Rheumatology Flashcards
What are 3 long term complications of JIA
uveitis flexion contracture leg length discrepancy of involved leg joint erosions muscle wasting growth disturbances delay of motor development malalignment of joints TMJ disease
what are the criteria for Kawasaki disease
fever >5 days and 4/5 of:
C- conjunctivitis (bilateral, non exudative)
R- rash (polymorphous)
A- adenopathy (>1.5cm)
S- skin changes (fissured lips, strawberry tongue)
H- hands and feet (edema, erythema) and perineal (erythema/peeling)
typical age 3 mon- 5 years
what do we worry about for familial Mediterranean fever? what is the treatment?
amyloidosis, especially renal amyloidosis
tx: colchicine
what rash is seen with dermatomyositis? what type of weakness? what nail changes? nodules?
heliotrope rash over the eyelids (purple)
gottron’s papules (dorsal surface of the knuckles)
symmetric proximal weakness
can get nailfold changes- drop out, dilatation, tuortuosity
calcinosis- calcium nodules
what 3 investigations would you do for dermatomyositis? Tx?
EMG- denervation and myopathy
muscle biopsy- necrosis and inflammation
lab work ( elevated CK, AST, LDH, aldolase)
MRI-can help identify muscle inflammation
Tx: corticosteroids
what are 2 renal complications associated with lupus?
HTN Proteinuria edema renal failure hematuria nephrotic syndrome
what are the criteria for rheumatic fever?
2 major or 1 major and 2 minor with evidence of GAS infection (positive throat culture or elevated or rising ASOT) J- joints (migratory arthritis) O- carditis N- nodules (subcutaneous) E- erythema marginatum S- syndenham's chorea
Minor: arthralgia, fever, ESR, CRP, prolonged PR
what are the 7 types of JIA
Age <16 and persists for > 6 weeks
- oligo
- polyarticular RF +
- polyarticular RF -
- systemic JIA
- enthesitis related arthritis
- psoriatic arthritis
- undifferentiated arthritis
what is the definition of arthritis
joint swelling/ effusion
OR
limited ROM with joint line tenderness or painful ROM
what is the most common type of JIA
-most frequent joints involved? (4)
oligoarthritis
- most frequent joints involved:
1. Knees
2. Ankles
3. Wrists
4. Elbows
what are the two types of oligoarthritis
persistent oligoarthritis- <4 joints
extended oligoarthritis- >4 joints after first 6 months
what increases risk of uveitis with oligoarticular JIA (4) and what is the treatment for uveitis?
ANA positive young onset age girls oligoarticular JIA tx: topical steroids
What causes neonatal lupus? why do we worry about neonatal lupus?
maternal autoantibodies anti- ro and la
worry about 3rd degree heart block
what is the treatment for Kawasaki disease?
acute phase:
IVIG x 2 (if poor response to first dose)
steroids for persistent symptoms unresponsive to IVIG x2, symptomatic myocarditis
regular dose ASA
subacute phase:
low dose ASA
echo surveillance in acute phase and at 6 weeks
uveitis in JIA is most common with what type?
oligoarthritis
associated with positive ANA
usually ASYMPTOMATIC
what type of JIA is associated with symptomatic uveitis
enthesitis related arthritis
what are 4 complications of uveitis
synechiae- irregular pupil
glaucoma
cataract
visual loss
what can be seen on x ray with JIA
acceleration of growth acceleration of maturation growth inhibition osteoporosis erosions loss of cartilage
what can be seen on MRI with JIA
bone marrow edema
erosions
synovitis
cartilage
what is required for systemic JIA
2 weeks of fever arthritis and at least one of: - rash (evanescent, salmon coloured) - generalized lymphadenopathy - hepatosplenomegaly - serositis
what lab findings are associated with MAS? on bone marrow?
massive release of pro inflammatory cytokines
accumulation of macrophages in liver, spleen, LN and CNS
elevated ferritin elevated lipids elevated CRP decreased ESR elevated d-dimer decreased fibrinogen
on bone marrow- hemophagocytosis
what is the treatment for oligo JIA? poly JIA? systemic JIA
oligo-NSAIDS, joint injection
poly-NSAIDS then MTX and/or SSZ, Biologic
systemic- NSAIDS then corticosteroids and/or MTX then biologic (often tx now with anti IL-1 or anti IL-6 first)
can live vaccines be given with MTX and biologics??
