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Lupus 101 Lupus 101 An Educational Seminar An Educational Seminar

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Lupus 101 Lupus 101 An Educational Seminar An Educational Seminar Alan Elliott, MD, FACR Arthritis and Osteoporosis Consultants of the Carolinas ... – PowerPoint PPT presentation

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Title: Lupus 101 Lupus 101 An Educational Seminar An Educational Seminar


1
Lupus 101Lupus 101An Educational SeminarAn
Educational Seminar
  • Alan Elliott, MD, FACR
  • Arthritis and Osteoporosis Consultants of the
    Carolinas

2
Overview
  • Definition of lupus
  • Potential causes of lupus
  • Types of lupus
  • Diagnosis/ lab testing
  • Treatment

3
What is lupus?
  • A type of immune system disease
  • Known as an autoimmune disease (your immune
    system reacts against your own body)
  • Autoimmune diseases may be organ specific or
    systemic
  • Other examples
  • Rheumatoid Arthritis
  • Sjogrens Syndrome
  • Multiple Sclerosis
  • Not Osteoarthritis, Fibromyalgia, Osteoporosis

4
What causes lupus?
  • Genetic predisposition
  • Most cases are sporadic but may cluster in
    families (5-12 of family members have SLE)
  • Lupus is polygenic (more that one gene
    responsible)
  • Hormones (estrogen)
  • Environmental factors
  • Infections, stress, sunlight
  • Medications

5
Lupus Incidence and Prevalence
  • 1,000,000 to 2,000,000 Americans have lupus
  • Women make up 90 of patients with lupus
  • Most cases occur between ages 15-40
  • More common in African American and Asian
    populations
  • Often affects women in childbearing years
  • Children, teenagers, men, and the elderly can
    develop lupus

6
Types of Lupus
  • Drug-Induced Lupus (DILE)
  • Cutaneous Lupus Erythematosus (Discoid)
  • Systemic Lupus Erythematosus (SLE)
  • Others
  • Undifferentiated Connective Tissue Disease
  • Overlap Syndromes
  • Rheumatoid Arthritis, Sjogrens Syndrome,
    Polymyositis, Dermatomyositis, Scleroderma

7
Cutaneous Lupus
  • Affects only the skin
  • 1 of 10 patients with cutaneous lupus will go on
    to develop systemic lupus
  • Symptoms include rashes/skin lesions, hair loss,
    cutaneous vasculitis, ulcers of the skin,
    photosensitivity

8
Cutaneous Lupus
  • Diagnosis made by a review of the medical
    history, physical exam, lab tests, skin biopsy
  • Treatments include sunscreen, steroid creams and
    gels, antimalarials, immunosuppressives

9
Drug-Induced Lupus
  • A side effect of long-term use of certain
    medications
  • Hydralazine, Isoniazid, Methyldopa, Minocycline,
    Procainamide, Quinidine, Chlorpromizine
  • Symptoms include joint and muscle pain,
    arthritis, flu-like symptoms, inflammation of
    heart/lungs.
  • Symptoms resolve when medication is stopped

10
Systemic Lupus ErythematosusDiagnosis
  • List of 11 ACR criteria 4 of 11 required for
    the diagnosis
  • Seemingly unrelated parts of the body are
    affected
  • Common symptoms can be non-specific and not
    necessary part of the 11 criteria
  • include fatigue, hair loss, sensitivity to the
    sun, painful and swollen joints, unexplained
    fever, skin rashes, edema

11
Systemic Lupus Erythematosus11 Criteria (1
through 7)
  • Photosensitivity
  • Malar rash
  • Discoid skin lesions
  • Oral ulcerations
  • Serositis pleurisy, pericarditis, peritonitis
  • Inflammatory arthritis
  • Neurologic seizures, psychosis (neuropathy)

