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11-SLE > SLE / TOG > Flashcards

SLE / TOG Flashcards

1
Q

What is the incidence of SLE among people?

A

Women 10: men 1
1 / 500 in childbearing age
Affect : afro- caribbean
Asian

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2
Q

What is the pathophysiology of SLE?

A

1- environmental trigger : ultraviolet light / viral infection ( Epstein barr)
2- genetic : 25 % concordance among monozygotic twins
👉 * polyclonal B- cell activation: ANABs production
* impairment of T- cell regulation

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3
Q

What are the symptoms & signs of SLE ?

A

1- malar rash
2- discoid rash
3- photosensitivity
4- oral ulcers: painless
5- arthritis
6- pleuritis & pericarditis
7- Renal disorder: proteinuria
8- neurological: seizures & psychosis
9- hematological: hemolytic anaemia / leukopenia/ lymphopenia / thrombocytopenia

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4
Q

How is the fertility affected by SLE?

A

is not affected unless:
- ovarian failure: due to high dose of cyclophosphamide
- renal failure: lupus nephritis
- using NSAIDS: luteinized unruptured follicle syn.

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5
Q

Why is it important to detect the presence of anti- Ro/La in women with SLE prior to pregnancy?

A

📌These antibodies associated with congenital heart block + neonatal cutaneous lupus syn. IN 🚩 2% 🚩
[ rarely occur together]
📌They are present in 30% of women with SLE
📌 they are associated with:
- arterial & venous thrombosis
- recurrent miscarriages
- FGR
- fetal loss
- preterm delivery

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6
Q

What are the organs need to be investigated prior to pregnancy in women with SLE?

A

1- cardiac: pulmonary hypertension
Valvar heart disease
2- respiratory : pulmonary fibrosis
3- renal : proteinuria + nephritis +
Renal functions

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7
Q

What are the laboratory tests before pregnancy in women with SLE?

A

APL / Ro / La / dsANA / ANA / C3 /C4
Baseline: CBC - LFTs - KFTs - U&E - urine analysis

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8
Q

When to give advice against pregnancy in women with SLE?

A

Pulmonary hypertension
Sever
Active
Nephritis till control

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9
Q

In what circumstances women with SLE have normal pregnancy outcomes?

A

In the absence of:
Pulmonary HNT
Active disease
APA
Renal involvement

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10
Q

Why is there great concern about pulmonary hypertension in women with SLE?

A

High mortality rate 33%
Occurs rate in women with SLE: 4 %
Mean age 41 y

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11
Q

How is antenatal management in women with SLE?

A

1- 4 weeks review: fetal growth + BP + proteinuria
2- LMWH if previous DVT antenatally + 6w postnatally

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12
Q

What is the management of SLE flares in pregnancy? When the risk of it is high?

A

📌 high risk of flares in pregnancy with active disease 3-6 months prior to conception
📌usually: second half of pregnancy
📌 managed expectantly
📌 BP +proteinuria should be monitored

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13
Q

How to distinguish between preeclampsia & lupus nephritis since high BP + proteinuria exist in both?

A

Suggest lupus nephritis:
1- the presence of hematouria or red cell casts
2- rise in anti- dsDNA titres
3- lupus activity in non- renal organs

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14
Q

What are the adverse outcomes of SLE in pregnancy?

A

Miscarriage- IUGR - PROM - Preterm delivery - IUFD - LBW

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15
Q

What is the fetal scan frequency in women with SLE?

A

1- Growth scan : every 4 w
2- uterine artery doppler: first at
20 w then every 4w if abnormal
3- fetal echocardiogram: if anti-Ro/La is present.

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16
Q

When FGR is more likely to happen in women with SLE?
What is the occurrence rate?

A

Occurrence rate 35% or 1/ 4
More likely to happen: if: APS / HTN / PET

17
Q

What is the usual presentation of fetal heart block associated with maternal anri-Ro/La ? Occurrence rate? Recurrence rate?

A

1-Fixed fetal bradycardia 60-80 /m
Between 18-28 w
2- hydrops fetalis:
🚩 occurrence rate: 2-3% of (+anti-Ro/La)
🚩recurrence rate : 16% in future pregnancies

18
Q

What is the usual presentation of neonatal lupus rash?

A

Annular lesions on the face & scalp
In the first 2 weeks/ persist up to 6 months

19
Q

What is the most common indication for preterm delivery in women with SLE?

A

Preeclampsia
Fetal distress
FGR
📌occurrence rate 20 %

20
Q

What are the medications that are considered safe in women with SLE?
Considered teratogenic?

A

❤Safe:
Prednisolone
Azathioprine
Hydroxychloroquine
🔴Teratogenic:
Methotrexate / cyclophosphamide
Mycophenolate mofetil(MMF)

21
Q

What are the medications that may cause lupus -like syndrome?

A

Hydrazine / quinidine/ diltiazim / isoniazid/ minocycline

22
Q

In what conditions thromboprophylaxis should be considered postnatally in women with SLE?

A

APS +previous DVT + Nephrotic syndrome

23
Q

Regarding conconception in women with SLE what to advice?

A

Avoid estrogen containing pills
( increase the risk of flare)

24
Q

What is the risk of fetal loss in active lupus nephritis?

A

8- 36 %

25
Q

What percentage of women with SLE have associated APLA?

A

30%

26
Q

In postpartum period in women with SLE:

A

High risk of thrombosis
High risk of flares
Estrogen pills should be avoided
Azathioprine is safe

11-SLE (2 decks)

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