Lupus Flashcards
Key Points:
•Disease is much more common in ?.
•Lupus can virtually affect ? organ.
•Arthritis symptoms are usually symmetrical and ?.
•Diagnosis is based on ? combined with ? testing.
•Disease progression is based on ? predisposition combined with triggers occurring over a lifetime.
•Treatment focuses predominantly on 3 things???
Key Points:
•Disease is much more common in women.
•Lupus can virtually affect every organ.
•Arthritis symptoms are usually symmetrical and migratory.
•Diagnosis is based on clinical symptoms combined with lab testing.
•Disease progression is based on genetic predisposition combined with triggers occurring over a lifetime.
•Treatment focuses predominantly on reducing triggers, balancing hormones, and eradicating viral and bacterial infections.
Epidemiology:
•MUCH more common in ?
•Onset is usually between ? – ? years
•The use of ? and ? increases the risk of developing lupus.
•? disease is associated with an increase risk of developing lupus
Epidemiology:
•MUCH more common in women (10x more likely than men)
•Onset is usually between 16 – 55 years
•The use of OCP and HRT increases the risk of developing lupus.
•Celiac disease is associated with an increase risk of developing lupus
Etiology:
The etiology of SLE is for the most part ?
Genetic component:
•#? gene loci with polymorphisms have been associated with SLE
•Genetics account for only ?% of susceptibility to SLE
•SLE requires a combination of genetic influences to increase risk.
Hormonal Component:
•Decrease in ?3?.
•Increase in ? and ?
Environmental Triggers:
•?4?
Etiology:
The etiology of SLE is for the most part unknown
Genetic component:
•50 gene loci with polymorphisms have been associated with SLE
•Genetics account for only 18% of susceptibility to SLE
•SLE requires a combination of genetic influences to increase risk.
Hormonal Component:
•Decrease in testosterone, progesterone and DHEA
•Increase in estradiol and prolactin
•Environmental Triggers
•Viruses, UV light, silica dust, medications
Clinical Features:
•Raynaud’s phenomenon
Lupus symptoms vary and can affect virtually every organ
- Constitutional symptoms – 4?
- Joint involvement – migratory symmetrical arthritis, usually in the ?.
- Skin lesions – 2?
- Renal – 1?; (periodic urinalysis should be done routinely)
- GI symptoms – 5?
- Pulmonary – 3?
- Cardiac – 2?
- Neuro – 5?
- EENT – 3?
- Blood – 4?
Clinical Features:
Lupus symptoms vary and can affect virtually every organ
- Constitutional symptoms – fatigue, myalgia, weight loss, fever
- Joint involvement – migratory symmetrical arthritis, usually in the hands.
- Skin lesions – erythematous malar rash (butterfly rash), photosensitivity
- Renal – lupus nephritis; periodic urinalysis should be done routinely
- GI symptoms – gastritis, peptic ulcer, pancreatitis, peritonitis, colitis
- Pulmonary – pleurisy, pneumonitis, pulmonary hypertension
- Cardiac – endocarditis, pericarditis
- Neuro – cognitive changes, psychosis, seizures, headache, peripheral neuropathies.
- EENT – keratoconjunctivitis sicca (dry eyes); oral or nasopharyneal lesions
- Blood – leukopenia, anemia, thrombophilia (increased risk of embolism), lymphadenopathy
- Raynaud’s phenomenon
Triggers: 8
Triggers: •Current smoker •Sun exposure (UV light) •Infections •EBV, CMV, parvovirus, HPV, retroviruses •Stress •Surgery or mechanical trauma •Hormonal fluctuations (postpartum) •Environmental triggers: silica, mercury, agricultural pesticides
Laboratory Testing:
Tests that support a diagnosis of SLE if abnormal:
- Anti nuclear antibodies (ANA) – ?
- Anti-dsDNA and Anti-Sm – ?
Antiphospholipid antibodies
•C3 and C4 or CH50 complement levels - ?
•ESR/CRP - ?
•Urine protein/creatinine ratio - ?
