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24 Cards in this Set
- Front
- Back
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a) What is the prevalence of SLE in women of childbearing age?
b) What is the incidence of SLE in pregnancy? |
a) 1/500
b) 1/1250 |
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List the causes of most lupus-related deaths
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Infection
Lupus flare End-Organ failure HTN Stroke Cardiovascular |
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List some autoantibodies seen in patients with SLE
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Anti-nuclear antibody (ANA) - >85%
Anti-dsDNA (>60%) APLA (25-50%) anti-Ro/La or SS-A/B (10-50%) |
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List organ systems/clinical findings in patients with SLE
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1) Systemic - fatigue, malaise, wt loss
2) MSK - arthralgia, polyarthritis, myalgia, myopathy 3) Heme - APLA, splenomegaly, anemia, leukopenia, hemolysis 4) Skin - malar or discoid rash, oral ulcers, photosensitivity 5) Renal - nephrotic syndrome, proteinuria, renal failure 6) Cariopulmonary - pulmonary hypertension 7) Ocular - conjunctivitis |
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List criteria for diagnosis of SLE
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Malar rash
Discoid rash Photosensitivity (rash w/ UV light) Oral ulcers (painless) Polyarthritis ANA titre Additional Abs (APLA, dsDNA) Renal failure Serositis (pleural/pericardial) Neurological (seizure, psychosis) Hematological (anemia, leukopenia, thrombocytopenia) |
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List key factors in predicting the risk/prognosis of pregnancy in a woman with SLE?
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Recent Lupus flare (6/12)
Pulmonary HTN Restrictive lung dz (forced VC <1L) Heart failure Chronic renal failure (Cr > ) Active renal disease Hx of severe preeclampsia or HELLP syndrome Recent stroke (6/12) |
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With regards to their SLE, what percentage of patients
a) worsen b) improve c) stay the same in pregnancy? |
a) 1/3
b) 1/3 c) 1/3 |
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According to Williams OB, pregnancy in women with SLE will be less morbid if what factors are present/not present?
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No lupus flare last 6 months
No renal disease (prenatal) No preeclampsia develops No APLA activity |
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List complications of pregnancy that are increased in patients with SLE?
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Preeclampsia (20%)
Eclampsia (0.5%) PTL (20%) FGR (5%) Thrombotic (2%) M&M (3/1000) |
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List key issues to consider in caring for a pregnant women with SLE
(e.g. what can happen to the woman, pregnancy, etc.) |
Exacerbation of SLE (flare)
renal, cardiopulmonary, etc. Fetal (IUFD, FGR, PTB) Neonatal Lupus Breastfeeding |
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Is maternal mortality increased in women with SLE?
Does active lupus nephritis increase this rate further? |
Yes
(325/100000) Yes - perhaps as high as 1% |
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Is rate of perinatal death increased in SLE with active nephritis?
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Yes
(10-30%, IUFD + miscarriage) |
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How can Lupus Nephritis be distinguished from pre-eclampsia?
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Urinalysis - casts (red, white, granular)
Hypocomplementemia Increased anti-dsDNA titres |
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For pregnant women with SLE, what factors might be associated with increased risk of fetal loss?
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Hypertension
Active lupus Lupus Nephritis Hypocomplementemia Increased anti-dsDNA Ab aPLA Thrombocytopenia |
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Does presence of aPLA increase risk of fetal loss?
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Yes, 2-3x
typically late (>10wks) loss |
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What organ systems are affected in neonatal lupus?
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Skin
(rash) Heart (heart block, myopathy) Less commonly liver, hematologic, neurologic |
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a) What percentage of neonates born to mothers that are anti-Ro/La positive will develop HB?
b) What if HB was present in a previous neonate? c) What if only cutaneous findings of neonatal lupus were present in a previous neonate? |
a) 2%
b) 15% c) 15% |
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What is a unique radiographic finding of neonatal lupus?
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Chondrodysplasia Punctata
(stippling of the epiphyses) |
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Is neonatal lupus only diagnosed in mothers who have SLE?
Explain. |
No
Anti-Ro/La Ab can be present in other autoimmune syndromes like Sjorgen's, although most women will go on to eventually be diagnosed with SLE. |
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Describe the rash of neonatal lupus
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maculopapular
red scalp/periorbital may be present at birth or after UV exposure |
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When is the fetus most vulnerable to neonatal heart block? (e.g. when is it most likely to develop de novo?)
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18-26wks
(new less likely 26-30wks rarely de novo after 30wks) |
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What is the risk of neonatal 3rd degree (complete) heart block?
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development of hydrops (pleuropericardial effusion)
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Can in utero neonatal 3rd degree HB be reversed?
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Probably not
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What is used to treat in utero neonatal heart block and when?
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Glucocorticoids
(betamethasone or dexamethasone) usually recommended for 2nd degree heart block, as this may be reversible. |
