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72 Cards in this Set

  • Front
  • Back
Who is Lupus most common in?
Young women
-15-40 y/o
F:M ration of 5-9:1
Most common manifestations of lupus?
Rash
Joint pain
When should you consider SLE?
any time an organ is involved and don't know why - it is systemic
What type of dz is lupus?
chronic inflammatory autoimmune dz
Lupus Ab are made to?
components of cell nucleus
ANA
What HLA types is Lupus assoc. w/
DR2 and DR3
What diffeciency may increase risk Lupus and why?
inherited complement deficiencies
ie: C4a, C1q, C1r/s, C2

b/c interferes w/ normal clearance apoptotic cells
What can trigger SLE?
enviro or exog factors like
-infections
-stress (phys/emotional)
-toxins (drugs)
-physical agents (sunlight)
-hormones
What is teh central immune disturbance of SLE?
autoantibody production
Where could autoantibodies be directed at self-molecules?
found in nucleus
cytoplasm
cell surface
What can measurably see w/ regard to immune system that may suggest lupus?
B-cell hyperactivity
-Hypergammaglobulinemia
-increased # ab producing cells
-heightened response to ag, both self and foreign

increased helpert T cell activity
Decreased # and function suppressor t-cells
Why might C1q def. lead to lupus?
if C1q absent, apoptotic cells inefficiently cleared
- this is proinflammatory
Why is SLE referred to sometimes as a "dz of waste disposal"
-abnormal apoptosis could be factor in SLE
(ie: large blebs like Ro, La, Sm, RNP, Mi2 and small blebs like Ro Jo-1 and RNP produced)
Is SLE a constant DZ?
no, periods of exacerbations and remissions
-malaise (wt. loss, fatigue, fever may affect patients at some point in dz)
How detect autoantibodies lupus (ANAs)?
Indirect immunofluorescence Ab
Of SLE Classification criteria below, how many must be present for SLE?
-Malar Rash
-Discoid rash
-Photosensitivity
-Oral Ulcers
-Arthritis
-Serositis
-Renal disorder
-Neurological disorders
-hematological disorder
-immunological disorder
-Antinuclear antibody (ANA)
4/11 criteria
SLE Criteria 10 (Immunological Disorder) of Lupus requires?
-antibodies to dsDNA
-anti-Sm (Smith antibodies)
-anti-phospholipid antibodies
What is the most specific test for Lupus?
anti-Sm
(S, for specific)
What does SLE criteria 11 test for?
Antinuclear Ab Test
-positive ANA is non-specific
What percent of SLE patients have ANAs?
95%
Does ANA titer levels correlate w/ dz activity?
No
What titer levels do correlate w/ SLE dz activity?
dsDNA
What are the SLE specific autoantibodies?
Anti-dsDNA
Anti-Sm (smit)
Once someone is Anti-Sm positive, does it need to be checked again?
No- this is an expensive test and level don't correlate w/ dz progression (unlike anti-dsDNA ab, which do)
anti-APL (antiphospholipid ab) put patient at increased risk for?
Arterial and/or venous thrombosis
*can be manifested by recurrent miscarriages
how does Lupus cause tissue damage?
ab bind to ags resulting in circulating immune complexes (CICs)
-CICs deposit in tissues
-consumes and activates complement-->inflammatory response
**sometimes serum complement levels can assist in determining dz activity
What ab titer can correlate w/ SLE dz activity?
=anti-dsDNA
- complement C3 and C4 can follow
How many criteria rq'd for dx lupus?
4 of 11
name 2 criteria for dx?
ANA
inflammation/rash
(there are 11)
Example of Ab mediated cell lysis?
Hemolytic anemia (anti-PLP)
What can measurably see w/ regard to immune system that may suggest lupus?
B-cell hyperactivity
-Hypergammaglobulinemia
-increased # ab producing cells
-heightened response to ag, both self and foreign

