SLE -Dr. Lee

Question 1

What is SLE?

Answer 1

“Inflammatory heterogeneous autoimmune disorder affecting multiple organ systems characterized by the production of auto-antibodies directed against cell nuclei”

-Immune complex deposition–> inflammation and vasculitis

Question 2

What age and sex is most likely diagnosed with lupus?

Answer 2

14-45 yo=peak incidence
child bearing years

females: males= 10:1

severity is the same in men and women.

not as common in caucasians

Question 3

What is a leading genetic contributor for lupus?

Answer 3

STAT 4

also predictive of RA

Question 4

What are some features of the discoid rash commonly seen in SLE?

Answer 4

Erythematous raised patches with adherent keratotic scaling and follicular plugging;

Atrophic scarring may occur in older lesions

Central clearing

Question 5

What else can feature photosensitive rashes (in addition to SLE)?:

1. scleroderma
2. cutaneous vasculitis
3. psoriatic arthritis
4. dermatomyositis

Answer 5

4. dermatomyositis

Question 6

A 42 yo woman with lupus since age 15 develops dyspnea and 2 hours of left sided substernal chest pressure with recent moderate exertion. What is the best course?

1. Treat for fibromyalgia
2. High dose steroids
3. Evaluation for acute coronary syndrome
4. Anti-anxiolytics

Answer 6

3. Evaluation for acute coronary syndrome

Question 7

***What are the 3 antiphospholipid antibodies for SLE??

Answer 7

• Lupus anticoagulant-antibodies to coagulation factors. Prolonged aPTT
• Anti-cardiolipin
• Anti-beta 2 glycoprotein

Question 8

What tests are specific for SLE?

Answer 8

Anti-dsDNA

Anti-Sm (Smith)

Question 9

Is ANA specific for SLE?

Answer 9

NO! but it is very sensitive

Question 10

What are some clinical findings in SLE?

Answer 10

• malar rash
• discoid rash
• oral ulceration
• alopecia
• Jaccoud’s arthritis***–> non erosive, reducible arthritis, can pull finger back into alignment

Question 11

What is an emergent condition associated with SLE?

Answer 11

pulmonary hemorrhage

life-threatening

Question 12

What hematologic issues can be seen in a SLE pt?

Answer 12

hemolytic anemia -AHA

leukopenia

lymphopenia

thrombocytopenia

all cells affected=pancytopenia

Question 13

What is the hallmark finding for renal problems in SLE pts (lupus nephritis)?

Answer 13

proteinuria (>0.5 g/day)

*most frequent cause of disease related death

Question 14

What is the diagnostic criteria for SLE?

Answer 14

4 of 11 things on the list

at least 1 clinical and 1 lab finding

Question 15

What is antiphospholipid syndrome (APS)?

Answer 15

-Hypercoagulability with recurrent thrombosis of either venous or arterial circulation
-Thrombocytopenia-common
-Pregnancy complication-recurrent miscarriages in first trimester
-
CAPS (catastrophic antiphospholipid antibody syndrome) is an emergency***

Question 16

What is the treatment for mild SLE? (mild skin or joint involvement)

Answer 16

NSAID +/- low dose glucocorticoids

-hydroxychloroquine

Question 17

What is the treatment for intermediate SLE? (serositis, cytopenia, marked skin or joint involvement)

Answer 17

• glucocorticoids (1 mg/kg/day)
• Azathioprine
• Methotrexate, Leflunomide
• Mycophenolate mofetil

Question 18

What is the treatment for severe SLE? (life-threatening organ involvement)

Answer 18

• high-dose IV or PO glucocorticoids (up to 1000 mg/day x 3 days)
• IV cyclophosphamide
• plasmapheresis
• IV immunoglobulin
• mycophenolate mofetil for nephritis
• Anticoagulation for APS/CAPS
• BENLYSTA

Question 19

What lab test should be used to monitor SLE?

Answer 19

CBC, UA, urine protein/creatinine

• ESR and CRP to monitor disease activity
• complement and anti-dsDNA to correlate to disease activity

pt clinical history