Orthopaedics & Rheumatology \ Lupus

Question 1

What is the pathogenesis of systemic lupus erythematosus (SLE)?

Answer 1

• Autoimmune disease in which antibodies are formed to various parts of the cell nucleus

Question 2

What organ systems are most commonly affected in SLE?

Answer 2

• Mucocutaneous (80%-90%)
• musculoskeletal (75%-100%)
• renal
• neurologic
• cardiovascular
• respiratory

Question 3

Which patient population does SLE most commonly affect?

Answer 3

• Women between the ages 15 and 40 years
• female to male ratio is 6-10 to 1

Question 4

What is a common initial presentation of SLE?

Answer 4

• Constitutional symptoms (fatigue, myalgias, fever, weight changes) in combination with skin and musculoskeletal involvement

Question 5

What are the diagnostic criteria for SLE?

Answer 5

Four of the following eleven criteria for diagnosis:

1. Malar rash (butterfly rash)
2. Discoid rash
3. Photosensitivity
4. Oral ulcers
5. Arthritis
6. Serositis
7. Renal disorder
8. Hematologic disorder
9. Immunologic disorder
10. Neurologic disorder
11. Positive antinuclear antibody (ANA)

Question 6

What are the common skin manifestations in SLE?

Answer 6

• Malar rash
• discoid rash
• alopecia
• ulcers in the mouth, nose, or anogenital area

Question 7

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

Answer 7

Malar rash (butterfly rash)

Question 8

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

Answer 8

Discoid rash

Question 9

Which joints does SLE commonly affect?

Answer 9

• Small joints of the hands (PIPs and MCPs)
• wrists,
• knees

Question 10

The World Health Organization’s five-class system to determine the severity of renal disease in lupus nephritis uses what factors?

Answer 10

• Sediment
• amount of proteinuria
• serum creatinine
• blood pressure (BP)
• anti-double stranded DNA (dsDNA) status
• complement levels

Question 11

What lab tests are used to screen for renal involvement in SLE?

Answer 11

• Urine dipstick
• urine microscopic evaluation
• plus or minus a baseline 24-hour urine analysis for protein and creatinine

Question 12

What should be monitored serially to assess renal activity in SLE?

Answer 12

BP and urine protein

Question 13

Autoantibodies in SLE

• present in 100% of people with SLE and therefore used for diagnois

Answer 13

ANA

Question 14

Autoantibodies in SLE

• Highly specific for SLE and associated with lupus nephritis - often used to predict disease flares

Answer 14

Anti-dsDNA

Question 15

Autoantibodies in SLE

• Insensitive but highly specific for SLE diagnois

Answer 15

Anti-Smith antibodies

Question 16

Autoantibodies in SLE

• associated with drug-induced lupus

Answer 16

Antihistone antibodies

Question 17

What medications can cause drug-related lupus?

Answer 17

• Chlorpromazine
• hydralazine
• isoniazid
• methyldopa
• minocycline
• procainamide
• quinidine

Question 18

NSAIDS in SLE

Answer 18

to manage musculoskeletal complaints

Question 19

Corticosteriods in SLE

Answer 19

• topical for cutaneous lesions
• intra-articular for joint manifestations
• oral for systemic disease

Question 20

Antimalarial agents , such as hydroxychloroquine in SLE

Answer 20

Used to manage

• Constitutional symptoms
• skin manifestations
• musculoskeletal complaints

Question 21

Cyclophosphamide in SLE What usually causes early mortality?

Answer 21

Used to manage Renal manifestations

Question 22

What usually causes late mortality in SLE?

Answer 22

Cardiovascular disease