Laboratory Testing:
Tests that support a diagnosis of SLE if abnormal:
- Anti nuclear antibodies (ANA) – positive
- Anti-dsDNA and Anti-Sm – highly specific
- Anti-Ro/SSA and Anti-La (SSB) – more associated with Sjögren’s
- Anti-U1 RNP antibodies – more associated with MCTD
- Antiribosomal P protein antibodies
- Antiphospholipid antibodies
- C3 and C4 or CH50 complement levels - decreased
- ESR/CRP - elevated
- Urine protein/creatinine ratio - elevated
Follow-Up Testing:
The following tests should be monitor lupus complications
CBC:
-Rule out.. 3?
Chem Panel:
-? – assess renal dysfunction
Urinalysis – Important!
-Assess for 3?
X-ray, CT, MRI, Ultrasound
-Only used to assess for other organ abnormalities (lungs, kidney, cardiac, GI, joints)
Follow-Up Testing:
The following tests should be monitor lupus complications
CBC:
-Rule out leukopenia, anemia, thrombocytosis
Chem Panel:
-Creatinine – assess renal dysfunction
Urinalysis – Important!
-Assess for hematuria, proteinuria or casts
X-ray, CT, MRI, Ultrasound
-Only used to assess for other organ abnormalities (lungs, kidney, cardiac, GI, joints)
Poor Prognosis: 7?
Poor Prognosis:
- Renal disease – occurs in 30% of those with SLE
- Hypertension
- Male
- Young age
- Presence of anti-phospholipid antibodies
- Severe disease activity
- Poor socioeconomic status
Dietary Modifications: •Modifications for dysbiosis: 2? •Anti-inflammatory diet – 4? •Elimination of food allergens- 1? •Short-term ?
Dietary Modifications:
•Modifications for dysbiosis: low carbohydrate, low sugar
•Anti-inflammatory diet – reduction in red meat, dairy, sugar, carbohydrates.
•Elimination of food allergens
•Gluten
•Short-term fasting
Hormones:
•Prolactin – ?
•Estrogen (Estradiol) – ?
•Cortisol14 – usually ?
•Testosterone – usually ?
•Men with SLE often have ? testosterone
•DHEA – usually ?
•Thyroid hormone – usually ?- Cortisol14 – usually decreased
- Testosterone – usually decreased
- Men with SLE often have low testosterone
- DHEA – usually decreased
- Thyroid hormone – usually decreased
- EBV antigens are similar to SLE antigens and EBV viral load is often higher in patients with ?
- SLE patients also have high titers of antibodies to endogenous ?
- Other viruses that may be associated with SLE: 2?
- Monolaurin – Antiviral properties against ?
- Reishi –(Ganoderma lucidum) – 2-6g of raw reishi or equivalent of concentrated extract.
- EBV antigens are similar to SLE antigens and EBV viral load is often higher in patients with SLE1,2.
- SLE patients also have high titers of antibodies to endogenous retroviruses3.’
- Other viruses that may be associated with SLE: CMV, HPV
- Monolaurin – Antiviral properties against CMV – 600mg TID
- Reishi –(Ganoderma lucidum) – 2-6g of raw reishi or equivalent of concentrated extract.
Dysbiosis:
Responses to bacterial DNA can trigger cross-reactivity to human DNA.
•Antimicrobial agents: 3?
Dysbiosis:
Responses to bacterial DNA can trigger cross-reactivity to human DNA.
•Antimicrobial agents: 3?
Vitamin D:
•At lease ?% of patients with lupus are Vitamin D deficient.
•Vitamin D supports normal ? function, is ? and ?
Vitamin D:
•At lease 50% of patients with lupus are Vitamin D deficient
•Vitamin D supports normal immune function, is anti-inflammatory and analgesic
Additional Treatments:
Avoid 1???
Additional Treatments:
1. •CoQ10 – 100mg BID
•Lowers blood pressure and is renoprotective
2 •Essential Fatty Acids – 3 – 6g EPA+DHA per day
•Well proven anti-inflammatory benefits in SLE
3. •Harpagophytum procumbens – 60mg harpagosides per day
•May be effective for relieving musculoskeletal pain
4 •Boswellia serrata
•Inhibits 5-lipoxygenase – anti-inflammatory and analgesic
5. •Sunscreen!
•Avoid Echinacea – May provoke flares in lupus nephritis
