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Rheumatology > SLE > Flashcards

SLE Flashcards

1
Q

what happens in SLE?

A

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

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2
Q

90% of patients are _____ age

A

childbearing

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3
Q

male or female predominance?

A

female (highest prevalence in black women)

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4
Q

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

A

estrogen containing OCPs and HCT

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5
Q

what does estradiol do?

A

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

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6
Q

what are some environmental stimuli that may influence SLE

A

exposure to UV light
EBV
tobacco use
occupational exposure to silica

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7
Q

what is the series of events for genes+environment

A

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)

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8
Q

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

A

true

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9
Q

are complete remissions common?

A

no. they are rare

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10
Q

what is the dx of SLE based on

A

clinical features and autoantiboidies

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11
Q

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

A

4

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12
Q

which things are included in the criteria?

A 
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)
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13
Q

what are the cutaneous manifestations called?

A

lupus dermatitis

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14
Q

what are the renal manifestations called?

A

lupus nephritis

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15
Q

what are the nervous system manifestations called?

A

lupus cerebritis

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16
Q

which autoantibodies do we care about?

A

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

17
Q

what is the best screening test?

A

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

18
Q

which 2 autoantibodies are specific for SLE

A

anti ds DNA

anti sm

19
Q

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

A

anti ds DNA

20
Q

are antiphospholipid antibodies specific for SLE?

A

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

21
Q

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

A

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

22
Q

what labs should you order initially?

A

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

23
Q

if all labs are neg and symptoms subside

A

not SLE

24
Q

if all labs neg and sx persist

A

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

25
Q

if ANA is positive and >4 criteria met

A

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

26
Q

if ANA is positive and

A

possible SLE

27
Q

what are recommendations to avoid with SLE

A 
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
28
Q

what are the 5 classes of pharmacologic tx

A 
NSAIDs
tylenol 
antimalarials
glucocorticoids
immunosuppressive agents
29
Q

why do we use antimalarials?

A

reduces dermatitis, arthritis and fatigue?

30
Q

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

A

REMEMBER potential retinal toxicity

SEE AN OPHTHALOMOLOGIST initially and q6months

31
Q

how are glucocorticoids given?

A

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

32
Q

what are the 3 immunosuppressive agents?

A

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

33
Q

which drug is FDA approved for SLE

A

Belimumab (Benlysta) - dereased b cell activation

34
Q

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

A

cyclophosphamide

35
Q

how should an SLE patient be controlled during pregnancy

A

prednisone

hydrochloroquine can also be used

36
Q

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

A

anti-ro

37
Q

What is seen in drug-induced lupus

A

+ANA
fever, fatigue, arthritis, rash with appears during therapy with certain drugs

resolves over several weeks with discontinuation of med

38
Q

what are offenders of drug induced SLE

A

procainamide, hydralazine, PTU, lithium, carbamazepine

39
Q

what is the leading cause of death in the first decade

A

lupus nephritis (renal failure)

followed by infx and then thromboembolic events

Rheumatology (10 decks)

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