Systematic Lupus Erythematosis

Question 1

SLE is a chronic inflammatory/multisystem disease that primarily affects ___ and ___. May also effect kidneys, lungs, heart, brain

Answer 1

Skin and joints

Question 2

What are risk factors of SLE?

Answer 2

Infections, hypertension, dyslipidemia, atherosclerosis, diabetes

Question 3

What is the clinical presentation of SLE?

Answer 3

Fever, joint pain, rash/ulcers around nose or mouth primarily
Could also have renal failure, HTN, edema, weight gain, photosensitivity

Question 4

True or False? 35% of SLE-related deaths occur in patients <45 years old

Answer 4

True

Question 5

What are drugs that can induce SLE?

Answer 5

Procainamide or hydralazine

Question 6

What is needed in order to diagnose SLE?

Answer 6

Complete blood count:
Leukopenia, hemolytic anemia, thrombocytopenia
Increased SCr
Urinanalysis with microscopy

Question 7

What is nonpharmacologic therapy for SLE?

Answer 7

Sun protection, tobacco cessation, exercise/weight control, pregnancy prevention, treating comorbid conditions

Question 8

What is Lupus Nephritis (LN)?

Answer 8

Persistent proteinuria > 0.5g/day or >3+ by dipstick and/or cellurar casts
Can also be defined based on renal biopsy

Question 9

What are the 6 classes of LN?

Answer 9

1. Minimal mesangial LN
2. Mesangial proliferative LN
3. Focal LN (< 50% of glomeruli)
4. Diffuse LN (> 50% of glomeruli)
5. Membranous LN (can be class 3+5 or 4+5)
6. Advanced sclerosing LN

Question 10

How do you treat the 6 classes of LN?

Answer 10

1/2: no immunosuppression needed
3/4: steroids + immunosuppression
5/6: prednisone + mycophenolate mofetil (MMF)

Question 11

All SLE patients with LN will receive what medication?

Answer 11

Hydrochloroquine

Question 12

In a patient with LN, if proteinuria > 0.5g/24, you add what medication?

Answer 12

ACE-I or ARB

Question 13

What is the BP goal of SLE patients?

Answer 13

< 130/80

Question 14

Initiate a statin in an SLE patient if their LDL > ___

Answer 14

100mg/dL

Question 15

What medication may exacerbate SLE?

Answer 15

Sulfonamides

Question 16

There is a sulfa allergy in up to ___% of SLE patients

Answer 16

30%

Question 17

What immunizations should be given to a patient with SLE once they are stable?

Answer 17

Pneumococcal, influenza, hepatitis B, HPV, haemophilus influenzae, and meningiococcal if splenectomized
Live vaccines must be administered at least 4 weeks prior to starting immunosuppressive drugs or 1 month after stopping (varicella, MMR, yellow fever)

Question 18

What type of counseling is critical for a patient with SLE?

Answer 18

Contraception counseling

Question 19

True or False? Pregnancy in a patient with SLE has a low risk of flares and lower complication rates

Answer 19

False. High risk of flares and higher complication rates

Question 20

A patient with SLE should avoid pregnancy within ___ months of a flare up, acute LN, or stroke

Answer 20

6

Question 21

Teratogenic drugs should be stopped ___ months prior to contraception

Answer 21

3

Question 22

How do you manage SLE flares for a pregnant patient?

Answer 22

Azathioprine < 2mg/kg/day
Steroids
Cyclophosphamide (last line)

Question 23

What medications are used to manage HTN in a pregnant patient?

Answer 23

Methyldopa or labetalol

Question 24

What medications should be avoided in a pregnant patient with SLE?

Answer 24

ACE-Is, ARBs, diuretics, NSAIDs