Systemic Lupus Erythematosus

Question 1

What is lupus?

Answer 1

complex multisystemic autoimmune disease characterized by presence of autoreactive B and T cells and the production of a broad, heterogenous group of autoantibodies

Question 2

What is a common antibody that is produced in lupus?

Answer 2

antinuclear (anti DNA) antibody

Question 3

Pathogenesis of lupus

Answer 3

genetic predisposition and environmental exposures
loss of self tolerance
immune activation

Question 4

Risk factors for lupus

Answer 4

women 15-44 y/o
BIPOC
UV light, infection, virus, stress
estrogen?

Question 5

Why might estrogen be associated with lupus?

Answer 5

lupus symptoms develop before menstruation and during pregnancy when estrogen levels are high

Question 6

What does loss of self tolerance mean?

Answer 6

production of autoantibodies without regulation

Question 7

What happens with immune activation?

Answer 7

T and B cells are hyperactive and the innate immune system is activated causing inflammation leading to tissue damage and clinical manifestation of the disease

Question 8

How is lupus diagnosed?

Answer 8

CBC, antibody (ANA, anti dsDNA), complement test, blood clotting tests, urine test, biopsies

Question 9

Criteria for diagnosis of lupus

Answer 9

need at least 4 serial or simultaneous from the classification list

Question 10

Criteria for classification of lupus

Answer 10

malar rash, photosensitivity, oral or nasopharyngeal ulcers, discoid rash, renal disorder, serositis, neurologic disorders, hematologic disorders, immunologic disorders, nonerosive arthritis of at least 2 peripheral joints, presence of ANA

Question 11

Signs and symptoms of lupus

Answer 11

Headaches, fever, hair loss, butterfly shaped rash across cheeks and nose, mouth or nose ulcers, abnormal blood clotting, sun or light sensitive, swelling (feet, leg, hands, around eyes), painful or swollen joints, anemia, pain in chest, fingers turning blue or white when cold (Raynaud’s)

Question 12

What are the 4 types of lupus?

Answer 12

systemic lupus erythematous
drug induced lupus erythematous
cutaneous lupus erythematous
neonatal lupus

Question 13

CNS effects of SLE

Answer 13

vasculitis, anxiety, depression, psychosis, seizures, stroke

Question 14

Blood effects of SLE

Answer 14

thrombocytopenia, anemia, leukopenia, antiphospholipid syndrome leading to embolism

Question 15

Heart effects of SLE

Answer 15

pericarditis, pericardial effusions, CHF, HTN

Question 16

Joint effects of SLE

Answer 16

arthritis, avascular necrosis d/t steroid use leading to needing joint replacement

Question 17

Kidney effects of SLE

Answer 17

nephritis, proteinuria, hypoalbuminemia, hematuria, renal failure

Question 18

Lung effects of SLE

Answer 18

pleural effusions, restrictive lung disease, atelectasis

Question 19

Airway effects of SLE

Answer 19

mucosal ulceration, cricoarytenoid arthritis, recurrent laryngeal nerve palsy

Question 20

What are the 3 main culprits that cause drug induced lupus?

Answer 20

Hydralazine, Procainamide, and Isoniazid

Question 21

How does drug induced lupus differ from SLE?

Answer 21

Signs and symptoms usually disappear 6 months after stopping the drug
Doesn’t mimic parts of SLE that are more severe
More cutaneous manifestations

Question 22

Where does cutaneous lupus cause rashes and discoid lesions?

Answer 22

face, arms, neck, shoulders, trunk

Question 23

How is cutaneous lupus affected?

Answer 23

Affected by sunlight and fluorescent

Question 24

Pregnancy risks of activating lupus

Answer 24

pre-eclampsia, pre-term delivery, miscarriages, intrauterine growth restrictions

Question 25

How does neonatal lupus present?

Answer 25

skin rash, liver problems, low blood counts, congenital heart blocks potentially needing pacemakers

Question 26

What are two antibodies that can be screened for in women looking to get pregnant?

Answer 26

anti SSA - RO

anti SSA - LA

Question 27

Treatment for lupus includes

Answer 27

NSAIDs, tylenol, immunosuppressants, corticosteroids, antimalarials, anticoagulants, monoclonal antibodies, repository corticotropin injections

Question 28

Which agent is the only FDA approved treatment for lupus?

Answer 28

Belimumab which is a monoclonal antibody agent

Question 29

Our pre-anesthesia evaluation is influenced by

Answer 29

magnitude of organ system dysfunction, drugs used to treat SLE, and any airway involvement

Question 30

What kinds of questions may we want to ask or think about with a patient who has SLE?

Answer 30

When was the last flare?
What does their lupus attack look like?
What things do they worry about during a flare?
When was their last rheumatologist visit and lab work?
Was there any recent changes to medications?