SLE Flashcards
what happens in SLE?
organs and cells are damaged bc of tissue-binding autoantibodies and immune complexes
90% of patients are _____ age
childbearing
male or female predominance?
female (highest prevalence in black women)
a woman exposed to what types of medications is at increased risk?
estrogen containing OCPs and HCT
what does estradiol do?
binds to receptors on T and B cells, increasing activation and survival of those cells, thus favoring prolonged immune responses
what are some environmental stimuli that may influence SLE
exposure to UV light
EBV
tobacco use
occupational exposure to silica
what is the series of events for genes+environment
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)
T/F: most patients experience exacerbations with a quiet period
true
are complete remissions common?
no. they are rare
what is the dx of SLE based on
clinical features and autoantiboidies
how many of the 11 criteria do they need to fulfull?
4
which things are included in the criteria?
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)
what are the cutaneous manifestations called?
lupus dermatitis
what are the renal manifestations called?
lupus nephritis
what are the nervous system manifestations called?
lupus cerebritis
which autoantibodies do we care about?
ANA autoantibody
Anti-ds-DNA
Anti-Sm
Antiphospholipid antibodies
what is the best screening test?
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
which 2 autoantibodies are specific for SLE
anti ds DNA
anti sm
which autoantibody correlates with disease activity and can be used to monitor success of treatment?
anti ds DNA
are antiphospholipid antibodies specific for SLE?
no, but if positive it fulfills one of the 4 criteria
what are pts with a positive antiphospholipid antibody more at risk for?
venous or arterial clotting, thrombocytopenia, and fetal loss. ** more likely to be thromboembolic
what labs should you order initially?
ANA, CBC, platelets, UA (looking for proteinuria)
if all labs are neg and symptoms subside
not SLE
if all labs neg and sx persist
repeat ANA, add anti ds DNA or Anti am, or anti Ro
if ANA is positive and >4 criteria met
positive for SLE. you dont need to order the Anti dsDNA or Anti Sm because you already know the diagnosis
if ANA is positive and
possible SLE
what are recommendations to avoid with SLE
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
what are the 5 classes of pharmacologic tx
NSAIDs tylenol antimalarials glucocorticoids immunosuppressive agents
why do we use antimalarials?
reduces dermatitis, arthritis and fatigue?
name of the antimalarial we use and what the patient needs to do
REMEMBER potential retinal toxicity
SEE AN OPHTHALOMOLOGIST initially and q6months
how are glucocorticoids given?
PO, highest doses during flares and then keep a maintenance dose daily
what are the 3 immunosuppressive agents?
cyclophosphamide (cytoxan)
mycophenolate mofetil (cellcept)
azathioprine (imuran)
which drug is FDA approved for SLE
Belimumab (Benlysta) - dereased b cell activation
which of the immunosuppressive agents can only be used for 6 months
cyclophosphamide
how should an SLE patient be controlled during pregnancy
prednisone
hydrochloroquine can also be used
being positive for what autoantibodies can increase risk of neonatal lupus (with a congenital permenant fetal heart block)
anti-ro
What is seen in drug-induced lupus
+ANA
fever, fatigue, arthritis, rash with appears during therapy with certain drugs
resolves over several weeks with discontinuation of med
what are offenders of drug induced SLE
procainamide, hydralazine, PTU, lithium, carbamazepine
what is the leading cause of death in the first decade
lupus nephritis (renal failure)
followed by infx and then thromboembolic events
