Systemic Lupus Erythematosus Flashcards
What is lupus?
complex multisystemic autoimmune disease characterized by presence of autoreactive B and T cells and the production of a broad, heterogenous group of autoantibodies
What is a common antibody that is produced in lupus?
antinuclear (anti DNA) antibody
Pathogenesis of lupus
genetic predisposition and environmental exposures
loss of self tolerance
immune activation
Risk factors for lupus
women 15-44 y/o
BIPOC
UV light, infection, virus, stress
estrogen?
Why might estrogen be associated with lupus?
lupus symptoms develop before menstruation and during pregnancy when estrogen levels are high
What does loss of self tolerance mean?
production of autoantibodies without regulation
What happens with immune activation?
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
How is lupus diagnosed?
CBC, antibody (ANA, anti dsDNA), complement test, blood clotting tests, urine test, biopsies
Criteria for diagnosis of lupus
need at least 4 serial or simultaneous from the classification list
Criteria for classification of lupus
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
Signs and symptoms of lupus
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)
What are the 4 types of lupus?
systemic lupus erythematous
drug induced lupus erythematous
cutaneous lupus erythematous
neonatal lupus
CNS effects of SLE
vasculitis, anxiety, depression, psychosis, seizures, stroke
Blood effects of SLE
thrombocytopenia, anemia, leukopenia, antiphospholipid syndrome leading to embolism
Heart effects of SLE
pericarditis, pericardial effusions, CHF, HTN
Joint effects of SLE
arthritis, avascular necrosis d/t steroid use leading to needing joint replacement
Kidney effects of SLE
nephritis, proteinuria, hypoalbuminemia, hematuria, renal failure
Lung effects of SLE
pleural effusions, restrictive lung disease, atelectasis
Airway effects of SLE
mucosal ulceration, cricoarytenoid arthritis, recurrent laryngeal nerve palsy
What are the 3 main culprits that cause drug induced lupus?
Hydralazine, Procainamide, and Isoniazid
How does drug induced lupus differ from SLE?
Signs and symptoms usually disappear 6 months after stopping the drug
Doesn’t mimic parts of SLE that are more severe
More cutaneous manifestations
Where does cutaneous lupus cause rashes and discoid lesions?
face, arms, neck, shoulders, trunk
How is cutaneous lupus affected?
Affected by sunlight and fluorescent
Pregnancy risks of activating lupus
pre-eclampsia, pre-term delivery, miscarriages, intrauterine growth restrictions
How does neonatal lupus present?
skin rash, liver problems, low blood counts, congenital heart blocks potentially needing pacemakers
What are two antibodies that can be screened for in women looking to get pregnant?
anti SSA - RO
anti SSA - LA
Treatment for lupus includes
NSAIDs, tylenol, immunosuppressants, corticosteroids, antimalarials, anticoagulants, monoclonal antibodies, repository corticotropin injections
Which agent is the only FDA approved treatment for lupus?
Belimumab which is a monoclonal antibody agent
Our pre-anesthesia evaluation is influenced by
magnitude of organ system dysfunction, drugs used to treat SLE, and any airway involvement
What kinds of questions may we want to ask or think about with a patient who has SLE?
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?
