What are the most common presenting clinical features of SLE? CORRECT ANSWER - Malar rash, photosensitivity, inflammatory arthritis, weight loss and
... [Show More] fever, rising titers of anti-dsDNA concordant with active SLE
People with SLE have a higher overall risk for what? CORRECT ANSWER - 1) Hematologic malignancies; risk for Non Hodgkin Lymphoma is 2-3x higher than in general population
2) increased prevalence of CAD-MCC of death among older patients with SLE
3) Increased risk for stroke
2 life threatening complications of Lupus? CORRECT ANSWER - Acute lupus pneumonitis-Fever, cough, dyspnea, hypoxemia, pleuritic chest pain and infiltrates
Diffuse alveolar hemorrhage-p/w dyspnea, hypoxemia pleuritic chest pain and infiltrates, high DlCO
What are first line agents for SLE? CORRECT ANSWER - Glucocorticoids
How to tx stable patient who is not having flare? CORRECT ANSWER - Hydroxychloroquine-prevents lupus exacerbations, reduces risk for congenital heart block, antithrombotic effects 2ndary to inhibition of platelet adhesiveness, aggregation.
Max dosage: 5 mg/kg
How should clinicians choose drug therapy for lupus arthritis? CORRECT ANSWER - Low dose glucocorticoids and antimalarials are 1st line agents
Methotrexate used for arthritis or cutaneous dx in patients w/o other s/x manifestations
MOA for Methotrexate? CORRECT ANSWER - Antagonizes folic acid and inhibits purine and pyrimidine synthesis, and it also increases extracellular adenosine release
What is the indication for kidney biopsy in patients with SLE? CORRECT ANSWER - 1) increasing serum creatinine level
2) Confirmed proteinuria>1.0 g/24 hour
3) Combo of proteinuria>0.5 g/24 hours+hematuria(>5 erythrocytes/hpf) or proteinuria>0.5 g/24 hr+ cellular casts
What should be used as maintenance therapy in lupus nephritis? CORRECT ANSWER - Mycophenolate mofetil or Azathioprine
Giant cell Arteritis usually affects who? CORRECT ANSWER - those over 50, white,
How do you treat GCA? CORRECT ANSWER - High Dose Prednisone-upto 80 mg+ IL-6 inhibitor Tocilizumab recommended as initial therapy for 2-4 weeks
You taper prednisone once symptoms resolve and inflammatory markers normalize
How do you treat acute visual loss in GCA? CORRECT ANSWER - IV pulse methylprednisolone for 3 days is recommended for acute visual loss
Pathophysiology of GCA? CORRECT ANSWER - Granulomatous inflammation of large and medium sized arteries , with infiltration of CD4(+) lymphocytes, macrophages and multinucleate giant cells
Involves: aorta-major branches, secondary branch vessels including external carotid, subclavian, axillary, temporal, ophthalmic, ciliary, vertebral arteries
What are the sx of GCA? CORRECT ANSWER - Headache( typically temporal, but more diffuse), constitutional sx, concomitant polymyalgia rheumatic, scalp tenderness over temporal arter, Jaw aching/fatigue with chewing
Extracranial version of GCA? CORRECT ANSWER - Claudication in only upper extremities, aortic dissection, aortic aneurysm [Show Less]