Lupus Flashcards
1
Q
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Is an autoimmune disorder that is chronic, progressive, & has spontaneous remissions & exacerbations (flares)
> Onset can be insidious or acute
> Autoantibodies (antibodies from the individual) attack the client’s own tissues, organs, & vascular system causing the inflammation, hypoxia, & death of them
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Systemic lupus erythematosus (SLE)
2
Q
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- Involves only the skin
- 70-80% develop SLE sx’s over time
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Cutaneous (CLE)
3
Q
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May involve organs & vasculature
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Systemic (SLE)
4
Q
Risk factors
- African American, Native American, Asian American, Pacific Islander, & Hispanic American
- Women usually of childbearing age
- Fhx - genetic component
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Triggers
- Infection: viruses → Epstein-Barr
- Injury or stressors → surgery, emotional
- Certain drugs can cause a SLE-like reaction: hydralazine, isoniazid, penicillamine D, procainamide
- Hormones
- Environmental exposures - silica, mercury, UV light (sometimes this includes fluorescent lighting), tattoos
5
Q
Manifestations
- Malar rash
- Discoid rash
- Photosensitivity
- Mucosal ulcers
- Arthritis (inflammation/non-erosive) so, not OA
- Hematological (thrombocytopenia, leukopenia, lymphopenia, & anemia)
- Immunological (elevated ANA)
> abn anti-dsDNA or antiSM, positive antiphospholipid antibodies (immunological studies)
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- Serositis, pericarditis, pleuritis (cp that worsens w/deep breath)/effusion, peritonitis, abd pain, pancreatitis
- Renal
> monitor for blood, casts, & protein in the urine; changes in u/o & fluid retention; monitor other renal studies - Neurological
> psychosis, migraines, palsies, or seizures
6
Q
Discoid Rash
- If no systemic sx’s - topical treatment of topical corticosteroids
- Plaques w/erythema, scaling, depigmentation, & atrophy on the face
- Disfiguring esp w/more pigmented skin
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Other Sx’s
- Fever (>100°F)
! is the classic sign of an exacerbation - Extreme fatigue
- Hair loss
- Raynaud’s phenomenon
- Myositis
- Vasculitis
- Anorexia
- Osteonecrosis
7
Q
Most common causes of death
! Chronic renal disease
! Cardiovascular impairment
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Diagnostics
- Skin bx, renal bx (w/immunofluorescent staining)
- CBC (looking for anemia, thrombocytopenia, leukopenia, & lymphopenia [pancytopenia])
- Urinalysis, renal, liver, & cardiac functions (looking for casts [pieces of cells normally removed by kidneys], protein, & blood)
! Kidneys, liver, & heart are often involved
8
Q
- Antinuclear Antibodies (ANA)
> Double-stranded DNA (anti-dsDNA)
> Single-stranded DNA (anti-ssDNA)
> Histone antibodies - often elevated w/med-induced SLE
> Anti-SS-a (Ro), Anti-SS-b (La), anti-Smith (anti-Sm) - Antibodies to phospholipids (aPLs)
> can cause narrowing of blood vessels, leading to blood clots in the legs or lungs, stroke, MI, or miscarriage
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- Venereal Disease Research Lab (VDRL)
- Rheumatoid Factor (RA)
- Erythrocyte sedimentation rate (ESR)
- Serum complement esp C3 & C4 - low lvls may indicate active lupus
9
Q
- ANA plus 3 clinical manifestations will cnfm dx
- anti-dsDNA & anti-Sm antibody are only found in lupus
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- Anti-SS-a (Ro) - more common in those cases that worsen w/sun exposure
- VDRL - false (+) syphilis test in SLE pts
10
Q
- Antibodies to phospholipids (aPLs) - can cause narrowing of blood vessels, leading to blood clots in the legs or lungs, stroke, heart attack, or miscarriage
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11
Q
Medications
- Topical corticosteroids - rash
- Corticosteroids
- Antimalarials
- Acetaminophen & NSAIDs
- Immune modulators (DMARDs)
- Monoclonal antibodies
- Janus kinase inhibitors (clinical trials)
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Cortisone - skin lesions
12
Q
Corticosteroids
- Used for its anti-inflammatory effect, h/e, suppresses immunity
- Pt must avoid crowds & sick people
- Many s/e incl but not limited to bone loss, sodium retention, increased BP, nervousness, weight gain, GI ulcers
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- When pts are on long-term steroids, the body stops producing their own; therefore, these meds cannot be stopped abruptly. They must be tapered down to discontinue
13
Q
Antimalarials
- Hydroxychloroquine, chloroquine require baseline & freq eye exams - can cause retinal damage !
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Tylenol & NSAIDs
- For arthralgias & myalgias
14
Q
Immune modulators & cytotoxic agents
- Suppress & prevent reproduction of immune cells
- Methotrexate - bone marrow suppression, incr LFT’s, n/v, mouth sores, HA (folic acid helps dec s/e)
! Do not drink alcohol; do not take NSAIDs w/antimalarials
> Both are tough on the kidneys; monitor serum creatinine - cyclophosphamide, azathioprine
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Monoclonal antibodies
- Prevent cytokines that induce inflammation
belimumab (Benlysta) - pt is monitored for infusion anaphylaxis rxn during & 2 hrs >infusion
15
Q
Janus kinase inhibitors
- Still in clinical trials, baricitinib, also block cytokines that induce inflammation
- Immunosuppressants lower immunity & expose the pt to infections or reactivation of infections
> TB testing before admin of med is recommended
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