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MSK 2 > SLE > Flashcards

SLE Flashcards

1
Q

SLE is a ___ autoimmune disorder associated with the production of ______

A

multi system

production of multiple antibodies

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2
Q

cause of SLE?

A

unknown

(in bold)

pts are genetically predisposed coupled with stimuli/trigger

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3
Q

SLE MC affects

A

Women
Women of Color (AA, Asian)
Young (20-30)*

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4
Q

SLE risk factors

A
  1. Immune system dysregulation
  2. Genetics (MC in daughter/mom)
  3. Hormonal (sex hormones)
  4. Environmental (geographic clusters)
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5
Q

characteristic manifestations of SLE

A

periods of active disease and periods of remission are

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6
Q

SLE flares caused by

A

illness, stress, or no identifiable cause

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7
Q

pathophysiologic mechanisms of SLE (2)

A
  1. trapping of immune complexes

2. direct autoimmune attack

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8
Q

trapping of immune complexes in SLE + symptoms

A

complexes in small blood vessels get trapped

causes plugging of the small capillaries that limit blood supply

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9
Q

direct autoimmune attack in SLE

A

direct attack - cell dysfunction and death

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10
Q

classic triad of SLE (+who gets it?)

A

Fevers
Rash
Joint pain

women of child bearing age

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11
Q

lupus mainly involves which systems

A 
Skin 
joints 
kidney 
blood cells
nervous system
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12
Q

constitutional symptoms of SLE

A
  1. fever (low grade)
  2. fatigue/diminished exercise tolerance
  3. myalgias
  4. weight changes
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13
Q

pt is classified as SLE IF

A
  1. biopsy proven lupus nephritis + ANAN or anti-dsDNA Abs

2. satisfies 4 of 11 diagnostic criteria (1 clinical and 1 immunologic)

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14
Q

diagnostic criteria of SLE

A

4/11 - SOAP BRAIN MD

Serositis
Oral Ulcers
Arthritis
Photosensitivity

Blood disorders 
Renal involvement 
Antinuclear ABs
Immunologic phenomena 
Neurologic disorder

Malar rash
Discoid rash

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15
Q

derm manifestations of lupus

A

malar rash
discoid rash
photosensitivity rash
oral nasal ulcerations

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16
Q

malar rash

A

“butterfly” pattern of fixed erythema of cheeks (malaria eminences) and bridge of nose

SPARES nasolabial folds

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17
Q

discoid lesions

A

erythematous raised patches with thick adherent KERATOTIC scaling

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18
Q

how to distinguish malar rash from rosacea

A

scaling in malar rash

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19
Q

photosensitivity rash

A

reaction to sunlight

face and hands

occurs AFTER sun exposure

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20
Q

arthritis in SLE

A

non erosive, non derforming arthritis of two or more peripheral joints with tenderness, swelling, effusion

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21
Q

where is arthritis MC in SLE

A

MCP, PIP, wrists

migratory and fleeting

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22
Q

positive ANA

A

> 1:160

speckled centromere pattern is most specific

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23
Q

renal manifestations of lupus

A 
proteinuria (0.5gm/day)
cellular casts (red cell casts)
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24
Q

serositis

A

inflammation of any serial membrane

pleuritis, pleural/pericardial effusion or pericarditis

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25
Q

symptoms of pericardial effusion

A

feels better when patient leans forward

friction rub on exam

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26
Q

heme criteria

A
  1. hemolytic anemia
  2. leukopenia (<4k)
  3. lymphopenia (<1.5k)
  4. thrombocytopenia (<100k)
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27
Q

hemolytic anemia in SLE

A

elevated LDH
bilirubin
decreased haptoglobin

USUALLY Coombs +

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28
Q

immunologic abnormalities of SLE

A

anti-DNA antibodies

antibodies to Sm

presence of antiphospholipid antibodies

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29
Q

neuro criteria of SLE

A

seizures or psychosis

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30
Q

diagnostic imaging

A

Joint radiographs

CT scan of chest/abdomen/pelvis

MRI of brain

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31
Q

where to start with SLE lab evaluation

A

quantitative ANA

if > 1:160+ get more

32
Q

secondary SLE labs

A
  1. ssDNA and dsDNA (HIGH specificity)
  2. Anti Sm
  3. Lupus anticoagulant
  4. anti-cariolipin antibodies
  5. anti-Ro and anti-La
  6. complement
  7. ESR, CRP
33
Q

urinalysis and SLE

A

microscopy + spot CR to protein ratio

34
Q

goals of SLE tx

A
  1. immunosuppression
  2. reduction of inflammation
  3. ID and reduce new onset of disease
35
Q

tx considerations

A

disease and treatment causes morbidity and mortality

early rheumatology referrals and close management

36
Q

behavioral tx of SLE

A

healthy diet,

avoid tobacco,

exercise,

annual CV risk assessment,

family planning

sunscreen and protective
clothes

vitamin D and Ca
supplementation

low dose aspirin

routine immunizations

37
Q

why must SLE pts have routine immunizations

A

aggressive tx

pts are immunosuppressed

non live vaccines are given during stable dz

38
Q

all medications used to treat lupus cause

A

bone marrow suppression

worsen hematologic abnormalities on CBC

39
Q

what drugs don’t cause bone marrow suppression?

