Systemic Lupus Erythematosus Flashcards

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Questions and Answers

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?

SOAP BRAIN MD, DOPAMINE RASH

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?

Clinically, with at least 4 criteria Signup and view all the answers

How does serositis in SLE present?

Pleurisy or pericarditis Signup and view all the answers

What type of ulcers meet criteria for SLE?

Oral or nasal ulcers, usually painless Signup and view all the answers

What type of oropharyngeal ulcer is most specific for SLE?

Palate Signup and view all the answers

What type of arthritis meets criteria for SLE?

Non-erosive, involving 2 or more peripheral joints Signup and view all the answers

What blood disorders are associated with SLE criteria?

Leukopenia, Lymphopenia, Thrombocytopenia, Hemolytic anemia Signup and view all the answers

What qualifies for renal involvement in the SLE diagnostic criteria?

Proteinuria (>0.5 g/day or 3+ positive on dipstick), Cellular casts, Opinion of rheumatologist or nephrologist Signup and view all the answers

When does a positive ANA not contribute to the diagnosis of SLE?

If it is associated with medications that can induce drug-induced lupus Signup and view all the answers

What immunologic phenomena contribute to the diagnostic criteria of lupus?

Positive dsDNA, Positive anti-Sm, Antiphospholipid antibodies (anticardiolipin IgG or IgM; lupus anticoagulant), False-positive syphilis serology Signup and view all the answers

How can lupus present neurologically?

Seizures or psychosis Signup and view all the answers

Describe a lupus discoid rash.

Erythematous, Raised-rim, Keratotic scaling, Follicular plugging Signup and view all the answers

What is the best screening lab for lupus?

ANA Signup and view all the answers

Which lab tests are most specific for lupus?

Anti-dsDNA and Anti-SM Signup and view all the answers

What lab test is drug-induced lupus associated with?

Anti-histone antibodies Signup and view all the answers

What is considered a significant ANA?

<blockquote> 1:160 </blockquote> Signup and view all the answers

What labs support the diagnosis of lupus flare?

Increased IgG, Increased Anti-dsDNA, Decreased complement (C3, C4 and CH50) Signup and view all the answers

What is the initial treatment for mild lupus with arthritis or serositis?

NSAIDs, Hydroxychloroquine Signup and view all the answers

For moderate SLE that is refractory to NSAIDs and hydroxychloroquine, what are the next options in therapy?

Steroids, Immunosuppressives (cyclophosphamide, azathioprine), Biologic B-cell inhibitors (rituximab, belimumab) Signup and view all the answers

How are SLE flares treated?

Prednisone burst with taper once remission is induced Signup and view all the answers

How are anti-phospholipid antibody patients managed?

Life-long anticoagulation with warfarin Signup and view all the answers

How does SLE impact pregnancy?

Higher rate of SAB (spontaneous abortion) Signup and view all the answers

What is a major cardiac concern of neonatal lupus?

Complete heart block Signup and view all the answers

What are possible causes of a stroke in lupus patients?

Arterial or venous thrombosis, Cardiogenic embolism, Small vessel infarcts, Vasculitis Signup and view all the answers

What are common causes of mortality in SLE?

Accelerated atherosclerosis, Infections, Malignancy, Renal disease Signup and view all the answers

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.

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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.