Term
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Definition
-Chronic, autoimmune disorder
-Systemic rheumatic disease
-Multiple systems involved
-Periods of activity and remission are unpredictable.
-Severity of symptoms range from mild to life-threatening.
-5 year survival in the 1950s was around 50%
-Currently, the 15-20 yr survival is approximately 80-85%. |
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Term
| Systemic Lupus Erythematous (SLE) |
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Definition
-most common form
-involves multiple body systems |
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Term
| Cutaneous Lupus Erythematous |
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Definition
-limited to skin involvement
-progresses to SLE in 10% of people |
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Term
| Drug-Induced Lupus Erythematous |
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Definition
-caused by certain prescription drugs
-similar sx's as SLE
-symptoms are reversible with D/C of drug |
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Term
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Definition
-rare
-affects infants of women who have SLE
-mother's antibodies attack fetus
-sx's disappear several months after birth |
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Term
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Definition
Affects 1 per 2000 persons
An estimated 1.5 M Americans have lupus and 5M people around the world have a form of lupus. |
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Term
Epidemiology Prevalence of Lupus
-overall prevalence?
-prevalence by race |
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Definition
-Overall, prevalence ratio of women to men is 10:1
-More prevalent in African-Americans, Hispanics, Native Americans, and Asians |
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Term
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Definition
-Cause unknown
-formation of autoantibodies and immune complexes
-autoantibodies may also target surface antigens of blood cells leading to anemia an destruction of platelets leading to thrombocytopenia
-autoantibodies may cause direct damage to tissues or form tissue-damaging complexes by combining with corresponding antigens.
-Identified autoantibodies include anti-nuclear antibodies (ANA) such as anti-deoxyribonucleic acid (anti-DNA) |
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Term
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Definition
-UV light from sun or fluorescent light bulbs
-Maternal influence during in utero development and early life experiences may predispose patient to lupus.
-Effect of sex hormones in women (?estrogen)-exacerbation during menses and pregnancy |
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Term
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Definition
-occupational exposure to some chemicals, metals or solvents.
-exhaustion
-emotional stress
-physical stress to the body (surgery, injury, infections, pregnancy). |
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Term
| Triggers of Drug-Induced Lupus Erythematous |
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Definition
-Sulfa drugs
-Hydralazine
-Procainamide
-Quinidine
-Methyldopa
-Isoniazid
-Phenytoin
-Penicillins |
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Term
| Lupus affects which body systems? |
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Definition
-Musculoskeletal
-Respiratory
-Cardiovascular
-Skin
-Renal
-CNS
-Red blood cells and platelets |
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Term
| General Manifestations of Lupus |
|
Definition
-fatigue
-flu-like symptoms
-fever
-heaviness in legs/general weakness
-neuropathy
-weight loss
-rash
-oral/nasal ulcers
-cough/dyspnea/hemoptysis
-HA's
-visual deficits
-abdominal pain, N/V
-recurrent miscarriages |
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Term
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Definition
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Term
| Skin Manifestations of Lupus |
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Definition
-malar or "butterfly" rash
-discoid lupus rash
-fingertip lesions
-hair loss
-mucous membrane lesions
-raynaud's phenomenon
-livedo reticularis |
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Term
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Definition
| changes in blood flow to the extremities |
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Term
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Definition
| purplish mottling of skin/lacelike appearance, usually note in the extremities (assoc with antiphospholipid syndrome) |
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Term
| Pulmonary manifestations of Lupus |
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Definition
-pleuritis
-pleural effusion
-pneumonitis
-pulmonary hemorrhage
-interstitial lung disease
-pulmonary embolism |
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Term
| cardiac manifestations of lupus |
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Definition
-pericarditis
-myocarditis
-valvular disease
-ischemic heart disease, risk of MI is 50 fold with SLE from 35-44 yo |
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Term
| Lupus hematologic manifestations |
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Definition
-hemolytic anemia
-leukopenia
-lymphopenia
-thrombocytopenia
-antiphospholipid syndrome |
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Term
| Antiphospholipid syndrome |
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Definition
-affects the ability to clot
-may be secondary complication of SLE
-may manifest as recurrent miscarriages, DVT's, or stroke |
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Term
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Definition
-occurs in 25-50% of patients
-persistent proteinuria
-cellular casts
-RBC's in urine
edema in legs, abdomen, around eyes.
-Hypertension |
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Term
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Definition
-2/3 of people with SLE experience CNS involvement
-Vasculitis limits blood flow and prodution of anti-phospholipid antibodies damages blood vessels in brain (CVA/hemorrhage)
-Seizures (more common in renal failure pts)
-Migraines
-Psychotic symptoms (mood changes-depression & euphoria), decreased cognition, confusion, altered LOC |
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Term
Criteria for Classification of SLE
-at least 4 of the 11 criteria are required for dx of SLE: |
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Definition
-malar rash
-discoid rash
-photosensitivity
-oral ulcers
-arthritis
-serositis (pleuritis or pericarditis)
-renal disorder (persitent proteinuria or cellular casts)
-leukopenia, hemolytic anemia, or thrombocytopenia
-neurologic disorder
-positive anti-DNA or anti-Smith antibody, or positive test for antiphospholipid antibodies
-antinuclear antibodies in high titers |
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Term
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Definition
-Antinuclear antibody (High sensitivity)
-Anti-double-stranded DNA (dsDNA) and anti-Smith antibodies (High specificity for SLE, Both are present in 30-40% of patients with SLE)
-ESR
-Rheumatoid factor
-Anticardiolipin IgG/IgM and lupus anticoagulant
-C3, C4
-CBC with diff
-BUN/Creatinine
-Urinalysis |
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Term
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Definition
-CXR
-Xray of involved joints
-Head CT scan
-Echo
-Renal bx
-Skin bx
-EEG |
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Term
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Definition
| No, no cure exists. The goal is to control and relieve symptoms and provide patient education to slow progression of the disease and decrease complications. |
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Term
| Evidence Based Tx of Lupus |
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Definition
-Topical or intralesional glucocorticosteroids for skin lesions
-NSAIDs
-ASA
-Hydroxychloroquine 400 mg PO qd-bid
-Systemic corticosteroids for pts who do not respond to hydroxychloroquine
-Immunocompressive agents
-Methotrexate
-Dialysis and kidney tx |
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Term
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Definition
-confusion and memory loss associated with SLE
-cognitive therapy may be helpful
-anti-depressants or anti-anxiety meds as needed |
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Term
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Definition
-avoid strong sunlight, use sunscreen
-low-impact aerobic exercise
-diet: avoid foods high in sat fats and sodium
-Foods high in calcium and Vit D, foods high in omega 3 fatty acids for cardiac benefits
-Immunization: avoid live vaccines, up to date
-Smoking Cessation
-Birth Control/Pre-conception counseling |
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Term
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Definition
-F/U appointments weekly to monthly for pts with active disease
-F/U every 3-6 months for pts with mild or inactive disease.
-Labs:CBC, serum creat, and U/A; monitor dereasing c3 or c4 and increasing anti ds-DNA/anti smith antibodies or ESR
-monitor medication effects |
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Term
It is common for patients with SLE to experience:
a. Raynaud’s phenomenon
b. Arthritis
c. Pericarditis
d. All of the above |
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Definition
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Term
A lab test that has the highest specificity for SLE is:
a. tTG
b. ESR
c. Anti-Smith antibody
d. Anti-SSB(La) |
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Definition
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Term
A laboratory test that has decreased results during flares of SLE is:
a. ESR
b. C3, C4
c. ANA
d. Anti-Smith antibodies |
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Definition
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