Lupus and AS

Question 1

What is the main culprit of SLE?

Answer 1

auto-antibody production

Question 2

What organ does SLE target?

Answer 2

All organs; multi system inflammatory disease

Question 3

Triggers of SLE?

Answer 3

genetics
hormones
Viral Infections
UV exposure
Smoking
Stress
Drug-induced

Question 4

Main drugs that can trigger SLE?

Answer 4

Procainamide
Hydralazine
Quinidine
Isoniazid
Chlorpromazine
Minocycline
TNF-inhibtors

Question 5

When does drug-induced lupus develop?

Answer 5

within weeks to years after starting agent

Question 6

Does drug induced lupus go away when d/c offending drug?

Answer 6

Yes, slowly resolves

Question 7

Gender more prevalent for SLE?

Answer 7

women

Question 8

Ethnicity’s more common for SLE?

Answer 8

african
asian
hispanic

Question 9

4 main symptoms seen in almost all SLE pts?

Answer 9

fatigue
fever
myalgia
wt fluctuations

Question 10

Malar rash characteristics?

Answer 10

acute onset, lasting hours to days

Question 11

Discoid rash?

Answer 11

occurs anywhere above the waist, aggravated by UV light

Question 12

What are other common dermatologic manifestations of SLE besides malar and discoid rashes?

Answer 12

nasal and mouth ulcers

Question 13

Musculoskeletal maifestations of SLE?

Answer 13

arthritis
osteonecrosis
osteoporosis
fractures
myalgia
weakness
atrophy
fibromyalgia

Question 14

Renal manifestations of SLE?

Answer 14

proteinuria
hematuria
pyuria
glomerular nephritis
can lead to renal fibrosis and necrosis

Question 15

Pulmonary manifestations of SLE?

Answer 15

pleurisy, coughing, and dyspnea to start. progresses to:
pneumonitis
interstitial lung disease
pulmonary HTN
shrinking lung syndrome
Alveolar hemorrhage

Question 16

Neurologic manifestations of SLE?

Answer 16

depression, anxiety and mania common
acute psychosis
general cognitive dysfunction
seizure disorders
neuropathies
movement disorders
stroke

Question 17

CV manifestations of SLE?

Answer 17

pericarditis
valvular disorders
conduction abnormalities
increased risk of CAD and HTN

Question 18

Vascular manifestations of SLE?

Answer 18

raynaud phenomenon
vasculitis
thromboembolic disease risk increased

Question 19

GI manifestations of SLE?

Answer 19

esophagitis
intestinal obstruction
pancreatitis
peptic ulcer disease

Question 20

What is the major cause of GI manifestations of SLE?

Answer 20

adverse medication reactions + acute illness

Question 21

How is SLE diagnosed?

Answer 21

When 4 or more of ____ are present:
malar rash
discoid rash
renal disorder
neurologic disorder
hematologic disorder
anti-nuclear antibodies
photosensitivity
oral ulcers
arthritis
serositis
immunologic disorder

Question 22

Who has worse outcomes of SLE?

Answer 22

severe flares
severe organ involvement
renal disease
very young/old onset
male
antiphospholipid antibody syndrome

Question 23

What is SLE’s mortality rate compared to general population?

Answer 23

2-3x higher

Question 24

what % of SLE pts live normal life spans?

Answer 24

80-90

Question 25

Treatment goals for SLE?

Answer 25

relieve acute symptoms
prevent chronic complications
treat secondary issues that may arise

Question 26

Non-pharm treatment of SLE?

Answer 26

diet
avoid prolonged UV exposure
- SPF >50 suggested
- Avoid photosensitizing drugs
- Vit D supplements
Exercise
Smoking cessation

Question 27

Preventative treatment of SLE?

Answer 27

immunization
treat comorbities:
- HTN
- Atherosclerosis
- Antiphospholipid syndrome
- Osteopenia/porosis
- Monitor/ maintain renal health

Question 28

Mild SLE treatment?

Answer 28

Hydroxychloroquine***
Oral steroids
topical corticosteroids
NSAIDs or Acet
Combinations of above

Question 29

Severe SLE steroid treatment?

Answer 29

high dose;
Pred 50-100mg daily for flares
chronic low dose pred 1-5mg a day may be used
IV pulse therapy of methylprednisolone 1000mg IV x 3 doses
–> effective but toxicity concerns

Question 30

Severe SLE immunosupressive treatments?

Answer 30

Azathioprine
Cyclophosphamide
Methotrexate
Cyclosporine
Mycophenolate

Question 31

Severe SLE biologics treatments?

Answer 31

B-cell depletion
Anti-TNF
Anti-B lymphocyte stimulator protein
Anti-IL10 therapy
Anti-complement therapy

Question 32

Raynaud treatment?

Answer 32

DHP-CCBs
PDE-5i
Nitroglycerin
Vasodilators

Question 33

What is ankylosing spondylitis (AS)?

Answer 33

chronic inflammatory auto-immune rheumatic disease primarily affecting sacroiliac joints and spine

Question 34

AS more common gender?

Answer 34

male

Question 35

First-line for pharm AS treatment?

Answer 35

NSAIDs

Question 36

Steroids good option in AS?

Answer 36

No, little to no benefit

Question 37

What DMARD has some efficacy in AS?

Answer 37

sulfasalazine