4 categories of SLE etiology
UV light
viruses
hormonal
drug induced
4 main lupus-inducing drugs
- hydralazine
- procainamide
- minocycline
- TNF inhibitors
in simple terms, what is the pathogenesis of SLE
multiple contrbuting factors including genetics causing normal immune response in abnormal places; a type 3 hypersensitivity rxn
3 manifestations of CHILDHOOD SLE
fever
neurological disease
renal disease
list some clinical features of SLE (7)
- nonscarring alopencia
- cutaneous or ulcers
- raynaud’s
- arthritis
- leucopenia
- fever
- serositis
NOT conclusive list
list some clincial features of SLE (7)
- nonscarring alopencia
- cutaneous or ulcers
- raynaud’s
- arthritis
- leucopenia
- fever
- serositis
- ulnar deviation w/o erosions– need Xray to diff. from PsA or RA
NOT conclusive list
what is neonatal lupus
passive transfer of autoantibodies that wears out with time; baby does not actually have the disease; born with the butterfly rash
5 tests to order if suspecting SLE
- CBC w/ differential
- ESR/CRP
- creatinine
- urinalysis to check for proteinuria
- ANA (w/ immunofluorescence)
negative ANA means…
r/o SLE
4 other general things that could casuse + ANA
- thyroid disease– hypo-
- infxn– parovirus, lyme, etc
- fam hx
- other autoimmune dz
3 futher testing you can do after ANA
- ENA panel– assocaited with other dz
- dsDNA– rise is SLE specific
- complement– associated w/ dz activity (low is bad)
over ____ in the SLE classification criteria = likely lupus
10
what two tests are repeated after SLE diagnosis? what 3 tests do you get ONLY if there is major change in sx or physical findings
- dsDNA & c3/c4
- if major change: ANA, RF, CCP
NOTE: don’t recheck ESR/CRP
3 main goals of therapy with SLE
tx active lupus
prevent medication SE & damage
improve survival
gender & ethnicity most affected
Black ppl and latinos; mostly women
3 main tx of SLE
- education– sun, pregnancy planning, smoking
- hydroxychloroquine to reduce autoimmunity
- steroids for flares and severe manifestations
1st and 2nd line for mild, moderate & severe SLE
1st: HCQ
2nd: steroids
monitoring patients involves frequent visits and getting labs liek CBC, renal fxn, ESR/CRP, SLE activity but what should NOT be rechecked?
ANA or other diagnostic antibodies
5 challenges in the tx of patients w/ SLE
- accelerated atherosclerosis
- antiphospholipid syndrome
- nephritis
- contraception and estrogen use
- pregnancy
what is the challenging condition
-autoantibodies; clotting assay
recurrent thrombosis
hx of recurrent fetal loss
antiphospholipid syndrome
name the challenging condition
- requires kidney biopsy for dx and tx selection
- tx w/ high dose steroids & immunosuppressive meds for induction and maintaned with azathioprine, mycophenolate
lupus nephritis
what type of contraceptive is recommended in patients w/ lupus to decrease risk of antiphospholipid syndrom
barrier methods or IUD
3 risks to mom in pregnancy with SLE?
- flares– can be fatal d/t active nephritis
- APS
- preeclampsia
5 risks to fetus during pregnancy w/ SLE
- miscarriage d/t APS
- impaired growth
- prematurity
- neonatal lupus syndrome
- complete heart block
