Rheum Sle

Question 1

Etiology of sle. Tip: divide by environmental, genetic and hormonal

Answer 1

Environment: uv radiation, cigarette smoke, silica exposure, drugs such as procainamide and hydralazine

Hormonal: hyperestrogenic states ie ocp use, endometriosis, postmenopausal hormone therapy

Genetic: hla dr2 and hla dr3 commonly present in individuals with sle

Question 2

Describe how a type 3 hypersensitivity reaction may lead to sle

Answer 2

Autoimmune

Environmental factors may aid in exposed genetic material leads to antibody antigen complexes being formed and travels in circulation and attaches to skin and organs leads to activation of complement system and subsequent inflammation leads to damage to organs they originally attached

Question 3

Describe how type 2 hypersensitivity reaction may happen in sle

Answer 3

Antibodies IGg and igm formed against antigens on cells such as red blood cells and white blood cells leading to anemia thrombocytopenia and leukocytosis

Question 4

What is the cornerstone of pharmocotherapy of sle

Answer 4

Hyroxychloroquine

Question 5

With severe disease and multi organ damage how is pharmacy treatment approached

Answer 5

Hydroxychloroquine for all patients regardless of severity

For severe they are given as well high dose glucocorticoids and other immunosuppressive agents

Question 6

How can medications induced side effects be prevented

Answer 6

Hydroxychloroquine: ophthal screening

Glucocorticoids: assess for defections

Offer influenza and pneumococcus immunization

Question 7

What are the clinical features of lupus nephritis

Answer 7

Hypertension
Edema
Hematuria

Manifests with nephrotic/nephritic syndrome

Question 8

Pharmacological treatment of lupus nephritis

Answer 8

Regular lupus treatment

Plus iv glucocorticoids (methylpresdnisolone)
Plus other immunosuprresant like cyclophosphamide

Question 9

How may one confirm the presence of lupus nephritis

Answer 9

Kidney biopsy

Shows unexplained increase in creatinine
Proteinuria more than 1g/g
Proteinuria more than .5g/g and hematuria or cell casts

Question 10

Describe Ana anti smith and anti double strand dna in terms of specificity and sensitivity for sle

Answer 10

Ana sensitive but not very specific

Anti smith not very sensitive but very specific

Anti dsdna sensitive (not as much as ana) but much more specific