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ICM Exam 2- Rheumatology > SLE > Flashcards

SLE Flashcards

1
Q

Genetic SLE associations

A

HLA DR2, DR3

Stat4 Haplotype Chromosome 2

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2
Q

___ susceptibility genes are needed for SLE

A

4

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3
Q

Drugs that induce SLE

A

Procainamide

Hydralazine

(Chlorpromazine, phenytoin)

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4
Q

_____ has been demo’d in SLE for both sexes

A

Abnoral E metabolism

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5
Q

Hormonal implicactions in SLE

A

Estrogen

Prolactin (immunostim)

HP Axis

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6
Q

How is ANA measured

A

patients serum is added to tissue

washed with fluorecein tagged rabbit anti-human IG

(check for binding of antibodies)

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7
Q

ANA is interpreted as positive at…

A

the highest dilution (titer) that fluorescence is observed

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8
Q

ANA spec/sens

A

95% for both

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9
Q

5 ANA patterns

Which are associated with SLE

A
  1. Diffuse
  2. Speckled
  3. Nucleolar
  4. Peripheral
  5. Anti-centromere
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10
Q

Specific autoantibodies in SLE (6)

A
  1. Anti dsDNA
  2. Extractable Nuclear Antigen (ENA)
  3. (Anti-Sm is specific for SLE)
  4. Anti-RNP
  5. Anti- Ro/La

Non-nuclear = Anicardiolipin (lupus anticoagulant)

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11
Q

Anticardiolipin test is _____

A

nondefinitive

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12
Q

What immune components/process increased in SLE

A

B cell activation

Apoptosis

IL-10

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13
Q

What immune components are reduced in SLE

A

T cell count

Macrophage-mediated clearance of apoptotic cells

IL-12

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14
Q

Much of the tissue damage in SLE caused by ____

A

deposition of IC’s –> activation of complement cascade

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15
Q

What causes the reduced cell count in SLE? What conditions occur?

A

Antbodies to cell membrane

HA, TC, LP

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16
Q

Two other components that have antibodies directed at them in SLE? (with resulting conditions)

A

Phospolipids (prolonged PTT, Thromboses, hypercoagulability)

Brain constituents (Lupus cerebritis)

17
Q

Most common cause of death in SLE (Lockwood)

A

Infection!

18
Q

Early systemic non-arthritic manifestations of SLE (complaints)

A

Fatigue, morning stiffness, weight loss, FEVER

19
Q

What does synovial fluid look like in SLE

A

only mildly inflammatory

20
Q

8 Dermatologic manifestations of SLE

A
  1. Sun sensitivity
  2. Malar rash
  3. Erythematous maculopapular eruption
  4. Discoid lupus (central atrophy and scar)
  5. Subacute cutaneous lupus
  6. Oral ulcers (roof)
  7. Diffuse alopecia (can be patchy)
  8. Vasculitis
21
Q

Vasculitis manifestations in SLE

A

Nodule

Ulcer

Purpura

LIVEDO RETICULARIS

splinter hemorrhages

Osler Nodes

22
Q

5 Cardiac manifestations of SLE

A
  1. Pericarditis
  2. Libman Sacks endocarditis (valve)
  3. Myocarditis
  4. CAD risk increase
  5. Conduction abnormalities
23
Q

Half of SLE patients have _____ involvement

A

Renal

24
Q

Four types of renal involvement in SLE

A

Mesangial GN

Focal proliferative GN

Diffuse Proliferative GN

Membranous GN

25
Q

Most common type of GN in SLE

A

Diffuse proliferative

26
Q

Lupus cerebritis may involve presence of ______

A

an organic brain syndrome

27
Q

Spinal cord inflammation in SLE =

What occurs as a result?

A

Transverse myelitis

Demyelation (idiopathic)

28
Q

Dx of Lupus cerebritis cant rely on…

Key feature?

A
  • CSF values are NORMAL
  • dsDNA, complement, and immune complexes DONT correlate

80% of active SLE has abnormal EEG (even without CNS lupus)

29
Q

Other manifestations of SLE

A
  1. Raynauds
  2. Myalgia
  3. Delayed menstruation, miscarriage
  4. Neonatal lupus (rash and heartblock)
  5. Avascular necrosis (hips)
30
Q

Diagnostic criteria for SLE

A

4/11

  1. Malar rash
  2. discoid rash
  3. photosensitivity
  4. oral ulcers
  5. arthritis
  6. serositis
  7. Renal disorder
  8. Neuro disorder (seiz.)
  9. Hematologic disorder
  10. Immunologic disorder
  11. POSITIVE ANA
31
Q

High specificity tests for SLE

A
  • Anti dsDNA
  • Anti Sm antibody

ANA is a useful screening tool but is not diagnostic

32
Q

What does libman sacks endocarditis cause?

A

deformity and mitral valve regurgitation

33
Q

Most common SLE respiratory finding

A

Pleuritic chest pain

34
Q

Arthritis location and appearance in SLE

A

Symmetric

non-erosive

PIP + MCP most common

35
Q

______ is a common joint complaint in SLE

A

morning stiffness of the hands

36
Q

5 Features that distinguish Drug-induced SLE

A
  • Antihistone AB
  • No AB against native DNA
  • No decrease in complement
  • Low Renal and CNS involvement
  • Remits when drug is discontinued
37
Q

General treatments for SLE

A
  1. NSAIDS
  2. Antimalarials
  3. CS
  4. Cytotoxics
    1. (AZT+Cyclophosphamide)
  5. Immune modulators
    1. MMF
    2. Rituximab (Anti-CD20)
    3. Belimumab (anti BAFF)
38
Q

Other labs for SLE

A

WSR + CRP

CBC + UA

Complement levels

ICM Exam 2- Rheumatology (13 decks)

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