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28 Cards in this Set
- Front
- Back
What are some of the criteria for diagnosing systemic lupus?
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Photosensitivity,
Malar rash, Mucosal ulcers, Serositis (pleurisy and pericarditis), Seizures/psychosis, Renal disease (often dictates treatment), Cytopenias, Positive antinuclear antibody test, Specific autoantibodies (anti-DNA) |
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Who is most at risk for getting SLE?
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Non-caucasians
Women (90%): onset usually in child-bearing years with flares post-partum |
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Is SLE more severe in children or adults?
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children
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What causes the disease manifestations of SLE?
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Pathogenic auto-antibodies (antibodies to cell surface antigens, anti-dsDNA, anti-phospholipid)
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What can result from anti-phospholipid antibodies?
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Thrombosis of arteries and veins
Spontaneous fetal loss |
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What are some of the laboratory manifestations of SLE?
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Andi-dsDNA antibodies (very specific)
Antinuclear antibody (ANA) test (but many false positives) Low complement levels |
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What was an initial use for anti-phospholipid antibodies?
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Explained some false positives for syphilis
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How can vascular injury occur in SLE?
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By immune complex deposition (complement fixation, then adherence/infiltration of inflammatory cells, then tissue injury by release of liposomal contents, then the injured vessel wall becomes a potential site for thrombosis)
This can lead to accelerated atherosclerosis at these sites |
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How does SLE present?
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Disease activity waxes and wanes with flares
Individual disease manifestations may appear separately and make diagnosis difficult Fatigue accompanies active disease |
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What are some common musculoskeletal sequelae of SLE and corticosteroid treatment?
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Muscle atrophy and weakness
Osteoporosis Osteonecrosis |
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What is the major cause of death and disability in SLE patients?
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Lupus nephritis; level of renal disease NEEDS to be assessed
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What causes lupus nephritis and how does it progress?
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Immune complex mediated
Early: hematuria, proteinuria, HTN Advanced: nephrotic syndrome, renal insufficiency |
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What are the two types of lupus nephritis?
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Proliferative and membranous
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What is proliferative lupus nephritis?
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Immune complex deposition between glomerular endothelial cells and the basement membrane, characterized by cellular infiltration
Often rapidly progressive and destructive Nephritic syndrome |
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What is membranous lupus nephritis?
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Immune complex deposition between the basement membrane and epithelial podocytes without the cellular infiltration
Nephrotic syndrome Slow progression: early disease causes hyperfiltration, disguising the renal injury |
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What causes neuropsychiatric lupus?
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Either from antibody-mediated neuronal injury or from vasculitis/thrombosis of vessels
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What is entailed in the long-term management of SLE? (7)
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Exercise
Weight control Diet low in saturated fat and cholesterol Optimal BP Prevention of osteoporosis Stop smoking Control manifestations with least toxic drugs as early as possible |
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What does prednisone do in SLE?
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Controls the constitutional symptoms
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What are the short term side effects of prednisone?
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infection, glucose intolerance, weight gain
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What are the long-term side effects of prednisone?
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HTN, accelerated atherosclerosis, aging/atrophy of skin, muscles, and bones; cataracts, diabetes
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What are 7 components of the idea drug for SLE?
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Anti-inflammatory
Immunosuppressive Anti-thrombotic Cholesterol lowering Slows atheroma formation Steroid sparing Protects against steroid induced hyperglycemia |
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What does hydroxychloroquine do in SLE treatment?
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Reduces severe flares (nephritis), slows thrombus formation, and improves serum cholesterol
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What are three immunosuppressive drugs in SLE?
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mycophenolate mofetil, cyclophosphamide and azathioprine
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When are immunosuppressive drugs used in SLE?
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For very severe disease manifestations (severe nephritis) or as steroid-sparing agents who would otherwise have to be an high dose of prednisone
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What are the risk factors/side effects of the immunosuppressive drugs?
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Infection and cancers
Birth defects (cyclophosphamide) |
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What is the general plan for drug treatment of severe SLE?
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Start with a powerful but highly toxic drug (cyclophosphamide), and then switch to a better tolerated one after the disease is controlled (azathioprine, mycophenolate mofetil)
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What are the three biologic agents that may eventually be used for SLE treatment ?
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Rituximab
LJP 394 Belimumab |
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How does rituximab work?
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chimeric monoclonal antibody against CD20 antigen on B-cells
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