Lupus Flashcards
Epidemiology
Affects women of child-bearing age. more severe in African americans
Etiology
Four genes required for development of SLE.
5% cases are familial
Environmental triggers such as sunlight, chemicals, diet, hormones, EBV
Pathophysiology
Triggering agents induce a response resulting in overproduction of autoantibodies.
Clinical manifestations
First symptoms appear after 3 years of formation of autoantibodies.
fever, malasise, arthralgia, fatigue, anorexia, weight loss, butterfly rash
Non-pharmacological therapy
Smoking cessation, limit sunlight, balance of rest and exercise for fatigue
What medications can induce lupus?
hydralazine, procainamide
chlorpromazine, isoniazid, methyldopa, minocycline, quinidine
What are the major differences between lupus and drug-induced lupus?
Drug-induced: anti-ssDNA, no prior history, rapid improvement after drug is d/c
most commonly musculoskeletal symptom
Describe the immunological response.
Hyperactivity of B lymphocytes. autoantibodies against nuclear, cytoplasmic, and surface components of various cells.
Loss of immune self-tolerance.
High antigenic load of environmental and self-antigens
What systems are involved with lupus?
Constitutional Musculoskeletal Skin Renal Gastrointestinal Pulmonary Cardiac reticuloendothelial hematologic neuropsychiatric
What are some lab findings?
ANA antinuclear antibodies (dsDNA)
aPL antiphospholipid antibodies
What are the requirements for diagnosis?
involvement of 2 organ systems
4 or more of classification criteria
What are the classification criteria?
malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, renal disorder, neurological, hematologic, immunologic, ANA titer
What are the goals of therapy?
manage symptoms and induce remission
maintain remission for the longest possible duration
What drugs are appropriate for mild SLE?
non-life threatening organ involvement
NSAIDS, antimalarials, low-dose glucocorticoids
What drugs are appropriate for severe SLE?
Life threatening (renal, cardiopulmonary, hematologic, cns) high-dose glucocorticoids, cytotoxic
