SLE / TOG Flashcards
What is the incidence of SLE among people?
Women 10: men 1
1 / 500 in childbearing age
Affect : afro- caribbean
Asian
What is the pathophysiology of SLE?
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
What are the symptoms & signs of SLE ?
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
How is the fertility affected by SLE?
is not affected unless:
- ovarian failure: due to high dose of cyclophosphamide
- renal failure: lupus nephritis
- using NSAIDS: luteinized unruptured follicle syn.
Why is it important to detect the presence of anti- Ro/La in women with SLE prior to pregnancy?
📌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
What are the organs need to be investigated prior to pregnancy in women with SLE?
1- cardiac: pulmonary hypertension
Valvar heart disease
2- respiratory : pulmonary fibrosis
3- renal : proteinuria + nephritis +
Renal functions
What are the laboratory tests before pregnancy in women with SLE?
APL / Ro / La / dsANA / ANA / C3 /C4
Baseline: CBC - LFTs - KFTs - U&E - urine analysis
When to give advice against pregnancy in women with SLE?
Pulmonary hypertension
Sever
Active
Nephritis till control
In what circumstances women with SLE have normal pregnancy outcomes?
In the absence of:
Pulmonary HNT
Active disease
APA
Renal involvement
Why is there great concern about pulmonary hypertension in women with SLE?
High mortality rate 33%
Occurs rate in women with SLE: 4 %
Mean age 41 y
How is antenatal management in women with SLE?
1- 4 weeks review: fetal growth + BP + proteinuria
2- LMWH if previous DVT antenatally + 6w postnatally
What is the management of SLE flares in pregnancy? When the risk of it is high?
📌 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
How to distinguish between preeclampsia & lupus nephritis since high BP + proteinuria exist in both?
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
What are the adverse outcomes of SLE in pregnancy?
Miscarriage- IUGR - PROM - Preterm delivery - IUFD - LBW
What is the fetal scan frequency in women with SLE?
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.
When FGR is more likely to happen in women with SLE?
What is the occurrence rate?
Occurrence rate 35% or 1/ 4
More likely to happen: if: APS / HTN / PET
What is the usual presentation of fetal heart block associated with maternal anri-Ro/La ? Occurrence rate? Recurrence rate?
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
What is the usual presentation of neonatal lupus rash?
Annular lesions on the face & scalp
In the first 2 weeks/ persist up to 6 months
What is the most common indication for preterm delivery in women with SLE?
Preeclampsia
Fetal distress
FGR
📌occurrence rate 20 %
What are the medications that are considered safe in women with SLE?
Considered teratogenic?
❤Safe:
Prednisolone
Azathioprine
Hydroxychloroquine
🔴Teratogenic:
Methotrexate / cyclophosphamide
Mycophenolate mofetil(MMF)
What are the medications that may cause lupus -like syndrome?
Hydrazine / quinidine/ diltiazim / isoniazid/ minocycline
In what conditions thromboprophylaxis should be considered postnatally in women with SLE?
APS +previous DVT + Nephrotic syndrome
Regarding conconception in women with SLE what to advice?
Avoid estrogen containing pills
( increase the risk of flare)
What is the risk of fetal loss in active lupus nephritis?
8- 36 %
What percentage of women with SLE have associated APLA?
30%
In postpartum period in women with SLE:
High risk of thrombosis
High risk of flares
Estrogen pills should be avoided
Azathioprine is safe