A

hydroxychloroquine (Plaquenil)

40
Q

categories of drugs used to treat SLE

A
  1. anti-malarials
  2. NSAIDs
  3. Glucocorticoids
  4. DMARDs
41
Q

antimalarials

A

mainstay of tx

decrease flares and prolong life

42
Q

anti-malarials are most useful for

A

fevers
arthritis
muco-cutaneous symptoms

43
Q

anti-malarials example

A

hydroxychloroquinalone (Plaquenil)

44
Q

NSAID use in therapy

A

anti-inflammatory

control of arthritis, HA, serositis systems

monitor for renal and liver toxicities

45
Q

glucocorticoids use in therapy

A

main agent for flares (high dose)

46
Q

ADRs in glucocorticoids

A

toxicities

obesity, DM, osteoporosis, AVN, ocular dx, increased infection risk

47
Q

non biologic DMARDs when?

A

symptoms of dz are severe

OR they are not well controlled to allow for discontinuing steroids

48
Q

non biologic DMARDs list

A

Azathioprine (imuran)
Mycophenolate mofetil (cellcept, myfortic)
methotrexate (arthritis)

49
Q

biologic DMARDs list

A

Belimumab (Benlysta)

Rituximab (Rituxan)

50
Q

when do you use biologic DMARDs

A

SLE is refractory to other tx

51
Q

family planning SLE

A

Intact fertility

pregnancy may worsen SLE and meds used to tx SLE are teratogens

appropriate contraception is essential in these patients

52
Q

safe family planning methods SLE

A

IUDS

Non hormonal barrier methods

53
Q

unsafe family planning SLE

A

estrogen products, Depo Shot

risk of osteoporosis

54
Q

pregnancy and SLE

A

causes SEVERE flares in patients

higher rates of spontaneous abortion and prematurity (Esp. at time of pregnancy)

55
Q

CVD in SLE

A

substantially increased risk of coronary artheriosclerotic disease

ESP. accelerated sclerotic disease

56
Q

leading cause of death in SLE

A

CV mortality

57
Q

when is CVD risk highest in pts?

A

prior to or within a few years of diagnosis

58
Q

cause of renal disease

A

occurs insidiously from dz or result of medications

59
Q

when should we preform a renal biopsy in SLE?

A
  1. increasing Cr w/o cause
  2. greater than 1 g proteinuria/24 hrs
  3. greater than 0.5 g proteinuria/24 hrs on hematuria or cellular casts on UA
60
Q

what symptoms/signs might occur in a flare?

A

new AKI or psychosis/seizure

elevated fevers

worsen joint

61
Q

treatment of an SLE flare

A

corticosteroid

62
Q

heme disease in SLE

A

have some at baseline + medications worsen it

must determine if infection or flare

63
Q

SLE infection heme abnormalities

A
  1. high fever
  2. leukocytosis
  3. thrombocytosis
  4. both ESR and CRP elevated
  5. Stable complement and dsDNA levels
64
Q

SLE disease flare or meds heme abnormalities

A
  1. afebrile/low grade
  2. lymphopenia
  3. thrombocytopenia
  4. ESR elevation, CRP normal
  5. hypocomplementemia, increased dsDNA
65
Q

life threatening SLE (4 main manifestations)

A
  1. lupus nephritis
  2. lupus cerebritis
  3. pulmonary hemorrhage
  4. vasculitis of small vessels
66
Q

drugs to avoid in SLE

A

sulfa drugs and estrogens

67
Q

pts with SLE are also at an increased risk for

A

CAD

68
Q

dx of lupus requires

A

CAD screening

69
Q

early causes of death in pts with SLE (5-10 yrs from diagnosis)

A

opportunistic infection

severe disease

70
Q

later cause of death in pts with SLE

A

MI or CVA 2/2 accelerated arteriosclerosis

71
Q

pts who survive long term must be monitored for

A

CAD
Cancer
AVN

72
Q

what must be excluded in pts with SLE diagnosis

A

drug induced lupus

73
Q

how does drug induced lupus present

A

mild arthritis, serositis, skin and constitutional symptoms

rare CNS or renal involvement

74
Q

drug induced lupus epi

A

individuals 50-70s

M=F

caucasians MC

75
Q

tx of drug induced lupus

A

withdrawal of drug

MSK 2 (10 decks)

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