Systemic Lupus Erythematosus

Question 1

SLE - Environmental Risk Factors

Answer 1

UV light
stress
smoking
drugs
viruses

Question 2

SLE - Hormonal Risk Factors

Answer 2

estrogen
prolactin

Question 3

SLE - Pre-Clinical Phase Pathophysiology

Answer 3

B-cell & T-cell overactivation
elevated CD4:CD8 ratio
dysregulation of cellular apoptosis

Question 4

SLE - Clinical Phase Pathophysiology

Answer 4

autoantibody production -> immune complexes form and deposit in vasculature and tissues -> Type III hypersensitivity reaction -> inflammation -> organ involvement

Question 5

SLE - Diagnostic Criteria

Answer 5

4/11 needed to diagnose
serositis
oral ulcers
arthritis
photosensitivity
blood disorders
renal involvement
antinuclear antibodies
immunology
neurologic disorder
malar rash
discoid rash

Question 6

SLE - Signs & Symptoms

Answer 6

fatigue
fever
weight loss
myalgia
Raynaud’s syndrome
dyspepsia, abdominal pain
alopecia
dry eyes

Question 7

SLE - Antibodies Involved

Answer 7

antinuclear
anti-dsDNA
anti-Sm
antiphospholipid

Question 8

Antiphospholipid Syndrome

Answer 8

aPL (+) and thrombotic event

Question 9

Lupus Nephritis

Answer 9

kidney inflammation due to deposition of immune complexes in either glomeruli or glomerular basement membrane

Question 10

Lupus Nephritis - Diagnostic Criteria

Answer 10

persistent proteinuria or cellular casts
renal biopsy to confirm

Question 11

Lupus Nephritis - Clinical Presentation

Answer 11

foamy urine
peripheral edema
concomitant hypertension

Question 12

SLE - Maintenance Drug of Choice

Answer 12

hydroxychloroquine 200-400 mg QD

Question 13

Hydroxychloroquine - Adverse Reactions

Answer 13

flu-like symptoms
ocular toxicity
allergic skin eruptions
hematological changes
GI upset
cardiomyopathy

Question 14

SLE - Glucocorticoids’ Role in Therapy

Answer 14

adjunctive treatment for moderate-to-severe initial presentation / organ- or life-threatening SLE / inadequate response to hydroxychloroquine / poor QOL

Question 15

SLE - Belimumab’s Role in Therapy

Answer 15

adjunctive treatment - to be used in combination with standard
B-lymphocyte stimulator antagonist
preferred in: non-active-CNS, LN III / IV / V

Question 16

Belimumab - Adverse Reactions

Answer 16

NVD
infusion reactions
depression / CNS effects
PML
infections

Question 17

SLE - Anifrolumab’s Role in Therapy

Answer 17

adjunctive treatment - to use in combination with standard
interferon antagonist
NOT in active LN or CNS disease

Question 18

SLE - Immunosuppressants’ Role in Therapy

Answer 18

refractory disease
organ-threatening SLE (mainly LN)

Question 19

SLE - Immunosuppressants

Answer 19

azathioprine
cyclophosphamide
cyclosporine
methotrexate
mycophenolate
rituximab
tacrolimus

Question 20

SLE - Methotrexate Indications

Answer 20

concomitant RA or primary presentation of arthritis

Question 21

SLE - Azathioprine Indications

Answer 21

second line after steroids for a moderate disease course
safest in class in pregnancy

Question 22

SLE - Mycophenolate Indications

Answer 22

mainly proliferative LN
second line in membranous LN

Question 23

SLE - Cyclosporine Indication

Answer 23

membranous LN

Question 24

SLE - Rituximab Indications

Answer 24

off-label severe renal / psychiatric / hematologic disease
last line

Question 25

SLE - Tacrolimus Indications

Answer 25

proliferative LN may be used with MMF

Question 26

SLE - Voclosporin Indications

Answer 26

adjunctive to other immunosuppressants in active LN (except cyclosporine)

Question 27

Voclosporin - BBWs

Answer 27

infections malignancies

Question 28

Voclosporin - eGFR Cut-Off

Answer 28

45 mL/min

Question 29

SLE Skin Disease - First-Line Agents

Answer 29

topical steroids topical CNIs hydroxychloroquine

Question 30

Mild SLE - First-Line Agents

Answer 30

hydroxychloroquine PO glucocorticoids

Question 31

Mild SLE - Refractory Agents

Answer 31

first-line plus methotrexate / azathioprine

Question 32

Moderate SLE - First-Line Agents

Answer 32

hydroxychloroquine PO glucocorticoids methotrexate / azathioprine CNIs MMF

Question 33

Severe SLE - First-Line Agents

Answer 33

hydroxychloroquine PO glucocorticoids MMF cyclosporine

Question 34

Severe SLE - Last Line

Answer 34

rituximab

Question 35

SLE - Glucocorticoid Dosing

Answer 35

prednisone 20-60 mg per day with 10% taper every 5-7 days

Question 36

Lupus Nephritis III-IV - Treatment

Answer 36

induction: MMF or cyclosporine PLUS steroid remission: taper steroid, switch immunosuppressant as needed

Question 37

Lupus Nephritis III-IV - No Response to Treatment

Answer 37

add tacrolimus or rituximab

Question 38

Lupus Nephritis III-IV - Treatment-Responsive

Answer 38

continue MMF or switch to azathioprine after 3-12 months

Question 39

Lupus Nephritis V - Treatment

Answer 39

RAAS blockade steroid MMF

Question 40

SLE - RAAS Blockade Indications

Answer 40

glomerular disease and persistent proteinuria or hypertension

Question 41

SLE - Statin Indication

Answer 41

LDL > 100 mg/dL

Question 42

SLE - Pregnancy Treatment Options

Answer 42

hydroxychloroquine acetaminophen instead of NSAIDs low-potency, non-fluorinated topical steroids

Question 43

Lupus Nephritis - Pregnancy Treatment Options

Answer 43

mild: hydroxychloroquine / azathioprine clinically active: non-fluorinated PO steroid highly active: pre-term delivery (28 wks)

Question 44

SLE - Pregnancy Options with aPL(+)

Answer 44

low-dose aspirin +/- LMWH

Question 45

SLE - aPL(+), No Event, Not Pregnant

Answer 45

low-dose aspirin

Question 46

SLE - Antiphospholipid Syndrome, Not Pregnant

Answer 46

warfarin arterial: INR 3-4 venous: INR 2-3