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22 Cards in this Set
- Front
- Back
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What are some drugs that induce lupus?
What is Neonatal Lupus? What can you say about the mom's status in terms of whether or not she has lupus? |
Drugs: hydralazine, procainamide, quinidine, INH, minocycline
Neonatal Lupus- transient (from Anti-Ro antibodies being transferred transplacentally from mom into fetus). Complication= heart block, from anti bodies attacking conduction system. Mom does NOT have to have lupus for this to occur. |
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What are the diagnostic criteria for lupus?
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4 out of 11:
1. malar rash (spares nasolabial folds) 2. discoid rash 3. photosensitivity 4. oral ulcers 5. arthritis 6. serositis (pleuritis/pericarditis) 7. Renal disorder 8. Neurologic disorder (seizure/psychosis) 9. Hematologic (anemia, thrombocytopenia) 10. Immunologic (dsDNA, Sm, etc.) 11. ANA+ (anti-nuclear antibody) *basically, it is a systemic disease |
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Describe the pathogenesis of Lupus?
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1. Genetic predisposition (certain HLA type) + 2. environmental trigger (UV light, infection?, etc.) -->
3. Abnormal Immune response (T cells activate complement and autoantibodies are produced 4. Inflammation (systemic) 5. End organ damage |
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Is there a genetic component to Lupus? If so what?
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Yes- there is a strong familial aggregation (no known specific genes, but most likely polygenic).
MCH II polymorphisms in patients --> HLA-DR2, HLA-DR3 (mnemonic: 2,3, S.L.E) |
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What happens to complement in patients with SLE? Describe the mechanism of how this results in SLE?
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Complement deficiencies seen in SLE (C1q, C2, C4a, etc.)
Complement usually clears the apoptotic cells. If deficient, apoptotic cell debris can persist and stimulate antibody response. |
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What is ANA? What other antibodies are targeted in SLE?
What is an autoantibody to a surface antigen that is seen in lupus? Which one is often correlated with renal diseasE? Which one is more frequently seen in drug induced lupus? |
ANA- antibodies to nuclear components (and other specific ones anti-dsdna, anti-sm, antiSSA, antiSSB, etc.)
anti-platelet antibodies- antibody to surface antigen DsDNA- correlated to renal disease anti-histone: seen in drug induced lupus |
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What is shown here?
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LE cell
Neutrophil that has engulfed chromatin/nuclear material + ANA. Presents as these reddish globs. *note: test is not done anymore |
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This is an immunofluorescence image from a biopsy of unaffected skin in a person with SLE. What do you see?
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Ig deposition in the DEJ. Immune complexes will deposit in the dermal epidermal junction.
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This is an image of the glomerular capillary interface in the kidney of a person with SLE. What is seen here?
What do you expect to see on immunofluorescence? |
Immune complex deposition--> Mainly subendothelial deposits (and some subepithelial and intramembranous deposits).
Lumpy bumpy pattern on Immunofluorescence. |
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Is there a gender predominance in lupus?
What about race? |
Female >> Male (9:1). Tends to occur more significantly during reproductive years.
No increased incidence in race but Increased mortality rates in African Americans. |
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What are the two most commonly involved systems of the body in Lupus?
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Skin and Musculoskeletal system
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Describe Acute, Subacute, and Chronic skin changes that occur in patients with SLE?
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Acute= malar rash, erythema, bullae
Subacute= papulosquamous and annular polycyclic rash Chronic: localized discoid rash *note: lupus non-specific rashes may occur like urticarial lesions, oral lesions, etc. |
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What type of rash is seen here (chronic/acute/subacute)? How can you tell the difference between this and rosacea
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Malar Rash (butterfly rash over the cheeks and bridge of nose)
*different from Rosacea- not pustular, spares the nasolabial folds |
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What type of rash is seen here (chronic/acute/subacute)? What condition can occur if this rash is found on the surface of the head?
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Chronic- this is a discoid rash (there is also post-inflammatory hypo and hyperpigmentation)
Scarring discoid rash can cause alopecia (loss of hair that generally doesn't grow back). |
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What is shown in this person with lupus?
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Sun exposed skin --> photosensitivity
(remember, sun exposure = environmental factor that can trigger auto-inflammatory process) |
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What is shown in this image? Can you tell Lupus related arthropathy or Rheumatoid Arthritis and how?
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Specific arthritic change *ulnar deviation and swans neck deformity i.e. Jaccoud's Arthropathy*
This is LUPUS and you can tell because there is no joint erosion or damage (unlike RA in which you see that). |
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Besides arthritis, what other musculoskeletal system manifestations occur in Lupus?
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- Avascular necrosis (especially of femoral head)
- Septic arthritis - Myositis (inflammation of muscles) |
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What is the predominant renal problem in patients with Lupus?
If you strongly suspect someone has renal involvement in lupus, what should you do? |
Lupus Nephritis--> a glomerularnephritis (proteinuria, elevated creatinine, etc.). There are different types (mesangial, focal proliferative, diffuse proliferative, etc.)
Renal involvement suspected? GET A BIOPSY!! |
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What are the diagnostic criteria for NeuroPsychiatric Lupus?
What are the key hematologic manifestations of Lupus? |
CNS criteria = unexplained seizure or psychosis
Heme= leukopenia and thrombocytopenia |
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A person comes in with pleuritic chest pain. You do a CXR and see no evidence of effusion. Why is Lupus on your differential?
What cardiac manifestation of lupus are we most worried about? |
Pleuritic chest pain on inhalation without effusion suggest Lupus due to inflammation of pleura.
Cardiac manifestation = Accelerated Atherosclerosis! |
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What characteristic valvular lesion (shown here) is seen in SLE? Why is it worrisome?
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Libman-Sacks endocarditis- verrucous vegetation on the valve. From fibrin thrombi and necrotic cell debris.
Can embolize and cause problems. |
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What treatment is used in lupus frequently for cutaneous and MS manifestations?
Otherwise, how would you manage the mild constitutional sxs of lupus? |
Anti-Malarial, specifically Hydroxychloroquine used for CUTANEOUS and MS symptoms. Also helps with fatigue.
NSAIDS used for mild constitutional sxs. |
