systemic lupus erythematosus Flashcards
What % of patients with SLE have skin findings? Which cutaneous lupus is most commonly seen?
- 80%, ACLE is most common
African americans have a ____ fold increased incidence of SLE and presents (earlier/later) with (higher or lower mortality)
4 fold increased incidence, presents earlier and has higher mortality
Pathogenesis of SLE:
- environmental factors + genetics:
- patients have type I gene signature in peripheral blood leukocytes
- phagocytic defect of monocytes and macrophages to clear apoptotic cells which causes autoreactive B cells to undergo class switching specific for DNA nuclear antigens and release of inflammatory cytokines
What are the susceptibility loci conferring the highest risk for SLE?
- genes encoding early complement components (C1,2,3)
- TREX1
- ITGAM
What are the environmental triggers for SLE?
- sunlight
- cigarettes
- infections
- Vitamin D deficiency
- estrogen
What are the SLE diagnostic criteria?
- Need four items (at least one clinical and one immunological) Or biopsy proven nephrities compatible w/ SLE in presence of positive ANA or anti-ds-DNA antibodies
SLE patients with _____ are at increased risk of complications.
lupus nephritis
What are possible fetal compliocations with pregnant SLE patient?
- preterm birth
- preeclampsia
- fetal loss
Anticardiolipin antibodies in pregnant patient with SLE associated with_______
- increased risk of fetal loss
Treatment for pregnant patient with SLE?
- continue Hydroxychloroquine and low dose steroids
- can consider azathioprine
- anticoagulation for APLS
What complement abnormalities do you see in SLE?
- decreased total complement levels
Autoantibodies against C1q in SLE patient is a/w_____
- severe SLE nephritis
What routine labs are significant in SLE?
- increased inflam markers (ESR CRP)
- hemolytic anemai (coombs positive)
- leukopenia or lymphopenia
- thrombocytopenia
- proteinuria
- hematuria
what percent of SLE have a positive ANA?
- 99%, very sensitive (good screening)
What are the highly specific antibodies for SLE?
- Anti-ds DNA and Anti-smith