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SLE
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· Anti-Ro? Neonatal Lupus
· Lupus nephritis is probably the most common cause overall of disability in patients with SLE.
· PREGNANCY AND SLE:
o They are fertile, and normal (طمئنهم من هذه الناحية), they only have ⤴️ risk for spontaneous abortion
o Screen all of them for anti-ro / anti-la (they cross placenta and causes neonatal lupus + heart block)
o In case SLE worsens during pregnancy → Steroids
· In case of antiphospholipid → LMWH
· How to confirm Dx of Drug-induced lupus? when u stop the drug, sx resolves within 2 weeks. thats how u dx.
· How to ddx acute lupus from drug-induced lupus? drug-induced lupus usually doesn’t have: renal + skin and it’s usually milder. It presents w/ Fever & arthritis.
o Hydralazine is the exception to anti-histone in drug-induced lupus, as only about one-third of patients will have positive anti-histone antibodies.
· What is antiphospholipid syn?
o simply, a hypercoagulable state that presents w/ abortion or embolism
o Antiphospholipid or anti-cardiolipin
o False +ve syphilis tests
· Management:
o Early (skin/arthritis) –> NSAIDs / Hydrochloroquine (check the eye)
o Late (Renal/CNS) –> Cyclophosphamide (prevent hemorrhagic cystitis w/ MESNA)
o Flares (many sx + FEVER + ⤴️ ESR) –> Steroids
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Presentation of SLE
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Sx
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· Constitutional: fever, fatigue & weight loss
· Symmetric, migratory arthritis
· Skin: butterfly rash & photosensitivity
· Serositis: pleurisy, pericarditis & peritonitis
· Thromboembolic events (due to vasculitis & antiphospholipid antibodies)
· Neurologic: cognitive dysfunction & seizures
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Labs
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· Hemolytic anemia, thrombocytopenia & leukopenia
· Hypocomplementemia (C3 & C4)
· Antibodies:
· ANA (sensitive)
· Anti-dsDNA & anti-Smith (specific)
· Renal involvement: proteinuria & elevated creatinine
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Fast HY Review 