Lupus Flashcards
What is the immunological pathogenesis of lupus?
Innate immunity is under active, failing to clear apoptotic material
Adaptive response is triggered to clear nuclear material still in circulation
Antibodies are developed against self material
What systems are affected by lupus?
Mucocutaneous
Nephritis
Neuropsychiatric
Musculoskeletal
Cardiopulmonary
Haematological
What’s the m:f ratio of lupus?
9:1 female
What demographics have a poorer outcome?
Young
Black (more severe disease phenotype)
What is the prevalence of lupus?
1 in 1000
What is the 15 year survival rate of lupus?
84% (1 in 6 chance of dying)
What is the most common sequela of lupus?
Lupus nephritis - 50%
What is the standard treatment for lupus?
Hydroxychloroquine - (takes 6 months to work, is well tolerated)
What is used for an acute flare of lupus?
Glucocorticoids eg prednisolone
What steroid sparing medications may be used?
Mycophenolate - renal
Azathioprine - lupus management in pregnancy
Methotrexate - joint and skin
What is the top line treatment for severe lupus?
Rituximab (anti-B cell antibody)
Cyclophosphamide (chemotherapy)
Given the demographic, what is a primary concern with cyclophosphamide?
Fertility
What is the age of onset of lupus?
Child bearing years
12-50
What is a neuropsychiatric sequela of steroid use?
Mania/hypomania
What scale is a measure of severity of lupus?
SLEDAI-2K
What are examples of non compliance in lupus?
1/3 don’t take medication
Many don’t come into clinic
(Due to issues of executive function)
What conditions fall under neuropsychiatric lupus?
Wide ranging
CNS and PNS
Stroke
Demyelinating syndrome + myelopathy
Headache
Movement disorder
Seizure
Acute confessional state
Mood disorder
Cognitive dysfunction
Psychosis
Neuropathies/plexopathies
Myasthenia gravis
What are the three factors for neuropsychiatric lupus?
Immunosuppression (corticosteroids/cyclophosphamide/rituximab)
Antipsychotics
Time
What are possible causes of neuropsychiatric symptoms of lupus?
Direct effects of inflammation
Damage from previously active lupus (eg stroke damage)
Iatrogenic effects of treatment
Concurrent psychiatric disorder (related or unrelated to SLE)
What was the patient reported incidence of hallucinations?
1 in 4
What are other commmonly reported symptoms?
Fatigue
Loss of coordination
Suicidal thoughts
Cognitive dysfunction
Positive and negative sensory symptoms
Mania
Low mood
What is a possible serological biomarker of neuropsychiatric lupus?
Anti-ribosomal P antibody
Non-specific to the brain symptoms - does not correlate to CSF levels either
What is the utility of CSF to identify neuropsychiatric lupus?
No specific biomarkers outside of inflammation
What is the utility of imaging to identify neuropsychiatric lupus?
No biomarkers as yet
Potential target could be BBB permeability (hippocampus)
What may be seen in lupus neuroimaging?
White matter changes
