SLE Flashcards
Etiology of SLE
- unknown..
- Hormonal Factors: Estrogen and Androgens
- Genetic factors: Polymorphism
- Environmental Triggers
What are some Environmental triggers for SLE
Diet - Alfalfa Sprouts; Saturated Fats
Hydrazines (aka aromatic amine exposure) - like hair dyes and tobacco smoke
UV light - Natural or Artificial
Pathophysiology of SLE: \_\_\_\_\_\_\_\_\_\_\_\_\_ Abnormalities and \_\_\_\_\_\_\_\_\_\_\_ shift overall will lead to \_\_\_\_\_\_\_\_\_\_\_\_\_
immunological; T Helper Cell; increase in auto-antibodies
Presentation of SLE:
same for every patient or can vary a lot?
varies hella much - even within a patient (a flare up from before may not cause a flare anymore…)
Clinical Features seen in SLE:
Constitutional Sx
fatigue/fever/weight loss
Clinical Features seen in SLE:
Cutaneous
MALAR RASH (aka butterfly rash); Photosensitivity; oral ulcers; alopecia; Discoid Rash; Raynaud’s Phenomenon
Clinical Features seen in SLE:
Renal
Lupus Nephritis (v severe); Hematuria/Proteinuria
Clinical Features seen in SLE:
GI
N/V; Anorexia; Abdominal pain
Clinical Features seen in SLE:
Neurologic
Psychosis, seizures, depression, anxiety
What is Raynaud’s Phenomenon?
vessels in extremities contract - less blood flow - discoloration seen in tips of fingers
Clinical Features seen in SLE:
Cardiovascular
Pericarditis/ CAD / HTN / Valvular disease
Clinical Features seen in SLE:
Pulmonary
Coughing/Dyspnea/Pelurisy
Clinical Features seen in SLE:
Hematologic
Hemolytic anemia; Leukopenia; Thrombocytopenia; ANTIPHOSPHOLIPID Abs
Clinical Features seen in SLE:
Immunologic
Autoantibody Production
ACR Diagnostic Criteria for SLE - what is their mnemonic for it?
DOPAMINE RASH
What does DOPAMINE RASH stand for
its how to diagnose SLE - need 4/11 D - discoid rash O - Oral ulcers P - Photosensitivity A - Arthritis M - Malar rash I - Immunologic Involvement NE - neurologic involvement
R - Renal involvement
A - Antinuclear Ab +
S - Serositis
H - Hematologic Involvement
ACR uses DOPAMINE RASH for SLE Diagnosis - is SLE related to dopamine?
nah
ACR guidelines - how many symptoms are needed to be diagnosed with SLE
4 (out of the possible 11)
What is the SLICC Criteria to be diagnosed with SLE
need 4/17 criteria
- at least 1 immunologic crterion
and
- at least 1 clinical criterion
If don’t use 4/17 criteria for SLICC - you can diagnose with this criteria - Biopsy proven ________ –> Systemic Lupus w/ ________
Nephritis; + ANA and + Anti-dsDNA
Non-Pharm treatment options for SLE:
- Limit sun exposure
- Nutrition (balanced diet during remissions; may need more calories during flares)
- Immunizations (NO LIVE VACCINES in immunocompromised/caution during flares)
- Smoking Cessation (smoking can increase flares)
- Exercise (exercise can control flares)
5 main groups of Pharmacological treatment for SLE
- NSAIDs
- Antimalarial Agents
- Corticosteroids
- Cytotoxic Agents
- Biologic Agents
when using NSAIDs in SLE patients - what ADR is more of a concern in SLE pts over the normal population
Greater incidence of HEPATOTOXICITY can be seen in SLE pts when taking NSAIDs
What are the antimalarial agents used in SLE
hydroxychloroquine and Chloroquine
when to use the antimalarial agents in a SLE pt
if NSAIDs did not work/ there are cutaneous symptoms
what is the first line agent to use in SLE pts and when to use it?
NSAIDs! use for mild arthritis/fever/muscoskeletal pain
Antimalarial ADRs
- RETINAL TOXICITY
- Dermatologic
- CNS
- GI
Biggest thing to monitor for Antimalarial Agents
Ophthalmologic
Corticosteroids - Topical Agents - are ______ line therapy for cutaneous symptoms
second (may be used adjunctively to NSAIDs or anti-malarials)
which medication option can lead to Telangiecatasias
topical corticosteroids can lead to this (its aka “spider veins”)
which agent do you have to check bone mineral density - due to the risk of osteoporosis
SYSTEMIC corticosteroids
what are cytotoxic agents that can be used for SLE
- cyclophosphamide
- Azathioprine
- Mycophenolate mofetil
which agent should decrease its dose if the pt is also taking allopurinol or Febuxostat
Azathioprine
MOA of Azathioprine
inhibits purine synthesis and DNA replication
MOA of Mycophenolate
inhibits proliferation and differentiation of lymphocytes
which drug needs to test for TPMT enzyme before use?
Azathioprine (that enzyme metabolizes the drug - know levels of TPMT - makes dosing more effective)
which cytotoxic drug do you need to test/do urinalysis monitoring?
Cyclophosphamide (bc of bladder cancer risk)
Which cytotoxic drug do you have to chest x-rays for?
Mycophenolate (bc of pulmonary risk)
Antiphospholipid syndrome - importance to SLE pts?
if they have this syndrome they are at a greater risk for clotting
which agent used for SLE - is the drug of choice for pregnant women
Hydroxychloroquine
caution of SLE pt on estrogen containing contraceptives?
if pt with SLE has antiphospholipid syndrome AND on estrogen containing contraceptives (BIG RISK FOR CLOTTING!)
Most Common Drugs that cause Drug Induced Lupus
- Procainamide
- Hydralazine
- Chlorpromazine
