Lupus Flashcards
What is systemic lupus erythematosus?
Systemic lupus erythematosus (SLE) is a chronic inflammatory disease associated with the production of antinuclear antibodies.
What are the most common symptoms of systemic
lupus erythematosus?
The most common presenting symptoms are polyarthritis and dermatitis. A malar rash occurs in about 1/3 of SLE patients. Renal disease occurs in over half of the patients with SLE and is the most common cause of death. About 10-20% of patients
with lupus erythematosus require dialysis. Because of the increased risk of vasculitis, these patients have a higher risk of CNS disorders such as seizures, stroke, dementia, peripheral
neuropathy, and psychosis. A diffuse serositis results in pericardial effusion in over half of these patients, but pericardial tamponade is rare.
What patients exhibit the highest incidence of
systemic lupus erythematosus?
SLE is typically seen in young women (incidence is
approximately 1 in 1000 females). The disease is most common in women of African and Asian descent.
What drugs are used to treat systemic lupus
erythematosus?
Corticosteroids are helpful in the treatment of moderate to severe SLE. Antimalarials are effective in the treatment of arthritis and dermatitis. Immunosuppressants such as azathioprine, methotrexate, cyclophosphamide, and
cyclosporine help reduce symptoms and reduce corticosteroid dose requirements.
What conditions and drugs can precipitate an
exacerbation of systemic lupus erythematosus?
Infection, pregnancy, and surgical stresses can precipitate an exacerbation of SLE. Over 80 drugs have been reported to precipitate an SLE exacerbation, but procainamide, hydralazine,
captopril, enalapril, isoniazid, d-penicillamine, and methyldopa are the drugs most frequently implicated in SLE exacerbation.
What are the pulmonary effects of systemic lupus
erythematosus?
Patients with SLE are prone to pleural effusion, pneumonitis, alveolar hemorrhage, and pulmonary hypertension. The end result is a restrictive defect.
What are the airway implications of systemic lupus
erythematosus?
About 1/3 of patients with SLE exhibit cricoarytenoid arthritis and recurrent laryngeal nerve palsy.
A patient with systemic lupus erythematosus takes
corticosteroids and cyclophosphamide. How might
this alter your anesthetic plan?
The patient may require additional corticosteroids during the perioperative period. Because cyclophosphamide inhibits plasma cholinesterase, the effects of ester local anesthetics and succinylcholine may be prolonged.
