SLE Flashcards
Describe hypersensitivity reactions I-IV
Type I = immediate (anaphalactic; atopic)
Type II = cytotoxic; target cell receptors; platelet-thrombocytopenia, Target fixed tissue ag; goodpastures
Type III = immune compex (vasculitis; SLE)***
Type IV: (delayed) cell mediated; Tuberculin rxn, cytotoxic cells destroy target cells (e.g allograft rejection)
SLE:
- what is this?
- MOA
- afffected areas
- MC in which gender? Age?
- cause
What; multisystem autoimmune disorder of unknown cause strongly associated with various autoabys.
MOA: deposition of ag-aby complexes along vascular and tissue basement membranes. Localized inflammatory responses occur: complement, neutrophil migration, cell-mediated tissue injury.
Affected areas: skin, joints, serosal surfaces, muscles, kidneys, heart, lung, CNS, red blood cells, and platelets.
MC in women, 20-40YO
Cause:
- genetics; Chromosome 6; HLA-DR3
- environmental factors:
- -UV light
- -bacterial/viral infections
- -drugs
- endocrine: sex hormones; develops after menarche and before menopause.
- Drug induces: procainamide, hydralazine
SLE:
- MC sx
- sx that might not be so common
MC sx:
- Systemic: low grade fever, photosensitivity
- mouth and nose ulcers
- muscle aches
- arthritis (symmetrical but w/o articular destruction)
- psychological; fatigue and loss of appetite
- butterfly rash on face
- inflammation of pleura and pericardium
- poor circulation (fingers and toes)
Sx:
- alopecia
- fingertip lesions
- periungual erythema
- nail fold infarcts (like hang nail..kinda)
- splinter hemorrhages
- raynauds phenomenon
Renal Features of SLE
- describe characteristics of lupus nephritis
- what is seen on bx of lupus nephritis?
Nephritis:
- glomerulonephritis
- nephrotic syndrome (proteinuria and hyaline casts)
- HTN
Bx lupus nephritis:
- glomerulosclerosis
- fibrous crescents
- interstitial fibrosis
- tubular atrophy
Ocular Manifestations of SLE?
conjuncitivitis
photophobia
transient or permanent monocular blindness
Blurred vision
cotton wool spots on retina
Musculoskeletal features of SLE
Transient symmetric polyarthritis in small and large joints.
–no signs of inflammation
Osteonecrosis of hips
fibromyalgia
Pulmonary features of SLE
Transient basilar pneumonic infiltrates = lupus pneumonitis
Lupus pneumonitis:
- nonproductive cough
- dyspnea
- hypoxemia
Pleural effusions
Pleuritis
Bronchopneumonia
Restrictive lung dz
(RARE) Alveolar hemorrhage with massive hemoptysis and death
Cardiac Features of SLE
Pericarditis
Myocarditis
- tachycardia
- ventricular arrhythmia
- conduction problems
- CHF, cardiomyopathy
Increased Muscle enzymes (MB or CPK)
Libman-sacks endocarditis:
- V. surface vegetations on valves
- vegetation break off may allow colonization
Serositis of SLE
pleuritis
pericarditis
peritonitis
Vascular features of SLE
Raynauds phenomenon
Arterial or venous thrombosis
Lupus vasculitis
Livedo reticularis
GI tract sx of SLE
Transient nonspecific abd pain
increased incidence of primary biliary cirrhosis
Vasculitis of mesentery can cause infarction or perforation of bowel.
CNS features of SLE
very common
Confusion, memory deficits, disorientation, hypomania, delirium, and schizophrenia
grand mal seizures, temporal lobe seizures
Severe HA (MC)
Stroke (anti-phospholipid abys b/c of increased risk of clotting)
MC cause of death of SLE?
infectious complications related to active SLE and immunosuppressive tx is the MC cause of dealth in early active SLE.
SLE Labs -findings of CBC -findings of ESR & CRP -findings of UA which abys are we looking for?
CBC:
- anemia;
- -normocytic, normochromic, hemolytic
- leukopenia
- thrombocytopenia (50-100K)
- Prolonged PTT (from antiphospholipid abys)
ESR and CRP are both elevated.
UA:
- proteinuria
- RBC/WBC
- cellular or hyaline casts.
Abys:
- ANA
- Anti-dsDNA
- Anti-SM
Dx of SLE
dx is clinical, no one test of feature is fully diagnostic.
Dx criteria:
- characteristic rash across the cheek
- discoid lesion rash
- photosensitivty
- oral ulcers
- arthritis
- inflammation of membranes in the lungs, heart, or abd
- evidence of kideny dz
- evidence of severe neurologic dz
- blood disorders, including low red, white blood cells, and platelet counts.
- Immunologic abnormalities
- positive ANA
- *Pt must experience 4 of the criteria before a doc can classify condition as SLE.