NO!
what antibiotic cannot be given with MTX except in prolyphactic dosing?
sulpha antibiotics
what is the treatment for rheumatic fever?
penicillin x 10 days
ASA/NSAIDS for arthritis
ASA/steroids for carditis
without carditis: prophylactic penicillin for at least 5 years or until 21 years
with carditis: up to 21 yo or 10 years post attack
residual heart disease: up to age 40 or 10 years post initial attack (essentially life long)
what is the most common vital organ involvement in SLE?
kidney- glomerulonephritis
what are the indications for testing for APS
thrombosis
SLE yearly
unexplained PTT prolong
clinical features of APS
what is the treatment for HSP?
supportive
NSAIDs
systemic steroids- considered if severe abdominal pain, severe renal disease
what are the criteria for HSP
palpable purpura with lower limb predominance and without thrombocytopenia or coagulopathy and at least 1 of the following
●Abdominal pain (usually diffuse, with acute onset)- can see intusseception
●Arthritis or arthralgia (acute onset)
●Renal involvement (proteinuria, hematuria)
●Leukocytoclastic vasculitis or proliferative glomerulonephritis, with predominant IgA deposition
recurrences common in approx 30% in the first 1-2 months
what investigation is typically done before treating someone with systemic JIA
bone marrow aspirate
what are the characteristics of growing pains
age 3-10 years bilateral leg pain occurs at night no interference with activities normal physical exam normal lab tests (if done)
what is the common cause of hip pain age 2-6
transient synovitis
- may follow viral infection
what is the common cause of hip pain age 4-10
legg calves perthes
what is the common cause of hip pain age 10-14
slipped capital femoral epiphysis
= SURGICAL EMERGENCY
No weight bearing until pinned
what is complex regional pain syndrome? treatment?
girls» boys
may follow trauma
very painful, tender extremity
autonomic changes (cool, sweaty, swollen, discoloration)
two types: no nerve lesion versus definable nerve lesion
treatment: physio, psychotherapy, pharmacotherapy
peak age for oligo? common joints?
peak age 1-3
girls>boys
affects large joints (knee most common- also ankles, wrists, elbows)
How often do we screen for uveitis for oligo
age of onset of arthritis <6 and ANA +: every 3 months initially then every 6 months
age of onset >6 and ANA +: every 6 months
what joints are affected with RF-neg polyarticular JIA
small and large joints
TMJs
what are the characteristics of RF positive polyarticular JIA
teenage girls
symmetrical small and large joint arthritis
rheumatoid nodules over pressure points in 30%
ANA may be positive
worse prognosis with erosive disease
what are the characteristics of enthesitis related arthritis
arthritis and enthesitis older boys >> girls lower limb arthritis sacroilitis family history HLA-B27 positive
enthesitis related arthritis may be associated with what 3 things
IBD
psoriasis
symptomatic uveitis
dactylitis is associated with what type of arthritis?
psoriatic arthritis
what are the characteristics of systemic JIA
fever (x 2 weeks for diagnosis)- must be 3d in a row over the 2 weeks
rash
arthritis- may be delayed*
hepatosplenomegaly
lymphadenopathy
serositis
lab work: anemia, high ESR, CRP, platelets
what type of fever is seen with systemic JIA
quotidian, daily, predictable (every night or morning and night)
what type of rash is seen with systemic JIA
evanescent- salmon colored rash
what are the clinical features of MAS
persistent fever hepatosplenomegaly lymphadenopathy hermorrhagic skin rash CNS dysfunction
what lab findings are associated with MAS
cytopenias hypofibrinogenemia transaminitis coagulopathy hypertriglyceridemia marked increase ferritin increase CRP decreased ESR low NK cell function high CD 25
what 3 rheumatic conditions are associated with MAS
SLE
systemic JIA
kawasaki disease
what are the treatment options for MAS
high dose corticosteroids IVIG cyclosporine etoposide ATG IL-1 inhibition
what side effects are associated with MTX
nausea
oral ulcers (typically do not get because they are also on folic acid)
hepatotoxicity
leukopenia
infection
pulmonary toxicity
adolescents- try to avoid EtOH entirely, contraception required if sexually active
what must you rule out before starting anti-TNF agents?
TB!
what antibodies are highly specific for SLE
anti-ds DNA
anti-sm
what is highly sensitive for lupus?
