Orthopaedics & Rheumatology \ Lupus Flashcards
What is the pathogenesis of systemic lupus erythematosus (SLE)?
- Autoimmune disease in which antibodies are formed to various parts of the cell nucleus
What organ systems are most commonly affected in SLE?
- Mucocutaneous (80%-90%)
- musculoskeletal (75%-100%)
- renal
- neurologic
- cardiovascular
- respiratory
Which patient population does SLE most commonly affect?
- Women between the ages 15 and 40 years
- female to male ratio is 6-10 to 1
What is a common initial presentation of SLE?
- Constitutional symptoms (fatigue, myalgias, fever, weight changes) in combination with skin and musculoskeletal involvement
What are the diagnostic criteria for SLE?
Four of the following eleven criteria for diagnosis:
- Malar rash (butterfly rash)
- Discoid rash
- Photosensitivity
- Oral ulcers
- Arthritis
- Serositis
- Renal disorder
- Hematologic disorder
- Immunologic disorder
- Neurologic disorder
- Positive antinuclear antibody (ANA)
What are the common skin manifestations in SLE?
- Malar rash
- discoid rash
- alopecia
- ulcers in the mouth, nose, or anogenital area
Name the following skin manifestation of SLE
Acute erythematous, edematous eruption over the bridge of the nose and onto the cheeks often brought on by exposure to sunlight
Malar rash (butterfly rash)
Name the following skin manfestation of SLE
Chronic, erythematous, discrete plaques involving the face, ears, neck, and scalp; may have scaling and involve the follicles
Discoid rash
Which joints does SLE commonly affect?
- Small joints of the hands (PIPs and MCPs)
- wrists,
- knees
The World Health Organization’s five-class system to determine the severity of renal disease in lupus nephritis uses what factors?
- Sediment
- amount of proteinuria
- serum creatinine
- blood pressure (BP)
- anti-double stranded DNA (dsDNA) status
- complement levels
What lab tests are used to screen for renal involvement in SLE?
- Urine dipstick
- urine microscopic evaluation
- plus or minus a baseline 24-hour urine analysis for protein and creatinine
What should be monitored serially to assess renal activity in SLE?
BP and urine protein
Autoantibodies in SLE
- present in 100% of people with SLE and therefore used for diagnois
ANA
Autoantibodies in SLE
- Highly specific for SLE and associated with lupus nephritis - often used to predict disease flares
Anti-dsDNA
Autoantibodies in SLE
- Insensitive but highly specific for SLE diagnois
Anti-Smith antibodies
Autoantibodies in SLE
- associated with drug-induced lupus
Antihistone antibodies
What medications can cause drug-related lupus?
- Chlorpromazine
- hydralazine
- isoniazid
- methyldopa
- minocycline
- procainamide
- quinidine
NSAIDS in SLE
to manage musculoskeletal complaints
Corticosteriods in SLE
- topical for cutaneous lesions
- intra-articular for joint manifestations
- oral for systemic disease
Antimalarial agents , such as hydroxychloroquine in SLE
Used to manage
- Constitutional symptoms
- skin manifestations
- musculoskeletal complaints
Cyclophosphamide in SLE What usually causes early mortality?
Used to manage Renal manifestations
What usually causes late mortality in SLE?
Cardiovascular disease
