lupus Flashcards
There are two types of Lupus
SLE: Systemic Lupus Erythematosus.
DLE: Discoid Lupus Erythematosus:
only affects the skin
Smaller percentage have this type
SLE is a (Janie is inflammed)
chronic inflammatory disease of unknown cause that affects the skin, joints, kidneys, lungs, nervous system , serous membranes and other organs of the body.
SYSTEMIC LUPUS ERYTHEMATOSUS ETIOLOGY - what causes lupus?
Etiology is unknown and is clearly multifactorial:
Genetic predisposition.
Hormonal involvement.
Immunological abnormalities.
Environmental triggers.
PATHOPHYSIOLOGY of SLE - antibodies are produced against which antigens?
Auto-antibodies are produced against antigens:
DNA/RNA
WBC’s
RBC’s
Platelets
OTHER IMMUNOLOGIC FACTORS MAY BE RESPONSIBLE for SLE (Ray and Janie)
HLA-DR2, 3, and 4 are associated with SLE
Hormones play a role in SLE.
Estrogens ↑ immune response
↑ SLE in post partum period.
May be precipitated by certain DRUGS & foods (Janie w/ celery)
Pronestyl shiitake mushrooms
Apresoline Parsley
Bactrim (Sulfa) Celery
Oral contraceptives
Alfalfa Sprouts
CLINICAL MANIFESTATIONS of SLE - is it fast or slow? Remission?
Extremely variable in its severity. It can be mild to severe, rapid to slow onset
Any organ can be affected
SLE is characterized by periods of exacerbation and remission.
CLINICAL MANIFESTATIONS of SLE (3 things) and what is the most common? (Janie is hot, tired and skinny)
Constitutional Sx: fatigue, fever, weight loss
Fatigue: the most common complaint and occasionally the most debilitating.
Fatigue: occurs in 80 to 100 of the cases.
Weight loss: occurs prior to diagnosis. Weight gain later due to treatment
Fever: thought to be due to active disease.
CLINICAL MANIFESTATIONS of SLE SPECIFIC ORGAN INVOLVEMENT - Mucocutaneous - (mucus butterfly)
The most common lesion is the butterfly rash: erythema over the cheeks and nose. Present in 40 % of SLE cases.
CLINICAL MANIFESTATIONS of SLE SPECIFIC ORGAN INVOLVEMENT - MUSCULOSKELETAL (janie and poly have joint pain)
Polyarthralgia (pain in joints) may precede the onset of multi-system disease by many years.
CLINICAL MANIFESTATIONS of SLE SPECIFIC ORGAN INVOLVEMENT - CARDIO-VASCULAR-PULMONARY (Janie ends my peri)
Contributes significantly to morbidity and mortality. Increased risk of CAD
Pericarditis 25% , endocarditis
Pleural effusions 50% , PTN,
Abnormal Pulmonary function test 90%
CLINICAL MANIFESTATIONS of SLE SPECIFIC ORGAN INVOLVEMENT - renal - what is the leading cause of death w/ SLE?
50% with renal involvement
Lupus Nephritis is leading cause of death in SLE.
CLINICAL MANIFESTATIONS of SLE SPECIFIC ORGAN INVOLVEMENT - neurologic (Janie is psycho)
Neurologic deficit may result from immune complex deposit in the brain tissue:
Organic brain syndrome, delirium, psychosis
Hematological involvement: issues w/ blood and lupus (Janie’s blood is TAL)
Antibodies are formed against blood cells:
98% ANEMIA
80% mild LEUKOPENIA
36% THROMBOCYTOPENIA (platelets)
INFECTIONS in SLE - which one causes the most deaths?
↓ antibodies
↑ infections
30% of SLE deaths occur from infections (PNA (pneumonia) (most common)
CLINICAL MANIFESTATIONS of SLE - what triggers it?
(janie in the sun stressed out after surgery)
Exposure to the sun
Infections
Stress
Surgery
Pregnancy.
SLE:DIAGNOSIS (janie was diagnosed by Smith and Ana’s DNA)
Diagnosis based on:
Pt’s history
Physical exam
Lab Tests:
Most specific tests for SLE
Anti-DNA and Anti-Smith (Anti-Sm)
ANA titer is (+) 99% (anti-nuclear antibody) but + in other conditions.
TREATMENT of LUPUS - is remission common?
Spontaneous remission in SLE is high
Corticosteroids are the mainstay of treatment for severe SLE.
NSAIDS for fevers and arthritic pains
SLE - immune? (Janie and Ray have Ana)
Immunologic abnormalities, especially the production of ANA ( antinuclear antibodies), are another prominent feature of the disease.
patho of SLE (Janie has a problem w/ her blood vessels)
Auto-antibodies bind to their specific antigens and immune complexes
Accumulation of immune complexes produces inflammation in the blood vessels causing vasculitis and ischemia.
Manifestations of SLE depend on which organs are involved
rash shape (Janie’s rash is DD)
Rash may be diffuse or discoid (coin shaped)
hair?
Alopecia is common (patchy hair loss)
ulcers?
Oral and nasopharyngeal ulcers in 33% of pts. Usually painless.
skeletal - shape? (Janie and Ray have swan necks)
Can have swan-neck and ulnar deviations.
joints - are they symmetrical? (Janie and Ray are symmetrical)
Joint symptoms usually migratory and symmetrical
RF factor?
15 – 35% test + rheumatoid factor
neurologic - (Janie, Don, and me)
Seizures, HA, strokes, meningitis
thromboembolic (clotting) disease
especially in patients with anti-phospholipid antibodies.
meds for lupus - PLAQUENIL - monitor for what? (plaq causes blindness)
PLAQUENIL (antimalarial drug) may improve skin and musculoskeletal problems. Monitor for blindness
meds - IMMUNOSUPRESSIVE MEDICATION ( ran and xan saved Janie’s life)
IMMUNOSUPRESSIVE MEDICATION Imuran and Cytoxan are used in life threatening situations when conservative treatment isn’t working
is arthritis common?
yes
lupus and arthritis? (Janie’s hands)
Arthritis occurs in 95% of patients
is false positive for RA common in lupus?
15 to 35% of SLE patients have a false positive rheumatoid factor
raynaud’s and lupus?
Raynaud’s phenomenon 20%