ANA- sensitive
>95% of patients with lupus are ANA +
antiphospholipid antibody syndrome is associated with what? causes what 2 things?
associated with lupus
causes arterial and venous thrombosis
what are the 2 types of lupus nephritis
mesagnial lupus nephritis
focal lupus nephritis
diffuse lupus nephritis
what do we monitor on labs for lupus
complement
ANA, anti-DNA antibodies
ESR- may reflect overall disease activity
CBC: anemia, thrombocytopenia and lymphopenia
* high CRP often suggests infection, serositis or MAS
what is the treatment for lupus
mild disease:
NSAIDS
plaquenil
low dose steroids
severe disease:
high dose steroids, immunosuppressive therapy (cyclophosphamide, rituximab etc)
what drugs can trigger drug-induced lupus?
anticonvulsants, minocycline, hydralazine, anti-TNF
tx: stop the drug
what are the 3 D’s associated with dermatomyositis affecting smooth muscle
dysphagia- difficulty swallowing
dysphonia- nasal speech
dyspnea- respiratory failure with severe weakness
what is the treatment of dermatomyositis
steroids
- pulse steroids
- MTX
- IVIG for more severe weakness
what should be monitored for HSP for 6 months min?
BP
urinalysis
what lab features are associated with kawasaki disease
neutrophilic leukocytosis anemia thrombocytosis (day 7+), occ thrombocytopenia elevated ESR, CRP elevated transaminases hypoalbuminemia* sterile pyuria
what are the two main risk factors associated with developing coronary aneurysms from kawasaki disease
age <1*and >9
prolonged fever*
what are other manifestations of kawasaki disease
aseptic meningitis anterior uveitis oligo-or polyarthritis hydrops of the gallbladder meatitis and dysuria diarrhea in approx 25% peeling in the perineal area
what is the main cardiac complication associated with kawasaki disease?
coronary artery dilation coronary artery aneurysms also associated with: myocardial infarction myocarditis pericarditis valvular dysfunction arrhythmias
what does PFAPA stand for? what is the typical history?
periodic fever, apthous stomatitis, pharyngitis, adenitis
onset <5years (self limiting within 5 years)
fever every 3-6 weeks, regular recurrence
fever typically lasts 5 days
associated with apthous stomatitis and or pharyngitis (strep swab -ve)
completely well between episodes
no genetic or ethnic associations!!
tx: single dose prednisone
what are the clinical features of FMF
*fever + serositis!
most common hereditary autoinflammatory disease
AR
fever episodes present age <20 short duration of fever <72h, irregular associated with serositis (peritonitis>pleuritis? pericarditis) erysipeloid erythema arthralgia>arthritis mylagia orchitis (5%) lack of eye involvement
what are the cardinal features of a joint infection
redness
fever
swelling
pain and tenderness
what is the joint position for joint infection
abduction
external rotation
what are the most common causes of septic joint
staph and strep
also get gram neg bacteria- meningococcus, kingella
what are the kocher criteria
unable to weight bear
fever >38.5
wbc greater than 12000
elevated inflammatory markers (ESR >40, CRP >20)
helps differentiate transient synovitis from septic arhtritis
what rash is seen with lyme disease?
erythema migrans
what two infections can mimic monoarthrtitis
TB Lyme disease (borrelia burgdorferi)- tx: amoxicillin or doxycycline if >10 yrs or ceftriaxone for disseminated
boy with slapped cheek rash and arthritis
parvovirus arthritis
Ddx erythema nodosum (6)
Group A strep TB Sarcoidosis IBD OCP SLE
what type of anemia is seen with lupus?
autoimmune hemolytic anemia
anti ro/la is associated with what 3 conditions
neonatal lupus
sjogren
SLE
c ANCA
wegener granulomatosis
p ANCA
microscopic polyangitis UC PSC SLE Churg-Strauss syndrome (EGPA)
Associations with HLAB27 (5)
ankylosing spondylitis JIA enthesitis related, psoriatic IBD reactive arthritis isolated acute anterior uveitis
general definition of JIA
arthritis of unknown ethology that begins before 16th birthday and lasts more than 6 weeks
definition of oligoarthrtitis
arthritis affecting 1-4 joints during the first 6 months
what is the major complication of systemic JIA
Macrophage activation syndrome
what is the criteria for enthesitis related arthritis
Arthritis and enthesitis
Or, arthritis or enthesitis with at least 2 of the following:
- Presence or history of sacroiliac joint tenderness and/or inflammatory back pain
- Presence of HLA B27 antigen
- Onset of arthritis in a male over 6 years of age
- Acute (symptomatic) anterior uveitis
- History of ankylosing spondylitis, enthesitis related arthritis, sacroiliitis with inflammatory bowel disease, or acute anterior uveitis in a first-degree relative
what is the hallmark of psoriatic arthritis
dactylitis “sausage digit”
what is the criteria for psoriatic arthritis
Arthritis and psoriasis Or, arthritis and at least 2 of the following: - Dactylitis - Nail-pitting or onycholysis - Psoriasis in a first-degree relative
what are characteristics of Raynaud phenomenon? triggers?
