generale

A

Febra → exacerbari

Fatigabilitate

simptomele NU sunt corelate cu activitatea bolii / severitatea afectarii altor organe

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8
Q

Afectare articulara

A

cea mai frecventa >90%

simptome gen AR → artralgii simetrice la niv articulatiilor mici

articulatii dureroase, aspect clinic NORMAL

uneori tumefactie discreta la niv tesuturilor moi periarticulare

RAR

deformari cauzate de contractia capsulei articulare si a tendonului

deformare articulara importanta gen cea din AR = artropatia Jaccoud

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9
Q

Necroza avasculara ce intereseaza soldul / genunchiul

A

complicatie rara a bolii / tratamentului cu CS

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10
Q

Mialgia

A

50%

miozita adevarata → <5%

miozita importanta → poate avea BRA complexa + suprapunere (overlap) de polimiozita + LES

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11
Q

Tegumentul e afectat in

A

85% cazuri

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12
Q

Caracteristic LES

A

eritemul dispus in fluture la nivelul obrajilor + piramidei nazale

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13
Q

Pot fi intalnite si

A

PELea PULA

Pigmentari

Eruptii plantare + palmare

Livedo reticularis

Purpura

Urticaria

Leziuni vasculitice degete + periunghial

Alopecie

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14
Q

Fotosensibilitate

A

40-50%

in special la pacientii cu anticorpi anti-Ro +

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15
Q

Pot fi intalnite si

A

Livedo reticularis

Eruptii plantare + palmare

Pigmentari

Alopecie

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16
Q

Alopecia cicatriciala poate duce la

A

pierderea focala ireversibila a parului

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17
Q

Fenomenul Reynaud

A

comun

poate aparea cu multi ani inaintea altor manifestari clinice

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18
Q

Afectare pulmonara

A

50%

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19
Q

Cele mai frecvente manifestari pulmonare

A

Pleurezii recurente

Revarsate pleurale (exudate)

adesea BILATERALE

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20
Q

Pneumonita

Atelectazia

→ unii pacienti pot sa dezvolte si

A

disfunctie respiratorie restrictiva

asociata cu

⇓ volume pulmonare

ascensionari hemidiafragmatice

= SINDROM DE PLAMAN MICSORAT

poate avea o baza neuromusculara

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21
Q

Rareori apare

(mai frecvent in sindroamele OVERLAP)

A

fibroza pulmonara

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22
Q

Complicatie rara, dar amenintatoare de viata

A

hemoragia intrapulmonara + vasculita

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23
Q

Inima este afectata in

A

25% cazuri

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24
Q

Este frecventa

A

pericardita

cu mici colectii pericardice detectabile ecocardiografic

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25
Q

Poate sa apara si o miocardita usoara

A

→ aritmii

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26
Q

Mai rar intalnite

A

leziuni valve aortice

cardiomiopatia

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27
Q

Apare foarte rar

A

endocardita non-infectioasa interesand valva mitrala = sindromul Libman-Sacks)

28
Q

Pot aparea mai ales in asociere cu sindromul antifosfolipidic

A

fenomen Raynaud

vasculite

tromboze arteriale + venoase

29
Q

Incidenta crescuta a

A

BCI

AVC

datorata partial f de risc comuni (HTA, dislipidemii)

contributie: prezenta inflamatiei cronice

30
Q

Afectare renala clinica apare in

A

30% din cazuri

postmortem modif histologice f frecvente

31
Q

Tuturor pacientilor li se efectueaza periodic

A

sumar de urina → hematurie / proteinurie

32
Q

Un pacient asimptomatic + proteinurie

A

stadiu incipient de nefrita lupica

*initiere tratament → previne evolutia catre IR

33
Q

Proteinuria si hematuria

A

proteinuria → cuantificata

hematuria → identificarea cilindrilor celulari / hematii fragmentate → GLOMERULONEFRITA

