-
What is the clinical presentation of lupus?
- Fatigue, malaise
- Butterfly rash
- Lupus Nephritis
- AND MANY MORE!!!
-
What is the epidemiology of lupus?
- Most prevalent in young females
- Less prevalent in whites
- Peak onset between late teens and early 40s (but can even occur in kindergartners)
-
What is the etiology of lupus?
- No single cause
- Genetic susceptibilities:
- multiple genes involved
- loci appear to co-localize with loci of other autoimmune diseases
-
What are the risk factors/exacerbation factors for lupus?
- UVB light
- Alfalfa sprouts (l-canavanine)
- Female gender
- Pristane
- High intake of saturated fats
- Smoking
- Pregnancy
- Drugs:
- Estrogen (for those with APS also)
- Sulfonamides
- Echinacea
- Hydralazine
- Procainamide
- Methyldopa
- d-Penicillamine
- INH
- Hydantoins
- Chlorpromazine
- Minocycline
- Interferon-alpha
-
What is the pathophysiology of lupus?
- Multiple autoantibodies react with various components of the cell nucleus
- Immune complexes may be present for years before sx appear
- Autoantibodies and complexes bind to target tissues, activating inflammation and phagocytosis, causing irreversible tissue damage
-
What are the complications of lupus?
- Lupus nephritis
- Antiphospholipd syndrome (APS)(thrombosis)
- Accelerated atherosclerosis (increased risk for cardiovascular and cerebrovascular diseases)
- Neurological/psychiatric presentations
- Other autoimmune diseases (Sjogren's, Scleroderma, etc)
-
What is the non-pharmacologic therapy for lupus?
- Balanced routine of rest and exercise (fatigue management)
- Avoid smoking
- Avoid alfalfa sprouts and other foods containing l-canavanine
- Avoid sunlight and use sunscreen with no PABA ingredients (Sulfa-related)
-
What drugs are used for lupus?
- NSAIDs
- Systemic or Oral corticosteroids
- Antimalarials
- Cyclophosphamide (lupus nephritis)
- Azathioprine (lupus nephritis)
- Mycophenolate (lupus nephritis)
- Rituximab
- IVIG
- Thalidomide
- Cladrabine
- DHEA (androgen/estrogen synthesis)
-
What are the special considerations for antimalarials?
- Hydroxychloroquine preferred over Chloroquine
- For long term management (slow onset)
- For moderate musculoskeletal sx not controlled by NSAIDs (arthralgia/arthritis)
- Stop if no response after 6 months
-
What is the usual initial therapy for Arthritis in lupus pts?
NSAIDs
-
What is the usual initial therapy for pleurisy and pericarditis in lupus pts?
NSAIDs
-
What is the usual initial therapy for rash in lupus pts?
Topical steroid
-
What is the usual initial therapy for lupus nephritis?
Systemic steroid
-
What is the only possible drug therapy for fatigue in lupus pts?
Hydroxychloroquine
-
What drugs can be used for rash in lupus pts?
- Hydroxychloroquine
- Topical steroid (preferred)
-
What drugs can be used for arthritis in lupus pts?
- NSAIDs (preferred)
- Hydroxychloroquine
- Systemic steroid
-
What drugs can be used for pleurisy and pericarditis in lupus pts?
- NSAIDs (preferred)
- Systemic steroid
-
What drugs can be used for lupus nephritis?
- Systemic steroid (preferred)
- Cyclophosphamide
- Azathioprine
- Mycophenolate
-
What are some other therapeutic considerations for lupus pts?
- Influenza and pneumococcal vaccinations (infection risk)
- Lifestyle modifications and medications for HTN, DM, and hyperlipidemia to decrease cardiovascular/cerebrovascular events
|
|
