Lupus Erythematosus Flashcards
What is Lupus?
An multisystem autoimmune disease characterised by flares and remissions.
Inadequate T cell suppressor activity with increased B cell activity
What are the common symptoms and signs of Lupus?
A RASH POINts Medical Diagnosis
ANA positive
Renal involvement - glomerulonephritis
Arthritis
Serositis (pleurisy or pericarditis)
Haemotological disorder
Photosensitivity
Oral ulcers
Inappropriate immune response
Neurological involvement - seizures or psychosis
Malar rash
Discoid rash
In what kind of individuals is Lupus Erythematosus most prevalent?
African-Carribeans
Asians
HLAB8, DR2 or DR3 +ve
What autoantibodies can be positive in a patient with Lupus?
ANA+ve - >95% patients
DsDNA antibody - 60%
ENA (Anti-Ro, anti-La, anti Sm, anti-RNP)
RhF+ve - 40%
Antiphospholipid antibodies
What are the three best tests for monitoring activity of Lupus?
1) Anti-dsDNA
2) Complement - low C3 and C4 indicates high disease activity
3) ESR
Important to note that CRP is usually normal
Name some causes of drug induced Lupus?
Isoniazide
Anti-TNF’s
Hydralazine
Phenytoin
Sulfonamides or the OCP can exacerbate idiopathic Lupus
What is the first line Pharmacological management for Lupus?
Hydroxychloroquine or low dose steroids can be used for mild flares.
High factor sun screen
Topical steroids for any dermatological manifestations
What Pharmacological management can be issued for maintenance?
Hydroxychloroquine and NSAID’s for joint and skin symptoms.
Azathioprine, Methotrexate and Mycophenylate can be used as steroid sparing agents and for moderate flares which means there is organ involvement.
Belimumab can be used for high disease activity.
How can a severe flare of Lupus Erthematosus be described?
If the Lupus is causing a threat to the organs and/or to life.
Eg. Haemolytic anaemia, nephritis, pericarditis or CNS disease
How would you treat a severe flare of Lupus?
High dose steroids
Mycophenolate
Rituximab
Cyclophosphamide
How would you manage Lupus Nephritis?
This may need more aggressive treatment with high dose corticosteroids and Mycophenolate or Cyclophosphamide.
BP control with ACE-i.
Renal replacement therapy may be indicated
Renal transplant - 50% recurrence post-transplant.
How does Anti-phospholipid syndrome present?
“CLOTS”
C - Coagulation defect
L - Livedo Reticularis
O - Obstetric (recurrent miscarriage)
T - Thrombocytopaenia
