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Lupus 101 Lupus 101 An Educational Seminar An Educational Seminar


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

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

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

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
  • Other examples
  • Rheumatoid Arthritis
  • Sjogrens Syndrome
  • Multiple Sclerosis
  • Not Osteoarthritis, Fibromyalgia, Osteoporosis

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
  • Hormones (estrogen)
  • Environmental factors
  • Infections, stress, sunlight
  • Medications

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
  • Often affects women in childbearing years
  • Children, teenagers, men, and the elderly can
    develop lupus

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

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,

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

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

Systemic Lupus ErythematosusDiagnosis
  • List of 11 ACR criteria 4 of 11 required for
    the diagnosis
  • Seemingly unrelated parts of the body are
  • 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

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)

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

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

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

Treatment Living Better Lifestyle Modifications
  • Exercise alternate with rest periods
  • Ultraviolet light and flourescent light take
  • 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

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
  • Develop good doctor/patient relationship find a
    physician who listens be honest and responsive

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

Plaquenil (hydroxychloroquine)
  • Used to treat malaria, lupus, and inflammatory
  • 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

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

Clinical Trials
  • May be appropriate options for resistant disease
    or access to new therapies
  • LFA Center for Clinical Trials
  • NIH (

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

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

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.

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