biopsie renala → tip + severitate nefrita

34
Q

Tromboza venei renale poate aparea in

A

sd nefrotic

asociere cu anticorpii antifosfolipidici

35
Q

SN

A

60%

simptomele fluctueaza

depresie usoara → ocazional tulburari psihice mai severe

36
Q

Pot fi intalnite

A

epilepsie

migrene

ataxie cerebeloasa

meningita aseptica

leziuni n. cranieni

boli cerebrovasculare

polineuropatii

37
Q

Leziunile pot fi datorate

A

vasculitei

depunerilor de complexe imune

trombozei

microvasculopatiei non-inflamatorii

38
Q

Lupus neurologic

A

infectii excluse / tratate in PARALEL cu adm de CS + imunosupresoare

39
Q

Vasculita retiniana

A

→ infarcte = exudate dure + hemoragii

40
Q

Pot fi intalnite

A

episclerita

conjunctivita

nevrita optica

CECITATEA NEOBISNUITA

41
Q

Sindromul Sjogren secundar

A

15%

42
Q

GI - sunt frecvente si pot fi o caracteristica de debut

A

ulceratiile bucale

nedureroase / suprainfectate → dureroase

43
Q

Vasculita mezenterica poate cauza

A

leziuni inflamatorii - intereseaza intestinul subtire (infarct / perforatie)

44
Q

Rare TGI

A

afectare

hepatica

pancreatita

45
Q

Investigatii

HLG completa

A

leucopenie

limfopenie

trombocitopenie

anemie (af cronica)

anemie hemolitica autoimuna

VSH ⇑ in raport cu activitatea bolii

PCR N

⇑ pleurezie lupica

peritonita

artrita

infectie coexistenta

46
Q

Ureea si creatinina cresc doar cand

A

boala renala e avansata

47
Q

Indicatori timpurii ai nefritei lupice

A

⇓ albumina serica

⇑ RAC (rap alb / creat urinara)

48
Q

AutoAc - cei mai semnificativi

A

ANA

anti-ADNdc

anti-Ro

anti-Sm

anti-La

Ac antifosfolipidici → 25-40%

nu toti dezvolta sindrom antifosfolipidic

49
Q

Complement seric

A

⇓ C3, C4 in cursul bolii active

50
Q

Poate anunta un puseu de boala combinatia

A

⇑ VSH

⇑ Ac anti-ADNdc

⇓ C3

toti markerii revin la normal pe masura ce puseul dispare

Ac anti-ADNdc ramane ridicat si in cursul remisiunii clinice

51
Q

Histologie

A

depozite IgG + complement

→ biopsii renale si cutanate

52
Q

CT

A

infarcte

hemoragii cu semne de atrofie cerebrala

53
Q

IRM

A

leziuni substanta alba

care nu sunt decelate pe CT

*DIFICIL DE DISTINS vasculita reala - tromb mic

54
Q

artralgia

artrita

febra

serozita

raspund bine la

A

dozele standard de AINS

55
Q

Lupus cutanat

A

CS topici

56
Q

Medicamentele antimalarice (clorochina / hidroxiclorochina)

A

formele usoare de afectare cutanata

fatigabilitate

artralgii

care NU raspund la AINS

+ CONSULT OFTALMO periodic (potential toxic retinian)

57
Q

Modificari retiniene sub medicatie antimalarica

apar in

A

7,5% → pacienti tratati pe termen lung cu hidroxiclorochina

risc mai mare la ncei care iau mai mult de 5mg / kgc / zi

58
Q

CS + medicamente imunosupresive

Trat pusee severe de

artrita

pleurezie

pericardita

A

injectii IM in priza unica de CS cu durata de actiune lunga

cure scurte de CS orali

*unele cazuri pot fi controlate doar cu

CS orali pe termen lung

59
Q

Afectarea renala / neurologica

Anemia hemolitica severa

Trombocitopenia

A

doze mari CS orali

afectarea renala / neurologica → IN PLUS + imunosupresoare

60
Q

Afectarea renala / neurologica

A

doze mari CS orali + imunosupresoare

CICLOFOSFAMIDA → inloc cu MICOFENOLAT DE MOFETIL (mai putine ef adverse) pt obtinerea remisiunii

AZATIOPRINA

agenti noi - cazuri refractare

RITUXIMAB

BELIMUMAB

= Ac monoclonali indreptati impotriva lf B

61
Q

Decesele timpurii in evolutia bolii sunt cauzate in special de

A

afectare renala

neurologica

infectii

ulterior →

boala coronariana

AVC

62
Q

RAR, progresia cronica a distructiei articulare, cum se obs in AR si artroza

A

o mica parte din pacienti → deviatie ulnara

63
Q

Pacientii cu LES → risc crescut pe termen lung de a dezvolta unele neoplasme gen

A

LIMFOM

64
Q

Safe in sarcina

A

Hidroxiclorochina

Azatioprina

doze mici de CS

65
Q

Au risc de 2% de a naste copii cu sindrom lupic neonatal

ERUPTII

HEPATITA

BLOC CARDIAC FETAL

A

femeile cu Ac anti-Ro + anti-La

Reumato (13 decks)

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