Lupus Flashcards
What is Systemic LUPUS Erythematosus?
- Autoimmune Disease: Body attacks self
- Causes widespread inflammation and tissue damage that affects almost any organ
What is the Epidemiology of Lupus?
- 16,000 new cases/year
- Females >males
- Age 15-45
What is the Pathophysiology of Lupus?
- Genes & Environment
- Leading to Abnormal Immune Response
- Making Autoantibodies Immune Complexes
- Resulting Inflammation & Damage
what are some of the Risk Factors for Lupus?
- Environmental: Infections, UV, Dust, Soil, Allergens, Smoking
- Genetic: 3+ on X-Chromosome –> why its female
- Hormonal
What is the way that Drug-INduced Lupus Erythematosus [DILE] happens?
- Its the overreaction to meds
- Symptoms within 3-6 months
- Resolution within weeks
What are some of the Medications that cause DILE in Lupus?
Need to know!!
- Metimazole, Propylthiouracil
- Methyldopa
- Minocycline
- Procainamide
- Hydralazine
- Anti-TNF Agents
- Terbinafine
- Isoniazid
- Quinidine
What are some of the symptoms of Lupus?
- Fatigue, Depression, Weight loss of gain, Muscle pain, “Butterfly” Rash, Photosensitivity, Joint Pain
What are some of the areas that Lupus could affect?
- Brain: Psychosis, Seizures
- Lungs: Pneumonitis
- Vessels: Vasulitis
- Kidneys: LUPUS NEPHRITIS
- Skin: Erythema, Butterfly Rash
- Heart
- Spleen
- Joints
What are some other important information about Lupus?
Mortality? QoL? Cost?
- Mortality: 10-15% will die early
- QoL: Limited functioning; 89% cant work
- Cost: Very expensive $33,223
What is Lupus known as?
- “Great Imitator”
- Mimics other diseases
Based on the 2012 SLICC Criteria, what is important to know about Diagonsis of Lupus?
Dont need to know everything just breif info
- Clinical & Immunologic Criteria
- Must meet 4 of 17 criteria [>1 clinical & >1 immunologic]; OR biopsy
What is the most common Immunologic Criteria that we look at for Lupus Diagnosis?
- ANA: 98% prevalence
What are the goals of therapy for Lupus?
- Induction: Control Disease
- Maintenacne: Maintain Remission; Prevent Flares
- Adjunctive: Reduce drugs adverse effects
Decreased Flares; Increase Remission
What are some of the Pharmacologic Treatments for Lupus?
- Hydroxycholorquine
- Glucocorticoids
- Immunsuppressants
- Biologics
What is important to know about Hydrocholoquine in Lupus?
MOA? Place?
- MOA: Antimalarial –> Reduces Autoantibodies
- Place: ALL patients with Lupus
What are some of the Side Effects of Hydrocholoquine in Lupus?
- Cardiomyopathy, Hemolytic Anemia [G6PD Deficiency], Hypoglycemia, QTc Prolongation, Rentinal Toxicity
Eye Exam ANNAULLY
Breif describe what happens within G6PD Deficiency in Lupus?
- G6PD makes glutathione that fights free radicals
- SO; Decreased G6PD = Increased Free Radicals = Lysed RBC
What is the importance of Steroids in Lupus?
MOA? Place?
- MOA: Decreased WBC Activity
- Place: Mild-Mod = PO Steroids; Severe = IV Steroids
What are some of the steriods that are used in Lupus?
- IV Methyprednisolone
- PO Prednisone
What is the Maintenacne goal for steriods in Lupus?
KNOW FOR EXAM
- < 7.5 mg/day [prednisone equivalent] and stop ASAP
What are some of the Side Effects of Steroids in Lupus?
Important to know
- Cardio, Insomina, Cushing Syndrome, N/V/D, Ulcers, Hyperglycemia, Infections, Osteoporosis, Glaucoma
What is the MOA of Immunosuppressants in Lupus?
- MOA: Stops immune system from attacking healthy tissues
What is the Place of Therapy for Immunosuppresants in Lupus?
- Insufficient response in HCQ & are Steroid Sparing [helps decreased steroid use]
- Mild Disease = MTX
- Mod Disease = AZA, CNI, MMF
- Severe Disease = CYC [a lot of side effects]
What are some of the Side Effects for the Immunosuppresants in Lupus?
For MTX, MMF, AZA, CYC
- Bone Marrow Suppression, Infections, Malignancy
What are two important things to understand about Methotrexate & Azathioprine in Lupus?
- MTX: dosed WEEKLY
- AZA: Genetic Test –> TPMT/NUDT15 Deficiency
Breif describe the TPMT deficiency in Lupus?
- AZA –> 6-MP and TPMT makes it INACTIVE
- SO; Decreased TPMT will Increase 6-MP [AZA] toxicities = Bone Marrow Suppression
What is the MOA for the Biologics in Lupus
- MOA: Monoclonal Antibodies blocks B-cells
What is the Place of Therapy for the Biologics in Lupus?
- Inadeqate response to HCQ + S
- Mod Disease = belimumab
- Severe Disease = rituximab
What are some of the Side Effects for the Biologics in Lupus?
- Hypersensitivity and/or Infusion Reactions
- Premedicate
Rituximab has Hep B reactivation and PML
What are some of the medications that are used for Premedication in Bioloigcs in Lupus?
- Acetaminophen [NSIADs], Histamines, Methylprednislone
What are some of the treatments for Cutaneuos Lupus?
- First Line: Topical [clobetasol, betamethasone, triamcinolone, hydrocortisone], HCQ, Steriods
What are some of the treatments for Lupus Nephritis?
- Induction: MMF or CYC + Steriods
- Maintenance: MMF or AZA [not in TPMT deficiency]
- Severe: RTX
What is Anti-Phospholipid Syndrome in Lupus?
MOA?
- Autoimmune disorder with antiphospholipid antibodies that causes blood clots and miscarrage
What are some of the Prophylactic Treatments that are used in Anti-phospholipid syndrome in Lupus?
- Primary Prophylaxis: Aspirin 81mg
- Secondary Prophylaxis: Warfarin +/- Aspirin 81mg
- During Pregnancy: Enoxaparin
What is important to know about Pregnancy in Lupus?
- Higher maternal and fetal risk [increased Miscarrage & flares]
- Should start to try to get pregnant 6 months after remission
- Avoid: Cyclophosphamide, Mycophenolate, Methotrexate –> wati 3-6 months before trying
