Uiuc M2 2010 Fcp Lupus Erythematosus

Front 1

Acute Cutaneous Lupus:

features:

Back 1

Butterfly rash’
• Spares nasolabial folds
• Erythematous, elevated, puritic/painful
• Strong association with systemic lupus erythematosus

Front 2

Subacute Cutaneous Lupus:

features:

Back 2

• ‘non-fixed, nonscarring, exacerbating and remitting’
• Originate as erythematous papules or small plaques with slight scale that can evolve to larger plaques
• Ro (SS-A) Ab often present

Front 3

Discoid Lupus

features:

Back 3

• Most common form of chronic cutaneous lupus
• Begin as flat to slightly-raised red purple macules with scaly surface that evolve into ‘coinshaped’ plaques or larger confluent plaques
• Often involve hair follicles, causing
‘follicular plugging’
• Frequent scarring
• Often involves
external ear and scalp
• Frequent scarring
• Can evolve to
cause central atrophy,
hypopigmentation

Front 4

SLE

epidemiology:
demographics:

Back 4

15-124/100,000 in USA
Female:male::9:1
More common in blacks and Asians

Front 5

SLE

symptoms/involvement: (7)
labs:

Back 5

1) malar rash, discoid rash, photosensitivity

2) oral ulcers
3) non-erosive arthritis
4) pleuritis or pericarditis
5) renal disorder:
6) seizures or psychosis
7) hematologic: eg: hemolytic anemia, leukopenia...

immunologic: Anti-dsDNA
Anti-SM, anti phospholipid

positive ANA

Front 6

SLE Nephritis

Types: (7)
Signs/Symptoms:
associated with:
can progress to:

Back 6

Nil, pure mesangial alterations, Focal segmental glomerulonephritis, Focal proliferative GN, diffuse GN, diffuse membranous GN, advanced sclerosing glomerulonephritis.

Often asymptomatic
1) Edema
2) Hypertension
3) Proteinuria (>.5g/24 h or 3+ dipstick),
4) hematuria, cellular casts.

Associated with anti-ds-DNA Ab, higher mortality

end stage renal disease

Front 7

Serositis in SLE

Back 7

Inflammation of
1) pericardium: pleuritic chest pain, pericardial effusion, tamponade

2) pleura: pleuritic chest pain, pleural effusions, respiratory compromise

3) peritoneum: abdominal pain, ascites, pseudoobstruction

Front 8

Effusion in SLE

features:

Back 8

typically exudative, normal glucose, moderate lymphocyte count

Front 9

Arthritis in SLE

features:

Back 9

Most common presenting feature of SLE

– Symmetric, somewhat inflammatory, nonerosive

Front 10

Osteonecrosis in SLE

features:

Back 10

Seen in hip and shoulder joints

– Related to previous arthritis, steroid use, and treatment with cytotoxic drugs

Front 11

Myositis in SLE

features:

Back 11

Mild inflammatory changes associated with proximal muscle weakness and CK elevations

Front 12

Neuropsychiatric Manifestations in SLE

symptoms:
findings:
pathogenesis:

Back 12

Hallucinations, delusions, thought
disorganization, Headaches, Seizures, Peripheral neuropathy, Transverse myelitis

–Multiple micro infarcts seen in postmortem studies
–Pathogenesis – inflammatory and noninflammatory thickening of cerebral vessel.

Front 13

Hematological Manifestations of SLE

types: (2)
features of each:

Back 13

Anemia most common, due to
1) Autoimmune hemolytic anemia
2) Renal insufficiency
3) Anemia of chronic disease
4) Leukopenia
Often parallels disease activity

Thrombocytopenia
-Anti-platelet antibodies often present
–Associated w/ antiphospholipid antibody syndrome

Front 14

SLE- cause of death

Back 14

ACTIVE SLE 15-50%

NEPHRITIS 20-30% (renal involvement increases mortality)

INFECTION 20-35%

STROKE, MI 10-30%