increased helpert T cell activity
Decreased # and function suppressor t-cells
Why might C1q def. lead to lupus?
if C1q absent, apoptotic cells inefficiently cleared
- this is proinflammatory
Why is SLE referred to sometimes as a "dz of waste disposal"
-abnormal apoptosis could be factor in SLE
(ie: large blebs like Ro, La, Sm, RNP, Mi2 and small blebs like Ro Jo-1 and RNP produced)
Is SLE a constant DZ?
no, periods of exacerbations and remissions
-malaise (wt. loss, fatigue, fever may affect patients at some point in dz)
How detect autoantibodies lupus (ANAs)?
Indirect immunofluorescence Ab
Of SLE Classification criteria below, how many must be present for SLE?
-Malar Rash
-Discoid rash
-Photosensitivity
-Oral Ulcers
-Arthritis
-Serositis
-Renal disorder
-Neurological disorders
-hematological disorder
-immunological disorder
-Antinuclear antibody (ANA)
4/11 criteria
SLE Criteria 10 (Immunological Disorder) of Lupus requires?
-antibodies to dsDNA
-anti-Sm (Smith antibodies)
-anti-phospholipid antibodies
What is the most specific test for Lupus?
anti-Sm
(S, for specific)
What does SLE criteria 11 test for?
Antinuclear Ab Test
-positive ANA is non-specific
What percent of SLE patients have ANAs?
95%
Two ways SLE autoantibodies can cause tissue damage?
1. ab bind directly to ag on cells --> cell lysis
2. ab can "tag" cell for uptake in the reticulo-endothelial system
Does butterfly rash (malar) cause scarring?
no
*it is itchy
**may be generalized
***Most photosensitive
Malar rash associated w/
UV sensitivity
Does discoid rash scar?
yes
Is discoid rash always associated w/ lupus?
no, can be independent
*may have associated alopecia (hair loss)
Where are common locations of SLE in mucous membranes?
Mouth ulcers (4)
Nasal septal ulcers
vaginal ulcers
w/ regard to the skin, where does inflammation and degeneration occur with SLE?
dermal/epidermal junction
**Band-like pattern of granular deposits IgG and complement
Is lupus pain symmetrical or one-sided?
symmetrical
Where does SLE typically impact joints?
Small and large joints (knees, hands, wrists)
What are the most common presentations of joint pain w/ SLE?
intermittent, migratory, chronic
-50% stiffness
-myositis and fibromyalgia common
Does lupus typically have deformities or erosions?
Typically deformites
-unlike rheumatoid arthritis, typically not erosions
Most common serositis manifestations?
-Pleurisy
-Pericarditis
sometimes peritonitis
*usually bilateral and may have exudate (fluid)
Most common heart involvement w/ lupus?
Pericarditis
Note, Gi, pulmonary manifestions, and cardiac manifestions not tested, nor are premature vasc. dz,s
any important points mentioned about these in her review ?'s will be covered later
History of someone w/ pleurisy?
chest pain w/ deep breath
2 SLE criteria that affect the skin?
Discoid, malar, photosensitivity, ulceritis, mucous membranes
Skin lesions that result in scarring?
Discoid (NOT malar)
Most common joint presentation SLE?
Symmetrical stiffness/ aching (amy mimic rheumatoid arthritis)
Are SLE renal manifestations usually symptomatic or assymptomatic?
assymptomatic
Clinical renal dz
-proteinuria?
>500mg/24hrs
>5 RBC/hpf in uinarlysis
>5WBC/hpf w/o infection
**elevated serum creatinine in blood
What are renal lupus biopsies examined for?
basic histology
-immunofluorescence for Ig and complement
-electron microscopy for immune deposits
when doing renal SLE biopsy, what do you need to determine?
Type and
Severity of kidney involvement
*graded in terms of activity and chronicity
What parts of the nervous system can be affected w/ SLE?
any parts
-classify as nervous system vs peripheral nervous system, or as
-neurological vs psychiatric
What are some things observed w/ CNS lupus
seizures, psychosis, chorea, stroke
what are some things observed w/ Peripheral nervous system SLE?
cranial neuropathies (visual defects), motor/sensory or mixed peripheral neuropathies
What are a few hemolytic abnormalities that occur w/ SLE?
-autoimmune Hemolytic anemia
-leukopenia (2,500-4000/mm3) common w/ active dz
Thrombocytopenia and Lymphopenia are also associated w/ SLE and what are their levels?
-Thrombocytopenia (<100,000/mm3) normal 150,000
-Lymphopenia <1,500/mm3):usually associated w/ antibodies to lymphocytes and active SLE
If patient has hemolytic anemia and thrombocytopenia, how many SLE criteria need to fulfill?
1
CNS manifestions SLE?
seizures, strokes, psychosis
2 ways renal DZ may present SLE?
-assymptomatic usually so

*proteinuria
*increased creatinine
*hypertension
*RBCs in urine
2 clinical findings drug induced lupus?
-lung involvement and rash, fluid in lungs
*antihistone Ab
**anti-dsDNA ab and renal dz not found
Is drug-induced lupus as severe as normal lupus?
usually less severe