tx?
vascular spasm leading to triphasic color sequence (white, blue, red)
well demarcated areas of color change
usually fingers and toes
triggers= cold, stress, caffeine, smoking
Treatment:
-avoid precipitants
-may need nifedipine (peripheral vasodilator)
what organisms cause reactive arthritis
salmonella shigella yersinia campylobacter chlamydia ureaplasma
Criteria for Lupus
- what do you see in complement level in SLE?
- what lab markers are used to monitor disease activity (2)?
SOAP BRAIN MD
4/11 criteria
Serositis – Pleurisy, pericarditis
Oral ulcers- usually painless
Arthritis- non erosive, 2 or more joints
Photosensitivity
Blood disorders (hemolytic anemia, leukopenia, thrombocytopenia)
Renal involvement- proteinuria, cellular casts
Antinuclear antibodies
Immunologic phenomena (dsDNA or anti-sm; anticardiolipin, lupus anticoagulant, false positive syphilis >6mo)
Neurologic disorder- seizures OR psychosis
Malar rash
Discoid rash
- **Complement is LOW in SLE
- C3 and C4 are used to monitor disease activity = levels fall during a flare and return to normal after appropriate treatment
criteria for APS
Vascular thrombosis: ≥1 clinical episode of arterial, venous, or small vessel thrombosis in any tissue or organ confirmed objectively by validated criteria
What is the differential diagnosis for monoarthritis?
Trauma/Mechnical/Orthopedic Infection (Acute-Septic/OM, Chronic- TB/Lyme) Inflammatory (JIA, FMF) Tumor Hemarthrosis
What is the differential diagnosis for polyarthritis
Inflammatory (JIA/SLE/Vasculitis)
Infection
Malignancy
Mechnical Pain syndrome
What is rheumatoid factor?
IgM autoantibody reacts to Fc portion of IgG antibodies
Top common causes of septic arthritis? (3)
In neonates?
In sickle cell?
In teenagers?
- Staph aureus
- Strep pneumonia
- Non Group A strep
- Kingella Kingae
In neonates: GBS and gram negatives
Sickle cell: Salmonella
Teenagers: gonorrhea
Antibiotic choice for osteomyelitis/septic arthritis:
- neonate
- 1-3 month old
- child
- teenager
- sickle cell
- Neonate: Cloxacillin and Gentamicin
- 1-3 month old: Cefuroxime (because of more gram negatives)
- Child: Cefazolin
- Teenager: ceftriaxone OR cefixime + azithromycin
- Sickle cell: cefotaxime (salmonella coverage)
3 circumstances where diagnosis of ARF can be made without Jones criteria:
- Chorea (may occur as the only manifestation)
- Indolent carditis
- Recurrent episodes
What is the timing of development of acute rheumatic fever in relation to when the GAS infection occurred?
2-4 wks after GAS pharyngitis
- 1/3 of patients with ARF have no history of antecedent pharyngitis
- only 10-20% of throat culture or rapid strep antigen tests will be positive at the time of presentation of ARF; this is why ASOT is needed!
What is the best confirmatory test for juvenile dermatomyositis?
-other tests?
EMG = denervation & myopathy
- other tests:
1. Muscle biopsy = perifascicular atrophy
2. CK can be normal or high
3. ANA: 80% can be positive
What are 3 ways that maternal SLE can affect neonate?
- Rash
- Congenital heart block
- Thrombocytopenia
What are physical exam findings of ankylosing spondylitis? (4)
- Loss of normal lumbar lordosis
- Positive Schober test (decreased forward flexion)
- Anterior uveitis
- Enthesitis (ie. patellar tendon and achilles tendon)
What is the pathophysiology behind acute phase reactants?
