sle Flashcards
risk factors for SLE
-Genetics: 1st degree
-Environment: sunlight, smoking, stress, meds
-Hormones (inc risk w/ inc levels)
what happens during pre-clinical
Auto-immune proliferation; Over activation of B cell and T cell activation
What happens during clinical phase
autoantibody production
Diagnostic Criteria
SOAP BRAIN MD
- Serositis
- Oral Ulcers
- Arthritis
- Photosensitivity
- Blood disorders
- Renal Impairment
- Antinuclear Ab (ANA)
- Immunotherapy
- Neurologic Disorders
- Malar Rash
- Discoid Rash
Serologic Testing
- ANAs (-) = NOT lupus (+)= maybe lupus
- Anti-dsDNA Ab
- Anti-Sm Ab
- Anti-PL (+)
Anti-phospholipid Syndrome
Anti-Pl + with thrombotic event
- hyper coagulable state life threatening, spontaneous abortion
Anti-phospholipid Syndrome Management with aPL (+) with no event
- Not pregnant: Low Dose Aspirin
- Pregnant: Low Dose Aspirin +/- LMWH
Anti-phospholipid Syndrome Management with APS
Pregnant : LDA +/- LMWH
Not pregnant, venous : warfarin INR 2-3
Not pregnant, arterial : warfarin 3-4
Lupus Nephritis clinical presentation
- kidney inflammation
- protein in urine +/- cast
- foamy urine, peripheral edema, HTN
- 6 class, 3-6 require immunosuppression or transplant
Lupus Nephritis Managment (induction vs remission)
Induction
- Immunosupressants ( Mycophenolate or CYC) +/- steroids
Remission
- Taper steroid doses + switch immunosuppressant doses as needed
Lupus Nephritis Class III-IV treatment
- G Cortico + MMF
- response 3-12 months
Lupus Nephritis Class V treatment
- RAAS inh (ACE/ARB)
- consider GC + MMF, if Urine protein >3gr/24hr
Clinical presentation
- malar rash (cheek bone), fever, arthralagias, alopecia, pain
- women childbearing age
Biggest risk factor for death in SLE patients
Infection
SLE & Pregnancy safe to use and pearls
- Hydroxycholorquine, APAP, low dose/potency Corticos
- In lupus nepritis HCQ or Azathi
- consider preterm delivery if LN highly active
- continue meds throughout pregnancy, best to wait to get pregnant until after remission
SLE monitoring
- s/s q3-6 months
- q6 months: UA, BMP, CBC, lipid panel, serological disease markers
Topical Steroids dosing, clinical pearls, alt
- low potency : facial rash; hydrocortisone 1%
- high potency: arm, legs, trunk
- Cyclical applications
- Alt: tacrolimus
NSAIDs clinical pearl, se, monitor
- Separate aspirin at least 1 hr b/f dose
- SE: Cardiac, AKI, GI
- Monitor CBC, BMP
hydroxychloroquine ae, dose, monitoring
1st line
- AE: skin pigment, flu-like symptoms, irreversible rare-ocular toxicity
- dose suppression: 400 mg QD-BID
- dose maintenance: 200-400 mg QD
- eye exam baseline
Who gets Corticosteroids
Adjunctive therapy for
- mod-severe initial pres
- organ-threatening or life- threatening SLE
- inadequate response to HCQ or NSAIDs
- Poor quality of life
Rapid Symptom Relief
Belimumab clinical pearls, AE, who to avoid
- monthly IV inf
- adj therapy w/ immunosuppressants
- AE: Depression/Suicidality/ CNS SEs, serious inf if given w/ live vaccines + biologics, avoid in preg
- avoid in dementia patients
Anfrolumab clinical pearls
- Adj w/ standard SLE therapy
- IV Inf q4 weeks
- Not indicated in active LE or CNS disease
who is inidicated for Immunosuppressants therapy with SLE
- for pts with poor symptom control refractory to HCQ/NSAID/Steroid
- organ-threatening SLE
- combo w/ steriods
what agent can cause permanent infertility
cyclophosphamide
Voclosporin clinical pearls, BBW
- adj to immunosuppressants in active LN
- BBW: infs + malignancy
- GFR <45 can cause nephrotoxicity
- CYP3A4 interactions, grapefruit
treat to monitor principles
- Shared decisions pts + MD
- Prolong survival, minimizing organ damage, improve health-related quality of life
- Multidisciplinary management
-Monitor, follow-up, to therapy
Non-pharm
Trigger
- sunscreen, broad coverage, avoid photosensitivity agents, stress, smoking
Prevent/Eradicate Inf
- Treat aggressively, immunosuppressants
Which agents treat membranous lupus nephritis 5
Mycophenolate
Cyclosporine
Calcineurin inh (Voclosporin)
