Lupus Flashcards
What is the pathophysiology behind lupus?
There are formation of immune complexes against a variety of autoantigens. These are then not able to be cleared and result in host immune responses that cause inflammation and damage
What are the features of lupus?
General features: -Fatigue -Fever -Mouth Ulcers -Lymphadenopathy Skin: -Butterfly rash - spares nasolabial folds -Discoid rash - in sun exposed areas -photosensitivity -raynaud's Musculoskeletal: -Arthralgia -Non edoding arthritis Cardiovascular: -Pericarditis -Myocarditis Respiratory: -Pleurisy -Fibrosing alveolitis Renal: -Proteinuria -Glomerulonephritis Neuro: -psychosis -seizures
What are the three best tests used for monitoring lupus?
Anti double stranded DNA titres
Complement - rate of consumption by measuring C3 and C4 levels
ESR - during characteristic disease CRP is normal and ESR is raised
What autoantibody is seen in drug induced lupus?
There is anti-histone antibody
How is lupus managed?
General measures:
-High factor sun block
-Hydroxychloroquine - reduces disease activity
Maintenance:
-NSAIDs unless renal disease and hydroxychloroquine for joint symptoms
-Azathioprine and methotrexate as steroid sparing agents
Mild flares - hydroxychloroquine and stroids
Moderate flares - DMARDs
Sever flares - if life or organ threatening e.g. haemolytic anaemia give urgent high dose stroids, micphenolate, rituximab and cyclophosphomide
How is lupus nephritis treated?
treat hypertension
corticosteroids if clinical evidence of disease
immunosuppressants e.g. azathiopine/cyclophosphamide
What is antiphospholipid syndrome? What are the features?
This can be assocaited with SLE or as its own disease antiphospholipid (anticardiolipin) antibodies Features CLOTS: -Coagulation defect -Livedo reticularis -Obstetric (recurrent miscarriage -Thrombocytopenia Paradoxial increase in APTT
What is the management of antiphospholipid syndrome?
With anticoagulation and advice in pregnancy
