lupus

Question 1

classic presntation

Answer 1

patient comes in with arthritis
systemic systems

Question 2

epidemiology

Answer 2

way more common in women and in afro caribbean orgin and asian

Question 3

triggers

Answer 3

Oestrogen-containing contraception hence why women on the pill

oestrogen in general - hence why women
Overexposure to sunlight.
Infections.
Stress

Question 4

triggers

Answer 4

Oestrogen-containing contraception.
Overexposure to sunlight.
Infections.
Stres

Question 5

dermatological manifestations

Answer 5

ulcers /mouth,genital, nose
vasculatis - petechia, purpura
disocoid plaques
hair loss /alopecia

malar rash (spares the nasolabial folds)

also associated with levido reticularis /

• note there is a a variant with just discloud lupus and no other systemic fidninds

Question 6

type of arthriis

Answer 6

The usual presentation is a polyarthritis which may be symmetrical or asymmetrical.

Question 7

CVS presentations

Answer 7

raynauds phenomenon
carditis - peri is the most common

Question 8

lungs

Answer 8

pleural
effusions

pneumonitis which chronic can lead to fibrosis

Question 9

most common cause of lupus death

Answer 9

kidney problems

Question 10

neurological

Answer 10

Seizures.
Migraines.
Peripheral neuropathies.
Psychiatric symptoms including psychosis or depression or anxiety.

Question 11

hematological

Answer 11

Anaemia of chronic disease (common).
Lymphopenia (common).
Autoimmune haemolytic anaemia.
Thrombocytopenia.
Leucopoenia.

Question 12

GI

Answer 12

Peritonitis (aseptic).

Hepatosplenomegaly.

Question 13

WHAT OTher diseases is lupus associated with >

Answer 13

Secondary Sjogren’s syndrome

Secondary anti-phospholipid syndrome

Mixed connective tissue disease (features of SLE, systemic sclerosis and poly/dermatomyositis)

Question 14

dil?

Answer 14

DRUG induced happens when someone takes meds for a month or more. in order to claim it they must have had no symptoms before the medication and symptoms would stop after

most common is the joint pain, and the systemic and serositis

malar rash less common and kindey involvement

Question 15

drugs known to cause DIL

Answer 15

sulfadiazine
Isoniazid
hlorpromazine

Question 16

what antibodies do we look for

Answer 16

doublce stranders
antinuclear antibodies
anti - sm
anti histone anitbodies

Question 17

what specif anitbody to look for in DIL

Answer 17

anti - histone anitbodies ( a type of anti nuclear anitbody )

Question 18

if you suspect someone has lupus what investigations

Answer 18

ESR CRP-i n absence of infection

urinalanalysi -screen for kindey involvement

complement - low c3 and c4

specific antibodies

Question 19

which antibody cannot tell you much

Answer 19

ANA cos + in other diseases

Question 20

whats more speicif for lupus

Answer 20

dbss
anti phospholipid

Question 21

treatment of lupus

Answer 21

cs
malaria drugs - hydroxychloroquine

immunosuppressants like cyclophosphamide
DMARD

Question 22

when do we use immunosippresnants

Answer 22

for more severe disease like organ invlvement othwrise if mild we use nsaids and hydroxychloroquine

Question 23

when do we use immunosippresnants

Answer 23

for more severe disease like organ invlvement othwrise if mild we use nsaids and hydroxychloroquine

Question 24

what do we use for lupus nephritis

Answer 24

CS and usually a cytotoxic drug like cyclopohosphamide

Question 25

hypertensive medications for nephritis ?

Answer 25

ace inhibitors are CI because they reduce renal blood flow but may be needed if hypertension so senior consultation

Question 26

any genetic predispostions

Answer 26

HLA B8
HLA DR2/DR3

Question 27

what can give a false positive for lupus

Answer 27

wasserman test