SLE Flashcards
Main 3 regions of the body affected by SLE.
Skin
Joints
Kidneys
What is the hypothesis on the effect of hormones causing SLE?
Estrogen Effect: the longer a patient is exposed to elevated estrogen, the greater the chance and severity of SLE
(early menarche, late menopause, post-menopausal hormone replacement)
Which virus is associated with SLE?
EBV
How does SLE lead to Renal Disease?
Anti-nuclear antibodies (ANA) combine with cellular antigens forming immune complexes that deposit in the joints, superficial blood vessels in the skin, and in this case the glomerular capillaries
-the deposition prevents glomerular filtration and decreases renal blood flow.
How does the American College of Rheumatology standardize a diagnosis of SLE?
at least 4 of the 11 pre-determined criteria must be present
- Malar Rash
- Discoid Rash
- Photosensitivity
- Oral Ulcers
- Arthritis
- Serositis
- ANA(+)
- Neuro disorder (seizure, psychosis)
- Immuno disorder
- Hemeatologic disorder
- Renal Disorder
What is important when remembering the Systemic Lupus International Collaborating Clinics (SLICC) classification of diagnosis SLE? (there are 17 here, different from the AMR 4/11 criteria)
The criteria are cumulative and don’t need to be present concurrently.
main criteria include: nonscarring alopecia, low complement, direct coombs test (+), low lymphocytes
How does Lupus Nephritis progress?
6 stages
- basically early stages only show immunofluorescence and electron microscope changes with normal urinalysis
- eventually urinalysis picks up proteins and microscopic hematuria,
- late stages show renal failure, gross hematuria and proteinuria
What are the 3 steps used in laboratory diagnosis of SLE?
Step 1: ANA testing
Step 2: anti dsDNA Antibody testing
Step3: Anti-Smith Antibody testing (RNA binding proteins)
Tissue biopsy is done but SLE is usually diagnosed before this final step is needed.
What are 4 major cardiovascular complications of active SLE?
- Accelerated Atherosclerosis
- Renal Failure
- CVA
- Infection
What type of cancer is at higher risk in SLE patients?
Lymphoproliferative Disorders (ex. lymphomas)
What are 4 drug classes used to treat SLE?
- NSAIDs (ibuprofen, naproxen) for pain
- Antimalarials (hydroxychloroquine) anti-inflammatory
- Systemic Glucocorticoids (prednisone) immune regulating
- Immunosuppressives (methotrexate is best)
Main side effects of Hydroxychloroquine
Retinal deposition and retinopathy
Rash
Nausea
(recommended eye exams each visit)
Major side effect of Methotrexate
Pulmonary Fibrosis
chest x-rays to monitor
Treatment for the renal disease caused by SLE
ACE Is
ARBs
Statins
Most common type of SLE
Relapsing Remitting
