Rheum - MedEd - lupus Flashcards
What type of disease is lupus
Autoimmune and complex formation
Population of lupus
Females, blacks > whites
Which 2 diseases are the great imitators?
Lupus and syphilis
Lupus can effect all organ systems
What are the 11 symptoms associated with lupus? Can use mneumonic…
Need 4... Mneumonic - MDSOAPBRAIN Malar rash - butterfly (spares nasal-labial folds, nose cheek junction) - these are the areas that contact the sun Discoid rash Serositis (pleuritic chest pain) Oral ulcers Arthritis (joint pain - large joints) Photosensitivity (sunburns easily) Blood - anemia, thrombocytopenia Renal failure - lupus nephritis - dangerous, can lead to ESRD ANA positive Immunologic - other serologic positive Neuro - psychosis, cerebritis *can also get endocarditis also early pregnancy losses
What is the gateway antibody to check for in lupus
ANA
ANA is sensitive
*so that means if negative, can rule out rheumatologic/lupus, but not specific for lupus
Lupus - is there a confirmatory test?
No - no biopsy
But there are serologies that are more specific
Which serologies are more specific for lupus?
dsDNA - lupus nephritis
anti-smith
anti-histone - drug induced lupus
When diagnosis of lupus has been made, what are screening tests to do?
Nephritis - urinalysis and urine micro
Inflammation - ESR, CRP
Immune mediated - C3 and C4 (complement) levels - complements will be low in lupus flare (if C3 and C4 are not low when patient with lupus feels sick… probably not lupus flare but an infection)
Treatment options for lupus
Everyone gets: hydroxychloroquine - reduces number of flares
Steroids should be avoided - but can be used during lupus flares and first diagnosis of lupus
Optional: IV cyclophosphamide, oral methylphenidate/mycophenolate mofetil (both can be used for lupus nephritis)
*If there is a flare, use high doses and large guns - then scale back when in remission
What are the 3 targets of lupus flares?
Lupus flare - to remission
Inflammation
Lupus nephritis
What is the pathophys of drug-induced lupus
Anti-histone antibody
Presentation of drug-induced lupus?
Medication
Rash - photosensitivity
Pain - serositis, arthritis
*Things that kill - cerebritis and nephritis, don’t happen here
Diagnosis of drug-induced lupus?
Anti-histone antibody
Treatment of drug-induced lupus?
Remove offending agent
- Hydralazine!
- Drug-induced lupus is not life threatening
What are common drugs in drug-induced lupus?
Hydralazine (main one)
Procainamide
Methyldopa