- which lab markers increase in acute phase response? (11)
- which lab markers decrease in acute phase response? (3)
Acute phase reactants: plasma proteins produced by the liver that change production during acute phase of inflammation (mediated by cytokines)
- increased lab markers:
1. CRP
2. ESR
3. Complement proteins
4. Fibrinogen
5. Ferritin
6. Ceruloplasmin
7. Haptoglobin
8. G-CSF
9. IL-1 receptor antagonist
10. Serum amyloid
11. Coag factors - decreased lab markers:
1. Albumin
2. Transferrin
3. IGF-1
A patient with JIA has a positive ANA. What 3 things does this put them at risk for?
- Earlier disease onset
- Asymmetric arthritis
- Uveitis
What level is considered a positive ANA?
-when should specific antibodies (ie. anti-dsDNA) be ordered?
> 1:160
-specific antibodies should only be ordered if ANA is positive AND a disease other than JIA is suspected (ie. SLE)
What 4 antibodies are SPECIFIC for SLE?
-what antibody is SENSITIVE for SLE?
- most sensitive antibody: ANA (if negative, very unlikely to have SLE
- most specific:
1. anti-dsDNA
2. anti-Ro
3. anti-La
4. anti-smith
What specific auto-antibodies (3) can often be seen with juvenile dermatomyositis?
- Anti-Jo1
- Anti-SRP
- Anti-Mi-2
What specific group of auto-antibodies are associated with increased risk of thrombosis?
-two examples of these?
Antiphospholipid antibodies
- this is why people with antiphospholipid antibody syndrome are at increased risk of clots and pregnancy loss secondary to clots
- ex. lupus anticoagulant, anticardiolipin
A patient presents to you with dactylitis. What is your differential diagnosis? (3)
- Sickle cell anemia
- JIA (ie. enthesitis related, psoriatic arthritis)
- Trauma
What is the diagnostic criteria for RF-negative-polyarthritis?
-what about RF-positive polyarthritis?
RF-negative polyarthritis:
- Arthritis affecting 5 or more joints during first 6 months of disease
- RF testing negative
RF-positive polyarthritis:
- Arthritis affecting 5 or more joints during first 6 months of disease
- 2 or more positive tests for RF at least 3 months apart during first 6 months of disease
Which population is usually affected by RF positive polyarthritis?
Adolescent girls = this is essentially adult-type rheumatoid arthritis presenting in a child or adolescent
-usually involve the PIP and MCP joints
What is the triad of Felty’s syndrome?
- Rheumatoid arthritis
- Neutropenia
- Splenomegaly
What are possible long term complications of SLE?
- Death from infection, renal, CNS, cardiac or pulmonary disease
- Early onset coronary artery disease from vasculitis
- Bone disease –> osteopenia, avascular necrosis from steroid use
- Malignancy from use of immunosuppressants/biologics
What are the clinical features of NLE?
- Cardiac: complete congenital heart block (associated with non-immune hydrops)
- Annular, erythematous papulosquamous rash with fine scale and central clearing
- usually photosensitive
- can be present at birth or develop within first few weeks of life
- predilection for face and scalp
- self-resolving - Hematologic: thrombocytopenia (most common), neutropenia and anemia less common
- Hepatic involvement: cholestatic hepatitis with elevated liver enzymes, hepatomegaly
- Neurologic: macrocephaly, hydrocephalus, spastic paraparesis, vasculopathy
What is the treatment for NLE
If fetal bradycardia is found during pregnancy, need fetal ECHO and may require treatment with Dex +/- sympathomimetics
-neonates with complete heart block may need pacemaker
What are types of:
- large vessel vasculitis (2)
- medium vessel vasculitis (2)
- small vessel vasculitis (4)
Large vessel vasculitis:
- giant cell arteritis (older adults)
- takayasu arteritis
Medium vessel vasculitis:
- Kawasaki
- Polyarteritis nodosa
Small vessel vasculitis:
- Wegener’s granulomatosis
- Churg-Strauss
- Microscopic polyangitis
- HSP
What are the clinical features of takayasu arteritis?
- diagnostic criteria?
- treatment?
