Lupus

Question 1

SLE predisposing factors

Answer 1

1. genetics
2. hormonal - estrogen
3. environment - smoking, drugs, UV, pollution, etc

Question 2

Drug-induced lupus medications (acronym)

Answer 2

my pretty malar marking probably has a transient quality

methimazole
propylthiouracil
minocycline
methyldopa
procainamide
hydralazine
anti-TNF agents
terbinafine
isoniazid
quinidine

Question 3

Which laboratory tests have high specificity for lupus?

Answer 3

anti-dsDNA antibody
anti-Smith antibody

Question 4

SLICC diagnostic requirements

Answer 4

must meet ≥ 4 total features with 1 from each group (clinical and immunological)

Question 5

What is the backbone treatment of SLE?

Answer 5

Hydroxychloroquine

Question 6

If someone has G6PD deficiency, which medication should they not take?

Answer 6

hydroxychloroquine

Question 7

HCQ side effects

Answer 7

1. retinal toxicity - bullseye maculopathy
2. neuropsychiatric effects
3. QTc prolongation
4. myopathy
5. hypersensitivity rxn
6. hypoglycemia
7. hemolytic anemia - G6PD deficiency

Question 8

Glucocorticoids place in therapy

Answer 8

adjunct treatment - if not response to HCQ or NSAIDs

Question 9

Glucocorticoids side effects

Answer 9

1. glaucoma
2. increased BP
3. increased risk of osteoporosis
4. GI bleed, gastritis
5. sleep disturbances
6. weight gain
7. increased BG/hyperglycemia
8. topical steroid - skin atrophy, rosacea

Question 10

Immunosuppressants place in therapy

Answer 10

• adjunct when disease gets more severe or to lower steroid dose
• insufficient response to HCQ

Question 11

Which immunosuppressants are used for SLE?

Answer 11

1. methotrexate
2. azathioprine
3. cyclophosphamide
4. mycophenolate

Question 12

All of the immunosuppressants have a side effect of increased risk of malignancy, EXCEPT

Answer 12

methotrexate

Question 13

All of the immunosuppressants have these side effects in common:

Answer 13

bone marrow suppression
infection

Question 14

Which immunosuppressant has the unique side effect of acute inflammatory syndrome (AIS)?

Answer 14

mycophenolate

Question 15

Which immunosuppressant should you not use with a TPMT deficiency?

Answer 15

azathioprine

Question 16

Which biologics are used for SLE?

Answer 16

1. Belimumab
2. Rituximab
3. Anifrolumab

Question 17

Biologics clinical pearls

Answer 17

1. no live vaccines 30 days before starting therapy OR during therapy
2. do not use more than 1 biologic at same time

Question 18

With which biologic should you premedicate 30 mins prior to infusion to avoid infusion reactions?

Answer 18

rituximab

Question 19

Which biologic may reactivate Hep B?

Answer 19

rituximab

Question 20

Additional therapies for SLE

Answer 20

Calcineurin inhibitors:
tacrolimus
pimecrolimus
volcosporin