SLE

Question 1

Clinical presentation
-It can involve almost any organ!
What’s common ?
What’s experienced by 83-95% of pt’s with SLE?
Men more likely to have which inveolvement?

Answer 1

skin and mucus membrane
arthritis or arthralgia’s

renal and hematologic involvement , but fewer dermatologic

Question 2

Can manifest in Neuropsych and CNS
-Provide examples of each

Answer 2

Neuropsych : cog dysfunction, mood disorder and HA

STroke, coma, cranial neuropathy

Question 3

Lupus Nephritis : Defined by 2 characteristics

Answer 3

1. Urinary protein >0.5 g per day or >3+ by dipstick analysis
2. Urinary protein : creatinine ratio of >0.5 AND active urinary sediment

Question 4

Hematologic (Blood)
5 characteristics

Answer 4

Anemia of chronic disease
Leukopenia : WNC <4.0 x10^3
Lymphopenia : lymphs < 1500 mm3
Thrombocytopenia : Platelelets less than 100x103/L
heomolytic anemia : high reticulocyte count, LDH, indirect bili

Question 5

SLE goals of therapy
-Prevent ___
-Decr ___ and prevent ____
-Reduce use of ___
Improve ____

Answer 5

disease flares and involvement of other organs

disease activity and prevent damage, maintain remission

corticosteroids ; minimization of treatment side effects

uality of life, while minimizing adverse effects and costs

Question 6

all SLE pt’s should receive which drug?
What should the dose NOT exceed?

Answer 6

Hydroxychloroquine
Does not exceed 5mg/kg Actual Body weight

Question 7

Hydroxychloroquine (Plaquenil)
MOA : (3)
Most useful for which subset of sx’s?
DOSE ???
AE’s?
MONITORING

Answer 7

anti-inflammatory, immunomodulatory (↓ t-cell stimulation), and antithrombotic

constitutional symptoms
(fatigue and fever) and MSK, SKIN and mild pleuritic complaints.

200-400 mg/day PO (5mg/kg based on ABW)

Generally MILD, GI and skin reactions, May cause ocular toxicity

CRP, ESR, CBC w/diff, eye exams baseline and every 5 yrs or anually

Question 8

Glucocorticoids usage for mild to mod SLE is what dose?
-Note glucocorticoids have rapid onset

Answer 8

<5mg/day of prednisone

Question 9

Azathioprine (Imuran)
-Place in therapy? SLE with what conditions?
-used frequently as a ?
-SAFE IN ___
Dose?
Main AE’s?
Monitoring
DDI ?

Answer 9

arthritis, serositis and mucocutaneous
manifestations, lupus nephritis

steroid sparing agent

pregnancy

2-3 mg/kg/day PO can divide doses

bone marrow suppression, GI
intolerance, hypersensitivity and hepatotoxicity

TPMT enzyme deficiency, CBC with
platelets weekly x 1 month then taper to monthly; LFT’s q2weeks first month then monthly

Warfarin. Aza makes INR go down (Blood clots)

Question 10

Tx of Cuteneous lupus erythemetosus ? Talk about drug choice flow

Answer 10

1. Topical corticosteroids , topical CNI
2. Hydroxychloroquine +/- oral steroid
   if no response
3. Biologics, mtx, mmf

Question 11

Pregnancy and SLE
What drugs to avoid because of ovarian failure and infertility?
Estrogen contraceptives associated with SLE?
Best preg outcomes observed in pt’s who have had inactive disease for how long?
WHAT CAN BE CONTINUED THROUGHOUT PREG?
If a flare occurs and immunosupp drug required during preg what drug can u use?

Answer 11

cyclophos
flares and thrombosis

6 months prior to the pregnancy

HYDROXYCHLOROQUINE

AZATHIOPRINE

Question 12

Immunizations : SLE pt’s incr risk infxn

-vaccines should be administered when?
-Which vaccines safe?
Which vaccines CI?

Answer 12

Prior to immunosupp therapy

killed vaccines
live attenuated

Question 13

General approaches to TX :
Lifestyle mods like ?
*Update vaccines
Optimize tx of ___

Answer 13

protection from sun, smoking cessation, exercise and weight control

comorbidities (HTN, HLD, depression)