Large vessel vasculitis involving the aorta and its branches (thoracic, abdominal, carotid)
-initially presents as non-specific inflammatory illness with fever, then evolves into chronic, fibrotic phase with signs and symptoms of chronic vascular insufficiency (pulse deficit, claudication, BP discrepancy, bruits)
***Diagnostic criteria:
Needs:
1. Angiographic abnormalities (MRI) of aorta or its main branches (aneurysm/diltation, narrowing or thickened arterial wall)
AND
1 of the following:
1. Pulse deficit or claudication
2. Discrepancy of 4 limb BP > 10 mm Hg
3. Bruits
4. Hypertension
5. Acute phase reactants elevated (ESR or CRP)
-treatment: corticosteroids plus second line agent: cyclophosphamide, methotrexate, etc.
What is the diagnostic criteria for:
- incomplete KD
- atypical KD
- alternate way to make diagnosis for KD aside from the 5 or more days of fever + 4/5 features
Incomplete KD: if 5 or more days of fever with 2-3 features instead of 4
-commonly seen in infants who are at higher risk of coronary artery involvement
Atypical KD: if KD with unusual manifestation (eg. renal failure)
Alternate way to diagnose KD: in presence of fever AND coronary artery involvement on echo
What is the usual age group for KD?
-what is the pathophysiology?
3 mo-5 yo
-small vessel vasculitis with predilection for coronary arteries; thought to be triggered by infectious agent
What is the diagnostic criteria for Wegener Granulomatosis?
***Overall, think small vessel vasculitis primarily affecting upper airway, lungs, and kidneys!!!!
Need 3/6:
1. Histopathology showing granulomatous inflammation within wall of artery
2. Upper airway involvement: chronic purulent or bloody nasal discharge, recurrent epistaxis, nasal septum perforation, saddle nose deformity, chronic sinus inflammation
3. Laryngo-tracheo-bronchial involvement: subglottic, tracheal or bronchial stenosis
4. Pulmonary involvement: nodules, cavities or pulmonary infiltrates (SOB, chronic cough, hemoptysis/alveolar hemorrhage)
5. ANCA positive
6. Renal involvement: proteinuria, elevated Cr, hematuria
What is the treatment for Wegener granulomatosis? (2)
Initial therapy: Corticosteroids and cyclophosphamide
Maintenance therapy: methotrexate, azathioprin, mycophenolate and low dose corticosteroids
What is the most common vasculitis in children?
HSP
What does the prognosis of HSP depend on?
Depends on severity of nephritis (worse prognosis with nephrotic syndrome)
-end stage renal disease occurs in 1-3% of patients
What is CREST syndrome?
-most important complication?
Aka Limited systemic sclerosis
- Calcinosis
- Raynaud phenomenon
- Esophageal dysmotility
- Sclerodactyly
- Telangiectasias
- most important complication: future development of pulmonary hypertension
A patient presents to you with isolated Raynaud phenomenon. What are the 2 best predictive factors for future development of autoimmune diseases?
- Positive ANA
2. Abnormal nail fold vasculature
What is the most common form of localized scleroderma in the pediatric population?
Linear scleroderma: characterized by one or more linear streaks (following dermatomal distribution) extending over upper or lower extremity
- can involve face or scalp (en coup de sabre), usually forehead
- Parry-Romberg syndrome: progressive hemi-facial atrophy, disfiguring
What is the minimum duration of fever to be called fever of unknown origin?
Fever needs to last > 14 days with standard investigations not resulting in a clear diagnosis
What are the clinical features of TRAPS?
-treatment?
TNF-receptor associated periodic syndrome
- Long duration of fevers lasting 3-4 weeks and occur at irregular intervals
- Migrating erythematous, maculopapular rash
- Severe migratory myalgias with rash, arthralgias
- Conjunctivitis, periorbital edema
- Severe abdo pain
- treatment: unproven therapy; steroids provide symptomatic relief but do not change frequency
What are examples of DMARDs? (7)
DMARDs = disease-modifying anti-rheumatic drug
- Azathioprine
- Cyclophosphamide
- Cyclosporine
- Hydroxychloroquine
- Methotrexate
- Mycophenolate mofetil
- Sulfasalazine
What monitoring needs to occur when patients are on hydroxychloroquine (plaquenil)?
Eye exams q6mo to assess for retinal deposits (retinal toxicity)
Name 2 classes of medications that can trigger drug-induced lupus.
antibiotics (ex: tetracyclines)
anticonvulsants
Name 1 non-medication cause that can exacerbate lupus (2)
- sun exposure
2. pregnancy
