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30 Cards in this Set

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SLE definition
multisystem autoimmune disease which is characterized by production of ANA Abs; prototype of human immune complex disease
epidemiology of SLE
incidence: 4 to 7 new cases per 100000 per year; prevalence 1:2000 population; peak onset ages 15 to 45; female to males 4 to 10:1; black:white 3:1; hispanics and chinese; low socioeconomic status
etiology
associated with DR2, DR3, C4A deficiency; 25-50% concordance in monozygotic twins; 5% in dizygotic and non-twin siblings; secondary to environmental factors--infection, hormones, UV irradiation
pathogenesis and pathophysiology
lesions: immune complex deposition with inflammation (vasculitis, vascular leukoocclusion, thrombosis mediated by anti-phospholipid Ab
nonlesions: autoantibodies to cells or cell precursors, inflammatory cytokines which suppress bone marrow
clinical manifestation
arthralgia/myalgia, fatigue, fever, CNS, skin changes, anemia, adenopathy, GI, renal, pericarditis, leukopenia, pleural effusion, arthritis
SOAP BRAIN MD
serositis, oral ulcers, arthritis, photosensitive rash, blood dyscrasias, renal disorder, ANA, immunologic disorder, neurologic rash, malar rash, discoid rash
serositis
pleuritis-around lungs
pericarditis-around lining of heart
peritonitis-lining of abdomen
oral ulcers
all mucosal surfaces; painless (diff from apthous ulcers)
arthritis
like RA; nonerosive, symmetric, inflammatory, >2 peripheral joints
jaccoid's arthropathy
ligamentous laxity; looks like RA, but no erosions and joints are preserved
photosensitivity
skin rash from UV radiation; patient should also get rash when it's sunny; part of therapy is wearing sunblock
blood dysrasias
Coomb's positive hemolytic anemia with reticulocytosis; AB directed against red cell surfaces; RBCs broken apart;
leukopenia
<4,000 WBC on >2 occasions
lymphopenia
<1,500 on 2 occasions
thrombocytopenia
<100,000 platelets on 2 occasions
renal disorder
persistent proteinuria > 0.5 g/day; cellular casts or >10 RBC/HPF in urine; urine must be sterile
lupus renal histology
WHO
I: normal under light microscopy, but immunoglobin and or complement deposits
II: mesangial lupus nephritis; mesangium of kidney proliferated
III: focal proliferative glomerulonephritis
IV: diffuse proliferative glomerulonephritis- worse case
V: membranous nephritis
ANA
significant titer is >1:80
found in 95% of SLE patients, but also seen in other diseases; not specific for lupus, but very sensitive
immunologic disorder 3 satisfiers
antiDSDNA Ab
anti-SM Ab
anti-phospholipid Ab
neurologic disorders
seizures, psychosis
malar rash
butterfly rash; fixed erythema; flat or raised; spares nasolabial folds
discoid rash
raised patches; adherent keratotic scaling; follicular plugging seen on biopsy; older lesions may scar; seen more commonly in black patients
other SLE rashes
palmar erythema and rash; subacute cutaneous lupus erythematosus (circles); bullous lupus dermatitis; neonatal lupus; raynaud's phenomenon
therapy-
serositis
NSAIDS, corticosteroids, immunosuppressives
arthritis
NSAIDS, hydroxychloroquine, DMARDS, corticosteroids, immunosuppressives
blood dyscrasias
steroids and immunosuppressives
renal
corticosteroids, immunosuppressives
neurologic
symptomatic- (antidepressant), corticosteroids, immunosuppressives
rash
topical corticosteroids, systemic steroids, hydroxychloroquine, methotrexate, immunosuppressives
see chart at end of NTS
joint fluid tests
cell count with differential, crystal analysis, gram stain with culture and sensitivity, NO protein, glucose, or LDH
**most imp are crystal analysis and culture