SLE

Question 1

What are the key characteristics/demographics of a Lupus patient

Answer 1

Age: 15-45
Female&raquo_space; male (10:1)
3-4x African, Asina, Hispanic
Chief complaint: joint pain, rash, chest pain, edema

Question 2

General symptoms of SLE

Answer 2

Fatigue, fever, weight loss, rashes, hair loss, oral/nasal ulcers, abnormal bleeding, chest pain/plueritis, CNS, edema, raynauds phenomenon

Question 3

Monozygotic twin concordance

Answer 3

24-35%

Question 4

Meds that are linked to SLE

Answer 4

Procainamide, hydralazine
Quinidine, D-penicillamine
Izoniazid, methyldopa, minocycline, chlorpromazine, Anti-TNG alpha

Question 5

General exam findings with SLE

Answer 5

Cachectic/thin, conjunctival pallor, Ill appearing, anasarca/diffuse edematous

Question 6

What are the RA like symptoms?

Answer 6

Jaccoud’s arthropathy: reducible finger bending

Question 7

What are the general lab findings

Answer 7

Low WBC
Low platelets
Various anemia
CMP: elevated creatinine, low albumin

Question 8

What are the associated antibodies and blood work up

Answer 8

ANA
*Anti-dsDNA - nephritis
*Anti-Smith
SSA - photosensitivity, neonatal lupus, Sjorgrens
SSB - Sjogrens
Anti-RNP - MCTD
Anti-phopholipid antibodies - blood clots, miscarriages

Question 9

Other lab findings

Answer 9

Low C3/4
Urinalysis - white cells, red cells, protein, red cell casts, Proteinuria >1g
ESR/CRP - mixed elevations or chronic

Question 10

Imaging findings of SLE

Answer 10

CXR - effusions, diffuse alveolar infiltrates
Echocardiogram/CT - pericardial effusion, myocardial dysfunction
MRI - brain changes

Question 11

Renal findings for SLE

Answer 11

H&E and immunofluorescence
Full house (IgG,A,M C3, C1q), MPGN Tram tracking and wire-loop lesions

Question 12

What class of renal dz

Answer 12

Class III and IV

Question 13

What is the base/first line treatment?

What are its adverse effects?

Answer 13

Hydroxychloroquine

Retinal deposition/vision loss

Question 14

Treatments for SLE induced Arthritis?

Answer 14

Hydroxycholoquine, methotrexate, azathioprine, belimumab

Question 15

What drug do you not give to SLE

Answer 15

TNF-alpha inhibitors

Question 16

Waht drugs for skin Lupus

Answer 16

Hydroxychloroquine, Belimumab, thalidomide, steroids

Question 17

What drugs do you give for serositis

Answer 17

Steroids, Azathioprine, colchicine

Question 18

SLE treatment for Renal dz

Answer 18

Steroids then mycophenolate or cysclophophomide
miantenace with mycophenolate, azathioprine
can add belimumab, voclosporin, calcineurin inhibitors, tarcolimus, or rituximab

Question 19

Treatment for CNS SLE dz

Answer 19

Steroidss

Pulse cycclophophamide, maybe rituximab

Question 20

Other treatemnt factors

Answer 20

Avoid UV light
Stop smoking
know complications of pregnancy
avoid foods of alfalfa sprouts, garlic, echinacea
Statins/aspirin in appropriate patients
Higher risk of infections

Question 21

Biggest killers for SLE

Answer 21

Renal dz - 35%
Cardiovascular dz - 30-40%
Infection - 25%
Malignancy - 5-10%

Question 22

SLE concerns with pregnancy

Answer 22

Increased symptoms
Increased risk of maternal death, pre-eclampsia,, pregnancy induced hpertension, spontaneous abortion, pre-term birth, intra-uterine growth restirictions

Continue hydroxychloroquine

Question 23

Signs of neonatal lupus

Answer 23

SSB, SSA antibody transfer

Rash, hepatic dysfunction, thrombocytopenia, heart block

Question 24

Treatment for antiphopholipid antibodies

Answer 24

81 mg Aspirin, heparin, Hydroxycholoroquine