SLE Flashcards
Genetic SLE associations
HLA DR2, DR3
Stat4 Haplotype Chromosome 2
___ susceptibility genes are needed for SLE
4
Drugs that induce SLE
Procainamide
Hydralazine
(Chlorpromazine, phenytoin)
_____ has been demo’d in SLE for both sexes
Abnoral E metabolism
Hormonal implicactions in SLE
Estrogen
Prolactin (immunostim)
HP Axis
How is ANA measured
patients serum is added to tissue
washed with fluorecein tagged rabbit anti-human IG
(check for binding of antibodies)
ANA is interpreted as positive at…
the highest dilution (titer) that fluorescence is observed
ANA spec/sens
95% for both
5 ANA patterns
Which are associated with SLE
- Diffuse
- Speckled
- Nucleolar
- Peripheral
- Anti-centromere
Specific autoantibodies in SLE (6)
- Anti dsDNA
- Extractable Nuclear Antigen (ENA)
- (Anti-Sm is specific for SLE)
- Anti-RNP
- Anti- Ro/La
Non-nuclear = Anicardiolipin (lupus anticoagulant)
Anticardiolipin test is _____
nondefinitive
What immune components/process increased in SLE
B cell activation
Apoptosis
IL-10
What immune components are reduced in SLE
T cell count
Macrophage-mediated clearance of apoptotic cells
IL-12
Much of the tissue damage in SLE caused by ____
deposition of IC’s –> activation of complement cascade
What causes the reduced cell count in SLE? What conditions occur?
Antbodies to cell membrane
HA, TC, LP
Two other components that have antibodies directed at them in SLE? (with resulting conditions)
Phospolipids (prolonged PTT, Thromboses, hypercoagulability)
Brain constituents (Lupus cerebritis)
Most common cause of death in SLE (Lockwood)
Infection!
Early systemic non-arthritic manifestations of SLE (complaints)
Fatigue, morning stiffness, weight loss, FEVER
What does synovial fluid look like in SLE
only mildly inflammatory
8 Dermatologic manifestations of SLE
- Sun sensitivity
- Malar rash
- Erythematous maculopapular eruption
- Discoid lupus (central atrophy and scar)
- Subacute cutaneous lupus
- Oral ulcers (roof)
- Diffuse alopecia (can be patchy)
- Vasculitis
Vasculitis manifestations in SLE
Nodule
Ulcer
Purpura
LIVEDO RETICULARIS
splinter hemorrhages
Osler Nodes
5 Cardiac manifestations of SLE
- Pericarditis
- Libman Sacks endocarditis (valve)
- Myocarditis
- CAD risk increase
- Conduction abnormalities
Half of SLE patients have _____ involvement
Renal
Four types of renal involvement in SLE
Mesangial GN
Focal proliferative GN
Diffuse Proliferative GN
Membranous GN
Most common type of GN in SLE
Diffuse proliferative
Lupus cerebritis may involve presence of ______
an organic brain syndrome
Spinal cord inflammation in SLE =
What occurs as a result?
Transverse myelitis
Demyelation (idiopathic)
Dx of Lupus cerebritis cant rely on…
Key feature?
- CSF values are NORMAL
- dsDNA, complement, and immune complexes DONT correlate
80% of active SLE has abnormal EEG (even without CNS lupus)
Other manifestations of SLE
- Raynauds
- Myalgia
- Delayed menstruation, miscarriage
- Neonatal lupus (rash and heartblock)
- Avascular necrosis (hips)
Diagnostic criteria for SLE
4/11
- Malar rash
- discoid rash
- photosensitivity
- oral ulcers
- arthritis
- serositis
- Renal disorder
- Neuro disorder (seiz.)
- Hematologic disorder
- Immunologic disorder
- POSITIVE ANA
High specificity tests for SLE
- Anti dsDNA
- Anti Sm antibody
ANA is a useful screening tool but is not diagnostic
What does libman sacks endocarditis cause?
deformity and mitral valve regurgitation
Most common SLE respiratory finding
Pleuritic chest pain
Arthritis location and appearance in SLE
Symmetric
non-erosive
PIP + MCP most common
______ is a common joint complaint in SLE
morning stiffness of the hands
5 Features that distinguish Drug-induced SLE
- Antihistone AB
- No AB against native DNA
- No decrease in complement
- Low Renal and CNS involvement
- Remits when drug is discontinued
General treatments for SLE
- NSAIDS
- Antimalarials
- CS
-
Cytotoxics
- (AZT+Cyclophosphamide)
-
Immune modulators
- MMF
- Rituximab (Anti-CD20)
- Belimumab (anti BAFF)
Other labs for SLE
WSR + CRP
CBC + UA
Complement levels
