Lupus Flashcards
What is Lupus
Chronic autoimmune disease where the immune system attacks healthy tissue and organs throughout the body
Epidemiology
More common in women of childbearing age
can affect anyone - most common ages 15-45
More prevalent in people of color
Etiology
3 main factors
Genetics: having a first degree family member with lupus, if your twin has it you are at increased risk
Hormonal: Estrogen production can increase risk of lupus
Environmental: Cigarette smoking, medications, UV light, air pollution, Viruses, Stress, and pesticides
Drug induced lupus - My Pretty Malar Marking Probably Has a Transient Quality
Methimazole
Propylthiouracil
Methyldopa
Minocycline
Procainamide
Hydralazine
Anti-TNF agents
Terbinafine
Isoniazid
Quinidine
Signs and symptoms
Fatigue, Depression, Photosensitivity, Joint pain, N/V, Fever, Weight loss, Malar “Butterfly” rash
Diagnostic tools
SLICC: Must meet at least 4 total features with 1 from each category
EULAR: Patient’s score is at least 10 and at least 1 clinical criterion is fulfilled
Key labs - EXAM Q
ANA - nonspecific and will be positive in those with lupus
ANTI-dsDNA - high specificity and corelated to disease activity IMPORTANT MARKER FOR LUPUS NEPHRITIS
Anti-Smith antibody: High specificity
Antiphospholipid antibody - if positive shows patient has increased clotting factor
Hydroxychloroquine - place in therapy, dose, side effects, and what to monitor
Recommended for all patients with lupus
200-400mg PO daily
SE: Bulls eye maculopathy, insomnia, anxiety, depression, QT prolongation, hypersensitivity reaction
IF patient has G6PD deficiency do not give them this - EXAM Q
Monitoring: CBC, LFTs, SCr, EKG, and eye exam (eye is 3 months after starting)
NSAIDS- place in therapy, dose, side effects, and what to monitor
considered first line for mild symptoms
Ibuprofen 400-600mg PO Q6-8H
Naproxen 500mg PO BID
SE: GI bleeding, Gastritis, perfofation, Increased BP, worsening HF, Cardiovascular events, increased SCr, renal toxicity, hepatoxicity
Monitoring: CBC, LFTs,SCr,BP, s/sx of fluid retention and bleeding
Glucocorticoids- place in therapy, dose
Adjunctive treatment, if not responsive to NSAIDs/Antimalarial
Oral: Mild- moderate disease - Prednisone 5-30mg a day
Severe: Prednisone 1mg/kg/day
IV: pulse therapy - 500-1000mg IV daily x 3-6 days then PO prednisone
Topical
Low potency: Fluocinolone Valerate and Hydrocortisone FOR Butterfly rash on face
Moderate potency: Triamcinolone acetonide and Betamethasone Valerate (trunk and extremities
High potency: Clobetasol (Scalp sores and palms)
Glucocorticoids Topical options
potency and what they are used for
Low potency: Fluocinolone Valerate and Hydrocortisone FOR Butterfly rash on face
Moderate potency: Triamcinolone acetonide and Betamethasone Valerate (trunk and extremities
High potency: Clobetasol (Scalp sores and palms)
Glucocorticoids SE for IV/PO and Topical
PO/IV
Glaucoma, increased BP, increased risk of osteoporosis, GI bleed, Gastritis, Psychosis/sleep disturbances, weight gain, increased BG, increased risk of infection annd risk of cushing syndrome
Topical
Skin atrophy, rosacea, telangiectasis
Glucocorticoids Monitoring
Baseline
BP,BMP,FLP,Bone mineral density
BMP every 6 months
FLP every 6 months
Bone Mineral density annually
Immunosuppressants- place in therapy, dose, side effects, and what to monitor
Adjunct to steroid therapy to lower the dose or insufficient response to HCG
Methotrexate
5-15mg PO once weekly
SE: BMS, Infection, renal GI, liver, pulmonary, hypersensitivity, dermatologic
Azathioprine
50mg PO daily
SE: BMS, Infection, Malignancy, N/V/D
Monitoring: TPMT deficiency
Cyclophosphamide
1-1.5mg/kg PO once daily
SE: BMS, Infection, Malignancy
Mycophenolate mofetil
1-1.5mg PO twice weekly
SE: BMS, Infection, Malignancy,AIS, GI
Biologics - place in therapy, dose, side effects, and what to monitor
inadequate response to antimalarial and immunosuppressants, severe disease
NO LIVE VACCINES 30 DAYS BEFORE THERAPY OR DURING THERAPY
Belimumab
10mg/kg IV every 2 weeks x 3 doses
SE: Hypersensitivity and or infusion reaction
Rituximab
1g on IV day 0 and 15 or 375mg/m2 IV once weekly for 4 doses
SE: infusion reactions, Hep B reactivation
- Premedicate 30 minutes prior to administration
Anifrolumab
300mg IV every 4 weeks
SE: Hypersensitivty reaction
