SLE Flashcards
What are the typical SLE risk factor groups?
Mostly female. Mostly child bearing ages.
seems to hit African-Americans, American Hispanics, Asian
Socio economic factors are critical
What are the ACR classification criteria for SLE?
note: this is a classification criteria, so people may not actually have lupus, but fit the criteria
need 4 / 11
M - Malar rash
D - discoid rash
S - serositis
O - oral ulcers
A - arthritis (non deforming polyarthropathy)
P - photosensitive rash
B - blood dyscrasia R - renal involvement A - ANA + I - immune findings - anti-phospholipid, anti-DNA, anti-Sm N - neurological (seizures or psychosis)
What are some of the more common lupus associated antibodies?
the Smith antibody - low sensitivity, but 100% specificity
approximately 1 - 5% will be anti-Sm positive, but if you got it, you have Lupus
anti-Ro (SSA), anti-La (SSB) and anti-RNP (ENA) can be seen in lupus.
ribosomal antibodies have a “dubious association”
histone-antibodies are associated with drug induced lupus
what are the antibodies associated with antiphospholipid syndrome?
lupus anticoagulant is associated with greatest clotting risk (10 fold inc)
anti-cardiolipin (4 fold inc)
anti-B2GP1 (4 fold inc)
if you have all three, very high risk for clots. Limited evidence that primary prophylaxis works
what is livedo reticularis associated with?
it is the APS, not really lupus itself.
therefore, it can occur independent of SLE
what are the most common haematological abnormalities with lupus?
it can affect all cell lines, but lymphopenia is particularly common
thrombocytopenia tends to go with APS
other abnormalities include:
AIHA
Macrophage activation syndrome - cytokine storm induced and macrophage eat bone marrow. Treatment essential
what are the cardiovascular complications of lupus?
Raynaud’s
pericarditis - most common heart manifestation
myocarditis
valve disease - Libman-Sacks is non-bacterial endocarditis - typically mitral valve. Probably APS related
List off some eye problems that go along with SLE…
Sicca can occur patients get cataracts (?why?) plaquenil can cause macular disease - clinically decreased visual acuity antiphospholipid syndrome retinal vasculitis
what can happen to the GIT in SLE?
can get oral ulcers, mesenteric vasculitis
can also get hollow organ enteropathy
What are treatments of lupus?
hydroxychloroquine (plaquenil) is a super important medication to pretty much always keep going in the background. it is important for maintenance of remission. Side effects of plaquenil are pretty slim. The eye concerns are actually quite rare and instead based on info about chloroquine.
steroids are, unfortunately, a mainstay of treatment
anticoagulation is important in the right situation
statins are an evolving area in SLE
The COCP isn’t contraindicated if only mild disease thus far. HOWEVER, if the patient has had multiple significant flares, then we need to use something else (mirena, perhaps)
deficiencies of which part of complement increase risk for lupus?
apparently C1q (a rare disease) and C3 deficiency (also rare)
terminal complement (C5-9) we won’t believe has any increased risk
which antibodies cross the placenta in neonatal lupus (mother has lupus)
Anti-Ro/SSA are the culprits.
risk isn’t that high - about 3% in high risk women
what is the antibody typical of drug induced lupus?
what drugs cause it?
anti-histone is the classical one
drugs assoc are:
hydralazine
procainamide
less common but recognised:
Infliximab anti (TNF-α) Etanercept anti (TNF-α) Isoniazid (antibiotic) Minocycline (antibiotic) Pyrazinamide (antibiotic) Quinidine (antiarrhythmic) D-Penicillamine (anti-inflammatory) Carbamazepine (anticonvulsant) Oxcarbazepine (anticonvulsant) Phenytoin (anticonvulsant) Propafenone (antiarrhythmic)
