Systemic Lupus Erythematosus 2

Question 1

What is a severe complication of SLE

Answer 1

Lupus nephritis
- renal involvement causes scarring and destruction of renal tissue
- classified as class 1-6, indicating amount of damage

Question 2

give examples of neuropsychiatric complications of SLE

Answer 2

• cognitive dysfunction
• anxiety disorder
• mood disorder

Question 3

what is iatrogenic lupus

Answer 3

lupus caused by use of certain drugs
- drug induced lupus

Question 4

give examples of drugs that may be associated with SLE

Answer 4

• carbamazepine
• levodopa
• omeprazole

Question 5

what should be checked if a patient is positive for lupus

Answer 5

check ANAs

Question 6

what is involved in the management of non renal and non CNS lupus

Answer 6

1. NSAIDs- caution with renal function
2. hydroxychloroquine
3. glucocorticoids- lowest dose for shortest period of time

Question 7

outline the treatment of neuropsychiatric lupus

Answer 7

1. establishment of NPSLE diagnosis
   - cerebrospinal fluid examination
   - autoantibody profile
   - neuroimagaing to assess brain structure
2. identification of aggravating factors
   - hypertension, infection, metabolic abnormalities
3. symptomatic therapy
   - anticonvulsants, psychotropics
4. cognitive rehabilitation
5. immunosuppression
   - corticosteroids, azathioprine
6. anticoagulation- heparin, warfarin

Question 8

how many classes of renal involvement are there

Answer 8

6 classes
- 1st class= minimal involvement
-6th class= most severe

Question 9

what are the 2 main phases involved in the treatment of lupus nephritis

Answer 9

1. acute induction of remission
2. maintenance of remission

Question 10

outline the treatment of lupus nephritis

Answer 10

1. gold standard: IV cyclophosphamide pulse therapy (rapid) in combination with glucocorticosteroids
   - can quickly establish remission and prevent organ failure
2. must also include a maintenance strategy

Question 11

what can azathioprine, mycophenalate and ciclosporin be used for in lupus nephritis

Answer 11

they are remission inducing and maintenance therapies
- if used correctly, can maintain remission at high rates
- seldom used for induction and IV cyclophosphamide is standard therapy

Question 12

describe the 2 phases of treatment of lupus nephritis and how does having 2 treatment phases affect treatment choice

Answer 12

1. induction of remission and maintenance of remission
2. we want a fast acting drug first to get the patient into remission, and then using a less toxic, slower acting drug to keep them in remission
   - so we need to choose a drug that is effective for treating each phase