Lupus

Question 1

What are some causes of lupus?

Answer 1

-No known specific cause.
-Genetics
-Start of menses, oral contraceptives, during or after pregnancy (worse immediately postpartum)
-Environmental factors: exposure to sunlight or UV light, stress, some chemicals or toxins
-Medications such as procainamide, hydralazine, quinidine

Question 2

What are general manifestations of lupus?

Answer 2

General complaints include fever, weight loss, joint pain, excessive fatigue. May precede worsened disease activity.

Question 3

What are dermatologic manifestations of lupus?

Answer 3

-Vascular skin lesions, mostly on sun-exposed areas
-Butterfly rash over cheeks and nose bridge
-Oral or nasopharyngeal ulcers
-Alopecia

Question 4

What are musculoskeletal problems associated with lupus?

Answer 4

-Arthritis
-Pain in multiple joints (polyarthralgia) with morning stiffness FIRST COMPLAINT
-Diffuse swelling with joint/muscle pain and some stiffness
-Increased risk for bone loss and fracture

Question 5

What are cardiopulmonary problems associated with lupus?

Answer 5

-Tachypnea and cough suggesting lung disease
-Pleurisy
-Dysrhythmias due to SA and AV node stenosis #1 cause of death
-Pericarditis, myocarditis, endocarditis
-Hypertension & hypercholesterolemia from steroid use
-Risk for secondary antiphospholipid syndrome, increases risk for stroke, gangrene, heart attack

Question 6

What are renal problems associated with lupus?

Answer 6

-Mild proteinuria to rapidly progressive glomerulonephritis
-Scarring and permanent damage leading to ESRD

Question 7

What are nervous system problems associated with lupus?

Answer 7

-Common in SLE
-Generalized-onset or focal-onset seizures
-Peripheral neuropathy leading to sensory and motor deficits
-Disordered thinking, disorientation, memory deficits
-Depression, anxiety, psychosis, headache
-Stroke or aseptic meningitis

Question 8

What are hematologic problems associated with lupus?

Answer 8

-Anemia, leukopenia, thrombocytopenia, coagulation disorders
-Many patients benefit from high-dose warfarin treatment

Question 9

What diagnostic studies are used with lupus?

Answer 9

-ANA titer: presence of antibodies
-Discoid rash: raised patches with scaling follicular plugging, scarring in older lesions
-CBC: anemia, leukopenia, lymphopenia, thrombocytopenia
-Immunologic disorder: antibody to Sm (SMITH) nuclear antigen or positive antiphospholipid antibodies
-Malar rash: butterfly rash
-Xray of affected joints
-ECG for cardiac involvement
-24 hour urine to assess for proteinuria or casts

Question 10

What are antimalarial agents used for in lupus?

Answer 10

Manage fatigue and skin/ joint problems. Hydroxychloroquine most common, patients should have eye exams every 6-12 months due to risk of retinopathy.

Question 11

What are corticosteroids used for in lupus?

Answer 11

Manage severe cutaneous SLE. Lowest dose possible for shortest amount of time.

Question 12

What are immunosuppressants used for in lupus?

Answer 12

Used to suppress the immune system and reduce end-organ damage. Monitor closely to decrease risk of drug toxicity and side effects.

Question 13

What is belimumab (Benlysta)?

Answer 13

B-lymphocyte stimulator that inhibits inflammation of SLE.