Lupus

_______ is a multi system chronic autoimmune disease that affects the musculoskeletal, cutaneous & renal systems

Systemic lupus is a multi system chronic autoimmune disease that affects the musculoskeletal, cutaneous & renal systems

Systemic lupus is a chronic immune disease that affects the _______, ______ & _____ systems.

Systemic lupus is a multi system chronic autoimmune disease that affects the musculoskeletal, cutaneous & renal systems

During lupus flairs, you would expect to see low serum ________ levels.

During lupus flairs, you would expect to see low serum complement levels *low C3 and C4

You draw labs on a patient and notice low C3 and low C4. This patient is most likely in a _______ flair

Low C3 and low C4 indicate a lupus flair *low serum complement levels (C3 & C4) indicate lupus flair

What is the pathophysiology behind systemic lupus

Many clinical manifestations that are all secondary to trapping of antigen-antibody ocomplexes in the capillaries of visceral structures or to auto antibody-mediated destruction of host cells

The rash associated with systemic lupus spares what area?

The rash spares nasolabial folds

Checking for low C3 & C4 may be helpful in evaluating for lupus. What other lab test may also be helpful?

In addition to low serum complement levels, anti-dsDNA may also be a lab test helpful in diagnosing lupus

Drug induced lupus spares the ________

Drug induced lupus spares the kidneys *drugs that induce lupus: hydralazineprocainamideisoniazidTNF alpha inhibitors statins HCTZ*drug induced lupus does not cause glomerulonephritis

_________ is a form of lupus that does not cause glomerulonephritis

Drug induced lupus is a form of lupus that does not cause glomerulonephritis**drug induced lupus spares the kidneys

What drugs may induce lupus?

Hydralazine procainamide isoniazid TNF-alpha inhibitors **drug induced lupus spares the kidneys

What is discoid lupus?

Autoimmune photosensitive skin disease presents as annular, erythematous patches on face and scalp that heal with scarring*treat with high potency topical steroids **squamous cell cancer may develop in DLE scars!!

______ is an autoimmune photosensitive skin disease that presents as an annular, erythematous rash on face and scalp that heals with scaring

Discoid lupus is an autoimmune photosensitive skin disease that presents as an annular, erythematous rash on face and scalp that heals with scaring *treat with high potency topical steroids ***squamous cell cancer may develop in DLE scars

How would you treat discoid lupus?

High potency topical steroids (clobestasol)

What type of drug is clobestasol, and what is it used to treat?

Clobestasol is a high potency topical steroid used to treat discoid lupus

______ cancer may develop in DLE scars

Squamous cell cancer may develop in DLE scars

Anticardiolipin antibody syndrome

Presence of antiphospholipid antibodies (aPL) result inarterial or venous thrombosis &/or adverse pregnancy outcomes

What antibodies are present In anticardiolipin antibody syndrome?what are 2 effects of these antibodies being present?

Antibodies: antiphospholipis antibodies (aPL) Arterial or venous thrombosis &/or adverse pregnancy outcomes may result in the presents of persistent antiphospholipid antibodies

How would you differentiate between lupus rash and rosacea???

Lupus rash: spares the nasolabial folds and does not have rosacea macular rash: involves the nasolabial folds

If rosacea macular rash involves intense itching, then consider diagnosing _______

If rosacea macular rash involves intense itching, then consider diagnosing dermatomyositis

Dermatomyositis

inflammation of the skin and muscles*consider this diagnosis if rosacea macular rash is accompanied by intense itching

When would you consider diagnosing dermatomyositis?

If rosacea macular rash is accompanies by intense itching

Hydrochlorothiazide (HCTZ) is a photosensitizing drug. Therefore, rashes associated with this drug often (involve / spare) the nasolabial folds

Spare

What is a schirmer test?what is it used to diagnose?

Schirmer test: evaluates tear secretions by the lacrimal glands. *a test used to evaluate decreased tear production Used to diagnose sjogren syndrome **a positive test doesnt necessarily mean sjogren syndrome, but + schirmer test with dry eyes, dry mouth and positive SSA is pretty specific for sjogren**parotid glands may also be enlarged

The parotid glands may be enlarged in _____ what other symptoms would you expect this patient to have?

The parotid glands may been enlarged in sjogren syndrome other symptoms: Dry eyes, dry mouth, fatigue, arthralgia

A negative ________ test rules out lupus, but a positive ______ test is not enough to diagnose lupus

Negative ANA test rules out lupus, but a positive ANA is not enough to diagnose lupus!!!

T/F: a negative ANA is enough to rule out lupus

True *a negative ANA is enough to rule out lupus, but a positive ANA is not enough to diagnose lupus - need 4 of the 11 symptoms

T/F: a positive ANA is diagnostic of lupus

False *positive ANA is not enough to diagnose lupus - need 4 of the 11 signs/symptoms to diagnose lupus. **1 in 10 healthy women have a high ANA ***however, a NEGATIVE ANA is enough to RULE OUT lupus

If there renal or CNS involved in lupus, then the lupus is likely NOT _____

Likely not drug induced lupus if there is renal or CNS involvement *drug induced spares the kidneys & CNS

Before prescribing a patient azathiporine what test do you need to do?

Before prescribing azathiprine test TPMT *TPMT is a genetic deficiency that requires lower doses of azathiprine

What is TPMT?when would we want to measure this?

genetic deficiency that requires lower doses of azathioprine measure before giving azathiporine ^

How would you treat systemic lupus with minor organ involvement (skin and oral mucosa)

Hydroxychloroquine **This drug is typically safe in pregnancy

How would you treat systemic lupus with major organ involvement?

Azathioprine**do a TPMT test prior to administering this drug *TPMT is a genetic deficiency that requires lower doses of azathioprine

When is azathioprine used for SLE?

Used in patients with major organ involvement **do a TPMT test prior to administering this drug *TPMT is a genetic deficiency that requires lower doses of azathioprine

When is hydroxychloriquine used for SLE?

Minor organ involvement (skin or oral mucosa involvement) *generally safe for use in pregnancy

If a patient has refractory arthritis, _______ and _______ is a great way to preserve joint function and enhance quality of life

If a patient has refractory arthritis, physical therapy and occupational therapy is a great way to preserve function and enhance quality of life

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