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Rheumatology > SLE > Flashcards

SLE Flashcards

1
Q

Types of Hypersensitivity Reactions

A

I: Immediate (anaphylactic)
II: cytotoxic; target cell receptors- platelet-thrombocytopenia; target fixed tissue antigen- goodpastures, M.G.
III: immune complex; vasculitis, SLE
IV: cell mediated- tuberculin reaction, allograft rejection

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2
Q

Describe SLE

A

Antigen-antibody complexes along vascular & tissue basement membranes

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3
Q

Factors Influencing SLE

A 
Genetic
UV light (rash)
Bacterial & viral infections
Drugs
Abnormal stimulation of immune system
Sex hormones
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4
Q

Pathogenesis of SLE

A

B-lymphocyte hyperactivity with exaggerated antibody production
Antigen-antibody complexes deposited along basement membranes of vasculature & tissue
Localized inflammatory responses: complement, neutrophil migration, cell-mediated tissue injury

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5
Q

Course of SLE

A

Onset insidious or acute (rare but devastating)

Characterized by exacerbations & remission

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6
Q

Constitutional Manifestations of Systemic Lupus Erythematosus

A 
Fatigue
Fever
Weight loss
Malaise
Anorexia
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7
Q

Skin Manifestations of SLE

A

Butterfly rash (malar rash)

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8
Q

Systemic Manifestations of SLE

A 
Polyarthritis
Arthralgias
Joint pain
Alopecia
Fingertip lesions
Periungual erythema
Nail fold infarcts
Splinter hemorrhages
Raynaud's phenomenon
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9
Q

Renal Features of SLE

A

Glomerulonephritis
Nephrotic syndrome: proteinuria, hyaline casts
HTN

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10
Q

Ocular Features of SLE

A 
Conjunctivitis
Photophobia
Transient or permanent monocular blindness
Blurred vision
Cotton wool spots on retina
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11
Q

Musculoskeletal Features of SLE

A

Transient polyarthritis with symmetric involvement
Osteonecrosis of hips
Fibromyalgia often present

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12
Q

Pulmonary Features of SLE

A 
Transient basilar pneumonic infiltrates
Pleural effusions
Pleuritis
Bronchopneumonia
Restrictive lung disease
Alveolar hemorrhage with massive hemoptysis (rare)
Death (rare)
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13
Q

Cardiac Features of SLE

A

Pericarditis
Myocarditis: tachycardia, ventricular arrhythmia, conduction problems, CHF, cardiomyopathy
Increased muscle enzymes: MB or CPK
Libman-Sacks Endocarditis: vegetation on valves, break off may allow colonization

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14
Q

Serositis of SLE

A

Pleuritis
Pericarditis
Peritonitis

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15
Q

Vascular Features of SLE

A

Raynaud’s phenomenon
Arterial or venous thrombosis
Lupus vasculitis
Livedo reticularis

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16
Q

GI Tract Features of SLE

A

Transient, non-specific abdominal pain
Increased incidenc of primary biliary cirrhosis
Vasculitis of mesentery can cause infarction or perforation of the bowel

17
Q

CNS Features of SLE

A 
COnfusion
Memory deficits
Disorientation
Hypomania
Delirium
Schizophrenia
Grand mal seizures
Temporal lobe seizures
Severe headaches
Stroke: anti-phospholipid antibodies
18
Q

Labs in SLE

A 
CBC
Elevated ESR & CRP
UA
ANA
Anti dsDNA
Anti ssDNA
AntiENA: anti SM & anti RNP
Elevated nonspecific IgG, IgM levels
Reduced complement levels
Decreased IgA levels
False positive for syphilis
Anti-histone
19
Q

CBC Findings in SLE

A

Normocytic, normochromic, hemolytic anemia
Lymphocytopenia
Thrombocytopenia
Prolonged PTT

20
Q

UA Findings in SLE

A

Proteinuria
RBCs/WBCs
Cellular or hyaline casts

21
Q

Differential Diagnosis of SLE

A 
Antiphospholipid syndrome
Fibromyalgia
Hepatitis C
Lyme disease
Lymphoma, B-cell
MCTD
Polyarteritis Nodosa
Rheumatic fever
Rheumatoid arthritis
Scleroderma
Serum sickness
TTP
22
Q

Diagnosis of SLE

A

Clinical

Criteria for classification of SLE

23
Q

Criteria for Classification of SLE

A 
Characteristic rash across cheek
Discoid lesion rash
Photosensitivity
Oral ulcers
Arthritis
Inflammation of membranes in the lungs, heart, or abdomen
Evidence of kidney disease
Evidence of severe neurologic diseaseBlood disorders
Immunologic abnormalities
Positive ANA
24
Q

Physical Findings of SLE

A

Butterfly rash
HTN
Alopecia
Discoid lesions

25
Q

Lab Findings of SLE

A 
ANA
dsDNA
Anti Sm ribonuclear protein
Hypocomplementemia
UA: WBC, RBC, proteinuria, hyaline casts
26
Q

Goals of Treatment of SLE

A

Incurable
Reducing inflammation
Suppressing the immune system
Closely following patients clinically to identify disease features early

27
Q

Patient Education & Prevention of Disease Flares

A 
Sunscreen & protective clothing
Protective, warm clothing
Avoidance of vasoconstrictive drugs
Psychological support
Routine immunization
28
Q

Pharmacologic Treatment of SLE

A 
Glucocorticoids
Antimalarials
Immunosuppresants
IVIG
Plasmapheresis
Belimumab: fully human monoclonal antibody
29
Q

Drug Induced Lupus Syndrome

A

Musculoskeletal, pulmonary, & polyserositic symptoms
Renal & neurologic disease uncommon
No hypocomplementemia
ANA present but return to normal with removal of drug
Reversal with discontinuation of drug

30
Q

Most Common Culprits of Drug Induced Lupus Syndrome

A 
Procainamide
Hydralazine
Methyldopa
Quinidine
INH
31
Q

Define Discoid Lupus

A

Chronic cutaneous lupus involving plaque-like lesions of the head, scalp,& neck

32
Q

Differential Diagnosis of Drug Induced Lupus

A 
Actinic keratosis
Dermatomyositis
Keratoacanthomas
Granuloma annulare
Lichen planus
Subacute cutaneous lupus
Psoriasis
rosacea
Sarcoidosis
SCC
Syphilis
Warts
33
Q

Goals of Drug Induced Lupus Treatment

A

Improve patients appearance
Control existing lesions & limit scarring
Prevent development of further lesions

34
Q

Treatment of Drug Induced Lupus

A

Sunscreen
Topical corticosteroids
Antimalarial agents

Rheumatology (8 decks)

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