SLE Flashcards
CLINICAL PRESENTATION
-Can involve almost any organ
-Skin and mucus membrane involvement is common
-Arthritis or arthralgia
-Men are more likely to have renal and hematologic involvement but fewer dermatologic features
-Butterfly rash on face
-Heme, renal, neuro
Neuropsychiatric Lupus and CNS Lupus
NP: cognitive dysfunction, mood disorder and headache
CNS: stroke, coma, cranial neuropathy
Hematologic (Blood) - “Autoimmune Cytopenias”
-Anemia of chronic disease (low Hgb)
-Leukopenia: WBC < 4.0 x 103
-Lymphopenia: Lymphs < 1500/mm3
-Thrombocytopenia: Platelets < 100 x 103/L
-Hemolytic anemia: high reticulocyte count, LDH, indirect bili
Goals
-Prevent disease flares and involvement of other organs
-Decrease disease activity and prevent damage, maintain remission
-Reduce use of corticosteroids; minimization of treatment side effects
-Improve quality of life, while minimizing adverse effects and costs
Monitoring
-Labs every 6 to 12 months (inactive disease and no organ damage), more if abnormalities
Lupus Tx Overview
-ALL PTS: Hydroxychloroquine
(max 5 mg/kg abw)
-During maintenance: GC minimized (<5mg day of pred) or withdrawn
-MTX/AZA/MMF/BEL/ANI for pts not controlled on HCQ (+/- GC)
-Persistent/flaring: Belimumab
-Rituximab or cyclophosphamide in organ- threatening, refractory disease
Hydroxychloroquine (Plaquenil)
-Most useful for constitutional symptoms (fatigue and fever) and MSK, skin and mild pleuritic complaints
-Dose: 200-400 mg/day
-AE: GI, skin rxn, ocular toxicity (SOG)
-Mon: CRP, ESR, CBC, eye exams (5 yrs, or annually)
Glucocorticoids
-Adjunct to control flares and maintain low disease activity
-AE: hypergly, osteo, htn, mood, glaucoma, GI, myopathy, atherosclerosis
-Prednisone < 0.5 mg/kg/day for mild
-IV MP 250-1000 mg/day for 1-3 days for severe (then pred 0.5-0.7 with tapering)
Azathioprine (Imuran)
SLE with arthritis, serositis and mucocutaneous
manifestations, lupus nephritis
-steroid sparing agent
-safe in pregnancy
Dose: 2 mg/kg/day
AE: BMS, GI, HS, hepatox
Mon: TPMT, CBC, LFT
DDI: warfarin
Methotrexate
-Articular or cutaneous involvement, renal lupus
-Steroid sparing
Dose: 10-25 mg once a WK
-with folic acid to reduce ae
AE: BMS, hepatitis, alopecia, pneumonitis, stomatitis (BASH PP)
-pregnancy category X
Mon: CBC, LFT, CXR, PFT, pregnancy test (CI)
Mycophenolate Mofetil, Cellcept
LUPUS NEPHRITIS
Dose
-IND: 1.5 g twice a day
-MAIN: 1-2 g twice a day
AE: nausea, abd pain, diarrhea, BMS, infections, teratogenic (TINA’s DB)
Mon: CBC, ANC, pregnancy test, hep b/c
AniFrolumab (Saphnelo)
Add-on therapy for inadequate control on first-line treatments and inability to taper steroids
-NOT for severe, active CNS lupus
Dose: 300 mg every 4 weeks
AE: infections, infusion rxns
-lung, zoster (ANIII)
Mon: hypersensitivity, infections
Cyclophosphamide (cytoxan)
For severe organ threatening SLE
AE: infections, alopecia, malignancies, bladder toxicity, infertility
-with MESNA to decrease bladder damage
cyc sike IM MIA B
Rituximab (rituxan)
-Adj therapy for refractory disease (cytopenias, nephritis, NP lupus)
SE: infusion rxn, neutropenia, infections
Mon: CBC, HBV, renal, infused related rxn
TX for Cutaneous Lupus Erythemetosus
- Topical CS/CNI
- Hydroxychloroquine, methotrexate, MMF
- Rituximab, CNI, IVIG
