1. What is the clinical presentation of lupus?
    • Fatigue, malaise
    • Butterfly rash
    • Lupus Nephritis
    • AND MANY MORE!!!
  2. 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)
  3. 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
  4. 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
  5. 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
  6. 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)
  7. 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)
  8. 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)
  9. 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
  10. What is the usual initial therapy for Arthritis in lupus pts?
  11. What is the usual initial therapy for pleurisy and pericarditis in lupus pts?
  12. What is the usual initial therapy for rash in lupus pts?
    Topical steroid
  13. What is the usual initial therapy for lupus nephritis?
    Systemic steroid
  14. What is the only possible drug therapy for fatigue in lupus pts?
  15. What drugs can be used for rash in lupus pts?
    • Hydroxychloroquine
    • Topical steroid (preferred)
  16. What drugs can be used for arthritis in lupus pts?
    • NSAIDs (preferred)
    • Hydroxychloroquine
    • Systemic steroid
  17. What drugs can be used for pleurisy and pericarditis in lupus pts?
    • NSAIDs (preferred)
    • Systemic steroid
  18. What drugs can be used for lupus nephritis?
    • Systemic steroid (preferred)
    • Cyclophosphamide
    • Azathioprine
    • Mycophenolate
  19. 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
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