Podcast
Questions and Answers
What are some common causes of drug-induced lupus? (Select all that apply)
What are some common causes of drug-induced lupus? (Select all that apply)
- Penicillamine (correct)
- TNF inhibitors (correct)
- Procainamide (correct)
- Minocycline (correct)
- Hydralazine (correct)
What are common mnemonics for the diagnostic criteria of SLE?
What are common mnemonics for the diagnostic criteria of SLE?
SOAP BRAIN MD, DOPAMINE RASH
What do the letters for SOAP BRAIN MD stand for?
What do the letters for SOAP BRAIN MD stand for?
Serositis, Oral ulcers, Arthritis, Photosensitivity, Blood disorders, Renal involvement, ANA positive, Immunologic phenomena, Neurologic disorder, Malar rash, Discoid rash
How is SLE diagnosed?
How is SLE diagnosed?
How does serositis in SLE present?
How does serositis in SLE present?
What type of ulcers meet criteria for SLE?
What type of ulcers meet criteria for SLE?
What type of oropharyngeal ulcer is most specific for SLE?
What type of oropharyngeal ulcer is most specific for SLE?
What type of arthritis meets criteria for SLE?
What type of arthritis meets criteria for SLE?
What blood disorders are associated with SLE criteria?
What blood disorders are associated with SLE criteria?
What qualifies for renal involvement in the SLE diagnostic criteria?
What qualifies for renal involvement in the SLE diagnostic criteria?
When does a positive ANA not contribute to the diagnosis of SLE?
When does a positive ANA not contribute to the diagnosis of SLE?
What immunologic phenomena contribute to the diagnostic criteria of lupus?
What immunologic phenomena contribute to the diagnostic criteria of lupus?
How can lupus present neurologically?
How can lupus present neurologically?
Describe a lupus discoid rash.
Describe a lupus discoid rash.
What is the best screening lab for lupus?
What is the best screening lab for lupus?
Which lab tests are most specific for lupus?
Which lab tests are most specific for lupus?
What lab test is drug-induced lupus associated with?
What lab test is drug-induced lupus associated with?
What is considered a significant ANA?
What is considered a significant ANA?
What labs support the diagnosis of lupus flare?
What labs support the diagnosis of lupus flare?
What is the initial treatment for mild lupus with arthritis or serositis?
What is the initial treatment for mild lupus with arthritis or serositis?
For moderate SLE that is refractory to NSAIDs and hydroxychloroquine, what are the next options in therapy?
For moderate SLE that is refractory to NSAIDs and hydroxychloroquine, what are the next options in therapy?
How are SLE flares treated?
How are SLE flares treated?
How are anti-phospholipid antibody patients managed?
How are anti-phospholipid antibody patients managed?
How does SLE impact pregnancy?
How does SLE impact pregnancy?
What is a major cardiac concern of neonatal lupus?
What is a major cardiac concern of neonatal lupus?
What are possible causes of a stroke in lupus patients?
What are possible causes of a stroke in lupus patients?
What are common causes of mortality in SLE?
What are common causes of mortality in SLE?
Study Notes
Drug-Induced Lupus
- Common causes include hydralazine, procainamide, penicillamine, TNF inhibitors, and minocycline.
Diagnostic Criteria for SLE
- Mnemonics: SOAP BRAIN MD and DOPAMINE RASH are useful for remembering the criteria.
- SOAP BRAIN MD components:
- Serositis
- Oral ulcers
- Arthritis
- Photosensitivity
- Blood disorders
- Renal involvement
- ANA positive
- Immunologic phenomena
- Neurologic disorder
- Malar rash
- Discoid rash
- Diagnosis requires clinical evaluation with at least four criteria met.
Clinical Manifestations
- Serositis presents as pleurisy or pericarditis, identifiable through examination or EKG.
- Oral or nasal ulcers, usually painless, meet SLE criteria, with palate ulcers being the most specific.
- Arthritis considered in SLE is non-erosive affecting two or more peripheral joints.
Blood Disorders in SLE
- Associated blood disorders include leukopenia, lymphopenia, thrombocytopenia, and hemolytic anemia.
Renal Involvement
- Criteria for renal involvement include proteinuria (>0.5 g/day or 3+ on dipstick) and cellular casts, often evaluated by a specialist.
Immunologic and Other Diagnostic Factors
- Positive ANA alone does not confirm SLE if induced by medications.
- Key immunologic phenomena include positive dsDNA, positive anti-Sm, antiphospholipid antibodies, and false-positive syphilis serology.
- Neurologic manifestations may involve seizures and psychosis.
- Discoid rash characteristics: erythematous, raised-rim with keratotic scaling and follicular plugging.
Laboratory Testing
- Best screening lab for lupus is ANA.
- Anti-dsDNA and anti-Sm are most specific tests for lupus.
- Drug-induced lupus is associated with anti-histone antibodies.
- Significant ANA is defined as >1:160.
- Diagnostic support for lupus flare includes increased IgG, increased anti-dsDNA, and decreased complement levels.
Treatment Guidelines
- Initial treatment for mild lupus with arthritis or serositis includes NSAIDs and hydroxychloroquine.
- Options for moderate SLE refractory to NSAIDs include steroids, immunosuppressives (cyclophosphamide, azathioprine), or biologic B-cell inhibitors (rituximab, belimumab).
- SLE flares are treated with a prednisone burst followed by tapering once remission is achieved.
- Patients with anti-phospholipid antibodies require lifelong anticoagulation with warfarin.
Pregnancy and SLE
- SLE is associated with a higher risk of spontaneous abortion (SAB).
- A major cardiac concern in neonatal lupus is complete heart block.
Stroke Risks in SLE
- Possible causes include arterial or venous thrombosis, cardiogenic embolism, small vessel infarcts, and vasculitis.
Mortality Risks in SLE
- Common mortality causes encompass accelerated atherosclerosis, infections, malignancy, and renal disease.
Studying That Suits You
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Description
Test your knowledge on Systemic Lupus Erythematosus (SLE) with these flashcards. Explore common causes, diagnostic mnemonics, and criteria associated with SLE. Perfect for medical students and anyone wanting to deepen their understanding of this complex autoimmune disease.
