Systemic Lupus Erythematosus

What type of hypersensitivity reaction is SLE?

Type III (immune complex-mediated) hypersensitivity

What are the classic board-style manifestations of SLE?

Malar rash, photosensitivity, oral ulcers, arthritis, nephritis

How can a lupus malar rash be distinguished from rosacea?

SLE rash spares the nasolabial folds and is sun-sensitive

What cutaneous lupus lesion causes permanent scarring?

Discoid lupus

What is the characteristic feature of lupus oral ulcers?

Usually painless

What type of arthritis occurs in SLE?

Non-erosive inflammatory arthritis occuring in small joints; Jaccoud’s Arthropathy-tendon inflammation + laxity

What hand deformity is associated with SLE and is classically reversible?

Jaccoud arthropathy- tendon inflammation + laxity

How does Jaccoud arthropathy differ from rheumatoid arthritis?

No erosions on imaging (RA has marginal erosions)

What cardiopulmonary manifestations are included under lupus serositis?

Inflammation of seroud membrane»Pleuritis, pleural effusion, pericarditis, pericardial effusion

What neurologic manifestations are classically associated with SLE?

Seizures and psychosis

What hematologic abnormalities are common in SLE?

Leukopenia, lymphopenia, thrombocytopenia, hemolytic anemia

What autoantibody is positive in almost all patients with SLE?

ANA

Which antibody is most useful for confirming SLE and tracking disease activity?

Anti-dsDNA

Which antibody is most specific for SLE?

Anti-Smith

What skin finding suggests antiphospholipid syndrome in a patient with lupus?

Livedo reticularis

What is Raynaud phenomenon?

Cold-induced vasospasm causing white(vasospasm)→blue(ischemia)→red(re-perfusion) color changes

What is considered the foundation therapy for nearly all SLE patients?

Hydroxychloroquine

Why is hydroxychloroquine called the “statin of rheumatology”?

Reduces flares, thrombosis, organ damage, and mortality

What is the major toxicity of hydroxychloroquine?

Retinal toxicity

What should generally never be stopped during pregnancy in patients with SLE?

Hydroxychloroquine

Which antibody should be checked in pregnant women with SLE and why?

SSA (Ro) because of fetal heart block risk and antiphospholipid antibodies because of fetal loss

What is the classic laboratory antibody associated with drug-induced lupus?

Anti-histone antibody

CAD and Lupus

High risk for early onset CAD, tx with aspirin, and statins (and hydroxychloroquine)

Which antibodies are typically absent in drug-induced lupus?

SSA, SSB, and Smith antibodies

What are the classic manifestations of drug-induced lupus?

Rash, arthritis, fever, pleuropericarditis, cytopenias

What is the treatment for drug-induced lupus?

Stop the offending medication

Which four drugs are the highest-yield causes of drug-induced lupus?

Hydralazine, procainamide, minocycline, TNF inhibitors

Which drug-induced lupus cause is more likely to have positive anti-dsDNA antibodies?

TNF inhibitors