12
Systemic Lupus Erythematosus11 Criteria (8
through 11)
  • Hematologic low red cell (anemia), white cell
    (leukopenia), platelet (thrombocytopenia) counts
  • Renal abnormal blood test (creatinine) or
    urinalysis may lead to complications of
    hypertension, peripheral edema, renal failure
  • Antinuclear Antibody (ANA)
  • Other serologic abnormalities
  • Complement deficiency (C3, C4, CH50)
  • Other antibodies
  • Anti-SSA, anti-SSB, anti-Smith, anti-RNP,
    anti-DNA antibodies
  • Anticardiolipin/Antiphospholipid antibodies,
    Lupus anticoagulant
  • False positive test for syphilis

13
Lupus Flare and Remission
  • A flare is a sudden increase in disease activity
  • Remission is a time that is free of disease
    activity
  • Learn when to call your physician

14
Lupus and pregnancy
  • Fertility of lupus patients is similar to the
    general population
  • Patients with lupus are considered high-risk
  • Hypertension, edema, pre-eclampsia, miscarriage,
    early delivery, flare of lupus
  • Lupus should be under control and in remission
    before getting pregnant (ideally for 6 months)
  • Pregnancy may increase the risk of lupus flares
  • Neonatal lupus occurs in 1-2 of pregnancies
  • Some medications taken for lupus are probably
    safe to take during pregnancy

15
Treatment Living Better Lifestyle Modifications
  • Exercise alternate with rest periods
  • Ultraviolet light and flourescent light take
    precautions
  • Diet and supplements there is not a lupus diet
  • Smoking eliminate the habit
  • Sleep prepare the mind and body
  • Rest determine the amount you need
  • Medication side effects communicate with your
    physician

16
Treatment Living Better Lifestyle Modifications
  • Control fatigue learn to pace activities
  • Control stress identify your stresses and use
    methods to control the stress
  • Manage depression
  • Address workplace issues discuss needs with
    employer
  • Develop good doctor/patient relationship find a
    physician who listens be honest and responsive

17
Treatment Medications
  • Topical steroids
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Systemic steroids
  • Antimalarial drugs
  • Plaquenil (hydroxychloroquine), Aralen
    (chloroquine), Atabrine (quinicrine)
  • Disease Modifying/Cytotoxic Agents
  • Imuran (Azathioprine), Cellcept (mycophenolate
    mofetil), Cytoxan (cyclophosphamide), Rheumatrex
    or Trexall (methotrexate), Sandimmune and Neoral
    (cyclosprine)

18
Plaquenil (hydroxychloroquine)
  • Used to treat malaria, lupus, and inflammatory
    arthritis
  • Decreases autoimmune activity
  • Helpful for rash, arthritis, and fatigue
  • Typical dose is 200mg twice a day
  • Baseline eye exam and exam every 6-12 months
  • GI upset is common
  • May take months for full effect

19
Biologic Therapies
  • Target components of the immune system
  • Orencia (abatacept) blocks stimulation of T-cells
  • Rituxan (rituximab) depletes B-cells
  • Other biologic drugs in testing
  • Bone marrow transplants have been used in severe
    disease

20
Clinical Trials
  • May be appropriate options for resistant disease
    or access to new therapies
  • LFA Center for Clinical Trials
  • NIH (clinicaltrials.gov)

21
LFA Research Program
  • Cognitive dysfunction in lupus
  • Role of autoreactive B-cells
  • Effects of inhibiting Type I interferon
  • Genetic factors related to lupus in males
  • Cardiovascular disease and lupus

22
What does the future hold?Prognosis
  • Lupus ranges from mild to life threatening
  • Majority of patients can look forward to a normal
    life span
  • Deaths from lupus are uncommon
  • ACR recommends follow-up approximately every 3
    months

23
What does the future hold? Research
  • Basic researchscientists are attempting to
    develop or refine theories of how the body works
    and how the immune system functions.
  • Clinical trialsscientists are using human
    subjects to test new therapies and to expand our
    understanding of different aspects of lupus.

24
Community Agencies and Resources
  • Health, social service, mental health agencies
  • Local lupus chapters
  • Local lupus support groups
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