SLE Flashcards
what is SLE
systemic lupus erythematosus
autoimmune disease that cause inflammation in various organs
risk factors of SLE
more common in women
diagnose bw ages of 15-45
SLE more common in African-Americans, Hispanics and Asian-American
external: sun exposure, hormonal and reproductive factors, viruses, drugs, smoking
describe photosensitivity in SLE
exposure to UVA, UVB, artificial lighting can increase disease activity
UV light on epidermal DNA –> inflammation and production of cytokines and oxygen free-radicals
describe role of hormones in SLE
OCPs and postmenopausal hormone therapy may have potential negative side effects for women with SLE
describe role of viruses in SLE
EBV sero-positivity is much higher in patients with SLE
no association w HPV vaccination and autoimmune disease
smoking role in risk for SLE
increased risk of SLE among current smokers
what can trigger SLE?
L-canavanine in alfafa sprouts
also certain drugs
MSK manifestations of SLE
Arthritis
Jaccoud’s arthropathy- ulnar deviation, swan next and boutonniere deformity
skin manifestations of acute SLE
butterfly (malar) rash that spares nasolabial folds
sun exposed skin
skin manifestations of subacute SLE
annular configuration with raised red borders
or
papulosquamous (eczematous or psoriasiform appearance)
skin manifestations of chronic SLE
discoid LE
confined to skin above neck
red, inflamed, coin-shaped lesions
mucosal manifestations of SLE
buccal mucosa most involved
palate and tongue less frequently involved
testing for renal involvement includes:
urinalysis
protein and creatinine excretion
serum creatinine
serology (c3, c4, anti-ds-DNA)
Hematologic abnormalities of lupus
ACD, MAHA, leukopenia, lymphopenia, ITP, TTP
ocular manifestation of SLE
dry eye, keratoconjuctivities sicca as a result of secondary Sjorgren
retinal vasculopathy as cotton wool spots
what does ANA test for
autoantibodies targeting components of cell nucleus
not specific - 10% normal people have it
what does anti-dsDNA test for
autoantibody against DNA
found in 70-80% patients w SLE
levels vary with disease activity
don’t order IgM anti-dsDNA or anti-ssDNA
what does anti-Sm test for
smith antigens are part of ENA (extractable nuclear antigen)
HIGHLY specific for SLE
does not change in titer, need not be monitored
don’t repeat ENA
what are levels of complement proteins in patients with lupus?
diminished serum levels of c3 and c4; complement activation
hereditary deficiency strongly associated with development of SLE
complications from NSAID use in lupus patients include:
transaminitis sun-induced rash edema HTN PUD aseptic meningitis
Rx for lupus
glucocorticoids has been frontline therapy
antimalarials
hydroxychloroquine
