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Flashcards in SLE Deck (34)
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1

Types of Hypersensitivity Reactions

I: Immediate (anaphylactic)
II: cytotoxic; target cell receptors- platelet-thrombocytopenia; target fixed tissue antigen- goodpastures, M.G.
III: immune complex; vasculitis, SLE
IV: cell mediated- tuberculin reaction, allograft rejection

2

Describe SLE

Antigen-antibody complexes along vascular & tissue basement membranes

3

Factors Influencing SLE

Genetic
UV light (rash)
Bacterial & viral infections
Drugs
Abnormal stimulation of immune system
Sex hormones

4

Pathogenesis of SLE

B-lymphocyte hyperactivity with exaggerated antibody production
Antigen-antibody complexes deposited along basement membranes of vasculature & tissue
Localized inflammatory responses: complement, neutrophil migration, cell-mediated tissue injury

5

Course of SLE

Onset insidious or acute (rare but devastating)
Characterized by exacerbations & remission

6

Constitutional Manifestations of Systemic Lupus Erythematosus

Fatigue
Fever
Weight loss
Malaise
Anorexia

7

Skin Manifestations of SLE

Butterfly rash (malar rash)

8

Systemic Manifestations of SLE

Polyarthritis
Arthralgias
Joint pain
Alopecia
Fingertip lesions
Periungual erythema
Nail fold infarcts
Splinter hemorrhages
Raynaud's phenomenon

9

Renal Features of SLE

Glomerulonephritis
Nephrotic syndrome: proteinuria, hyaline casts
HTN

10

Ocular Features of SLE

Conjunctivitis
Photophobia
Transient or permanent monocular blindness
Blurred vision
Cotton wool spots on retina

11

Musculoskeletal Features of SLE

Transient polyarthritis with symmetric involvement
Osteonecrosis of hips
Fibromyalgia often present

12

Pulmonary Features of SLE

Transient basilar pneumonic infiltrates
Pleural effusions
Pleuritis
Bronchopneumonia
Restrictive lung disease
Alveolar hemorrhage with massive hemoptysis (rare)
Death (rare)

13

Cardiac Features of SLE

Pericarditis
Myocarditis: tachycardia, ventricular arrhythmia, conduction problems, CHF, cardiomyopathy
Increased muscle enzymes: MB or CPK
Libman-Sacks Endocarditis: vegetation on valves, break off may allow colonization

14

Serositis of SLE

Pleuritis
Pericarditis
Peritonitis

15

Vascular Features of SLE

Raynaud's phenomenon
Arterial or venous thrombosis
Lupus vasculitis
Livedo reticularis

16

GI Tract Features of SLE

Transient, non-specific abdominal pain
Increased incidenc of primary biliary cirrhosis
Vasculitis of mesentery can cause infarction or perforation of the bowel

17

CNS Features of SLE

COnfusion
Memory deficits
Disorientation
Hypomania
Delirium
Schizophrenia
Grand mal seizures
Temporal lobe seizures
Severe headaches
Stroke: anti-phospholipid antibodies

18

Labs in SLE

CBC
Elevated ESR & CRP
UA
ANA
Anti dsDNA
Anti ssDNA
AntiENA: anti SM & anti RNP
Elevated nonspecific IgG, IgM levels
Reduced complement levels
Decreased IgA levels
False positive for syphilis
Anti-histone

19

CBC Findings in SLE

Normocytic, normochromic, hemolytic anemia
Lymphocytopenia
Thrombocytopenia
Prolonged PTT

20

UA Findings in SLE

Proteinuria
RBCs/WBCs
Cellular or hyaline casts

21

Differential Diagnosis of SLE

Antiphospholipid syndrome
Fibromyalgia
Hepatitis C
Lyme disease
Lymphoma, B-cell
MCTD
Polyarteritis Nodosa
Rheumatic fever
Rheumatoid arthritis
Scleroderma
Serum sickness
TTP

22

Diagnosis of SLE

Clinical
Criteria for classification of SLE

23

Criteria for Classification of SLE

Characteristic rash across cheek
Discoid lesion rash
Photosensitivity
Oral ulcers
Arthritis
Inflammation of membranes in the lungs, heart, or abdomen
Evidence of kidney disease
Evidence of severe neurologic diseaseBlood disorders
Immunologic abnormalities
Positive ANA

24

Physical Findings of SLE

Butterfly rash
HTN
Alopecia
Discoid lesions

25

Lab Findings of SLE

ANA
dsDNA
Anti Sm ribonuclear protein
Hypocomplementemia
UA: WBC, RBC, proteinuria, hyaline casts

26

Goals of Treatment of SLE

Incurable
Reducing inflammation
Suppressing the immune system
Closely following patients clinically to identify disease features early

27

Patient Education & Prevention of Disease Flares

Sunscreen & protective clothing
Protective, warm clothing
Avoidance of vasoconstrictive drugs
Psychological support
Routine immunization

28

Pharmacologic Treatment of SLE

Glucocorticoids
Antimalarials
Immunosuppresants
IVIG
Plasmapheresis
Belimumab: fully human monoclonal antibody

29

Drug Induced Lupus Syndrome

Musculoskeletal, pulmonary, & polyserositic symptoms
Renal & neurologic disease uncommon
No hypocomplementemia
ANA present but return to normal with removal of drug
Reversal with discontinuation of drug

30

Most Common Culprits of Drug Induced Lupus Syndrome

Procainamide
Hydralazine
Methyldopa
Quinidine
INH