systemic lupus erythematosus Flashcards

1
Q

What % of patients with SLE have skin findings? Which cutaneous lupus is most commonly seen?

A
  • 80%, ACLE is most common
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2
Q

African americans have a ____ fold increased incidence of SLE and presents (earlier/later) with (higher or lower mortality)

A

4 fold increased incidence, presents earlier and has higher mortality

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3
Q

Pathogenesis of SLE:

A
  • 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
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4
Q

What are the susceptibility loci conferring the highest risk for SLE?

A
  • genes encoding early complement components (C1,2,3)
  • TREX1
  • ITGAM
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5
Q

What are the environmental triggers for SLE?

A
  • sunlight

- cigarettes

- infections

  • Vitamin D deficiency
  • estrogen
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6
Q

What are the SLE diagnostic criteria?

A
  • 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
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7
Q

SLE patients with _____ are at increased risk of complications.

A

lupus nephritis

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8
Q

What are possible fetal compliocations with pregnant SLE patient?

A
  • preterm birth
  • preeclampsia
  • fetal loss
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9
Q

Anticardiolipin antibodies in pregnant patient with SLE associated with_______

A

- increased risk of fetal loss

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10
Q

Treatment for pregnant patient with SLE?

A
  • continue Hydroxychloroquine and low dose steroids
  • can consider azathioprine
  • anticoagulation for APLS
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11
Q

What complement abnormalities do you see in SLE?

A
  • decreased total complement levels
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12
Q

Autoantibodies against C1q in SLE patient is a/w_____

A
  • severe SLE nephritis
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13
Q

What routine labs are significant in SLE?

A
  • increased inflam markers (ESR CRP)
  • hemolytic anemai (coombs positive)
  • leukopenia or lymphopenia
  • thrombocytopenia
  • proteinuria
  • hematuria
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14
Q

what percent of SLE have a positive ANA?

A
  • 99%, very sensitive (good screening)
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15
Q

What are the highly specific antibodies for SLE?

A
  • Anti-ds DNA and Anti-smith
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16
Q

Which antibodies are a/w neuropsychiatric SLE?

A
  • Anti-RNP
17
Q

Drug induced lupus antibody?

A

Anti-histone

18
Q

What are the three antiphospholipid antibodies?

A
  1. anti-Beta 2 glycoprotein antibody

2. anti-cardiolipin

3. lupus anticoagulant

19
Q

Treatment for mild SLE (no life threatenting visceral organ involvement)?

A
  • hydroxychloroquine and NSAIDS
20
Q

Treatment for moderate-severe SLE lacking renal involvment?

A
  • prednisone + steroid sparing agent ( azathioprine, MTX, MMF)
21
Q

Treatment for severe active SLE w/ renal involvement?

A

high dose prednisone + pulsed IV cyclophosphamide or MMF

22
Q

Treatment options for moderate-severe recalcitrant SLE?

A
  • Rituximab

- Belimumab

23
Q

Prognosis of SLE with childhood onset?

A
  • higher risk of lupus nephritis and mortality
24
Q

most common causes of death in SLE in first 5 years? After 5 years?

A
  • in first 5 years= inflammatory lesions of SLE and infection
  • after that, arterial (MI), venous thromboses