SLE

Question 1

what happens in SLE?

Answer 1

organs and cells are damaged bc of tissue-binding autoantibodies and immune complexes

Question 2

90% of patients are _____ age

Answer 2

childbearing

Question 3

male or female predominance?

Answer 3

female (highest prevalence in black women)

Question 4

a woman exposed to what types of medications is at increased risk?

Answer 4

estrogen containing OCPs and HCT

Question 5

what does estradiol do?

Answer 5

binds to receptors on T and B cells, increasing activation and survival of those cells, thus favoring prolonged immune responses

Question 6

what are some environmental stimuli that may influence SLE

Answer 6

exposure to UV light
EBV
tobacco use
occupational exposure to silica

Question 7

what is the series of events for genes+environment

Answer 7

abnormal immune response (dendritic cells release b and t cells)…………..form autoantibodies leading to inflammation (rash, nephritis, arthritis, leukopenia, CNS dz, carditis, clotting)………….damage (renal failure, atherosclerosis, pulm fibrosis, stroke, etc)

Question 8

T/F: most patients experience exacerbations with a quiet period

Answer 8

true

Question 9

are complete remissions common?

Answer 9

no. they are rare

Question 10

what is the dx of SLE based on

Answer 10

clinical features and autoantiboidies

Question 11

how many of the 11 criteria do they need to fulfull?

Answer 11

4

Question 12

which things are included in the criteria?

Answer 12

malar rash, discoid rash
photosensitivity
oral ulcers
arthritis
serositis 
renal d/o
neuro d/o
hematologic d/o
immunologic d/o (anti ds-dna, anti 5M, and/or antiphospholipid)
antinuclear anitbodies (w/o presence of drugs known to unduce ANA)

Question 13

what are the cutaneous manifestations called?

Answer 13

lupus dermatitis

Question 14

what are the renal manifestations called?

Answer 14

lupus nephritis

Question 15

what are the nervous system manifestations called?

Answer 15

lupus cerebritis

Question 16

which autoantibodies do we care about?

Answer 16

ANA autoantibody
Anti-ds-DNA
Anti-Sm
Antiphospholipid antibodies

Question 17

what is the best screening test?

Answer 17

ANA autoantibody
if neg, you do not have lupus
if pos, you can have lupus, so check the more specific screening tests. can also be positive for other diseases besides lupus which is why you check the other ones

Question 18

which 2 autoantibodies are specific for SLE

Answer 18

anti ds DNA

anti sm

Question 19

which autoantibody correlates with disease activity and can be used to monitor success of treatment?

Answer 19

anti ds DNA

Question 20

are antiphospholipid antibodies specific for SLE?

Answer 20

no, but if positive it fulfills one of the 4 criteria

Question 21

what are pts with a positive antiphospholipid antibody more at risk for?

Answer 21

venous or arterial clotting, thrombocytopenia, and fetal loss. ** more likely to be thromboembolic

Question 22

what labs should you order initially?

Answer 22

ANA, CBC, platelets, UA (looking for proteinuria)

Question 23

if all labs are neg and symptoms subside

Answer 23

not SLE

Question 24

if all labs neg and sx persist

Answer 24

repeat ANA, add anti ds DNA or Anti am, or anti Ro

Question 25

if ANA is positive and >4 criteria met

Answer 25

positive for SLE. you dont need to order the Anti dsDNA or Anti Sm because you already know the diagnosis

Question 26

if ANA is positive and

Answer 26

possible SLE

Question 27

what are recommendations to avoid with SLE

Answer 27

``` sunlight exposure (USE SUNSCREENS) sulfa (since already has SE of photosensitivity), PCN, and high dose estrogen treat cardiac RFs (start on ASA) because of their high susceptibility to atherosclerosis ```

Question 28

what are the 5 classes of pharmacologic tx

Answer 28

``` NSAIDs tylenol antimalarials glucocorticoids immunosuppressive agents ```

Question 29

why do we use antimalarials?

Answer 29

reduces dermatitis, arthritis and fatigue?

Question 30

name of the antimalarial we use and what the patient needs to do

Answer 30

REMEMBER potential retinal toxicity | SEE AN OPHTHALOMOLOGIST initially and q6months

Question 31

how are glucocorticoids given?

Answer 31

PO, highest doses during flares and then keep a maintenance dose daily

Question 32

what are the 3 immunosuppressive agents?

Answer 32

cyclophosphamide (cytoxan) mycophenolate mofetil (cellcept) azathioprine (imuran)

Question 33

which drug is FDA approved for SLE

Answer 33

Belimumab (Benlysta) - dereased b cell activation

Question 34

which of the immunosuppressive agents can only be used for 6 months

Answer 34

cyclophosphamide

Question 35

how should an SLE patient be controlled during pregnancy

Answer 35

prednisone | hydrochloroquine can also be used

Question 36

being positive for what autoantibodies can increase risk of neonatal lupus (with a congenital permenant fetal heart block)

Answer 36

anti-ro

Question 37

What is seen in drug-induced lupus

Answer 37

+ANA fever, fatigue, arthritis, rash with appears during therapy with certain drugs resolves over several weeks with discontinuation of med

Question 38

what are offenders of drug induced SLE

Answer 38

procainamide, hydralazine, PTU, lithium, carbamazepine

Question 39

what is the leading cause of death in the first decade

Answer 39

lupus nephritis (renal failure) followed by infx and then thromboembolic events