SLE

Question 1

Drug induced lupus

Answer 1

procainamide
hydralazine
phenytoin
isoniazid
minocycline

Question 2

Most common symptom at onset

Answer 2

arthralgia

Question 3

Jaccouds looks like

Answer 3

ulnar deviation of fingers at MCP
looks a bit like RA
no errosions

Question 4

APL ab syndrome and first DVT

Answer 4

6 months warfarin
INR 2-3

If recurrent
life long 2-3
If recurrent on warfarin
life long 3-4

If ARTERIAL thrombus life long warfarin 2-3

Question 5

most common neuro sx in SLE

Answer 5

cog dysfunction

Question 6

PRES in SLE?

Answer 6

Yes can get
oedema across vessel boundaries
not like stroke because on DWI no diffusion restriction
treat with steroids

Question 7

Classes lupus nephritis

Answer 7

1. minimal mesangial (only on IF seen)
2. mesangial proliferative (cells and IF)
3. Focal proliferative (under 50% gloms)
4. Diffuse proliferative (over 50% gloms)
5. Membranous- if put on MMF also give hydroxycchlor as triples reponse)
6. advanced sclerosing

Full house on immunohisotchemistry

Question 8

lupus nephritis

Answer 8

induction: pred + MMF (safer) or Pred + cyclo (if bad renal disease)
If doesnt work by 6 months, try other
Both dont work try ritux

maintenance: MMF + pred

ACE if protein more than 0.5g/day
BP under 130/80
Vit D replace
aim LDL under 2.6

If membranous, go MMF plus pred

Question 9

What kind of monitoring with hydroxychloroquine

Answer 9

visual field challenge testing and fundoscopy

IFN type 1 interesting molecule in lupus lately, and HCQ inhibits this

Question 10

treatment CNS luppus

Answer 10

cyclo
and
high pred

Question 11

can you use the pill in SLE

Answer 11

no increase of flares but does increase clotting risk in APS

HRT increase minor flares but not major

Question 12

What drugs increase risk osteoporosis

Answer 12

antiepileptics (more osteomalacia)
heparin
PPI
glitazones
aromatase inhibitors eg anastrazole