108 SLE and Vasculitides Tintinalli Chapter

108 SLE and Vasculitides Tintinalli Chapter Review

1. SLE and Vasculitides
PGI Cecilio Gabriel F. Magsino - Group 4B

2. SLE: Principles
•Mediated through organ inflammation and destruction
•Present in 20 to 70 per 100,000 general population
•Etiology has multiple factors
•Pathophysiology: Autoimmune reaction

3. SLE: Clinical Features
•Symptoms related to SLE that is not yet diagnosed
•Progression or acute deterioration due to known SLE
•Complications of immunosuppression of SLE
•Complaints of disease unrelated to SLE

4. SLE: Diagnostics
Laboratory Tests
•Serum creatinine, UA, CBC
•Immunologic assays:
•Antinuclear antibody
•Anti- DNA
•Anti-Smith (Sm) antibody
•aPL antibody

5. SLE: Diagnostics
Imaging
•Radiography
•Computed Tomography
•Echocardiography and Ultrasound
•Nuclear Imaging

6. SLE : Special Consideration
Antiphospholipid Syndrome
•Unfractionated or low–molecular-weight heparin
•Vitamin K antagonists

Drug-Induced Lupus
•Self-resolving illness
•The diagnosis is typically clinical
•Resolution of symptoms with withdrawal of medication
•NSAIDs or steroids for symptom control are indicated

7. SLE: Disposition
•Non life threatening → Discharge
•Poor insight into their disease, significant comorbidities, or weak
social or home supports → Hospitalization
•SLE flares, new thrombotic events, and infectious complications
due to immunosuppression → Initiation of systemic therapy
•Progressive circulatory or respiratory derangement → ICU

8. Vasculitides: Principles and Clinical Features

9. Vasculitis Presenting With Large-Vessel
Occlusive Symptoms
Giant Cell Arteritis: Temporal Arteritis
•Diagnostics: ESR, Temporal artery biopsy
•Management: High-dose corticosteroids


Takayasu’s Arteritis: pulseless disease or occlusive thromboaortopathy
•Diagnostics: Clinical assessment and imaging
•Management: Oral corticosteroids, steroid-sparing agents

10. Vasculitis Typified by Pulmonary-Renal
Manifestations
Wegener’s Granulomatosis
•Clinical presentation: Upper airway and lower respiratory symptoms
•Management: Corticosteroids and cyclophosphamide, dialysis and
transplant

Goodpasture’s Syndrome
•Clinical presentation: Upper airway and lower respiratory symptoms
•Management: High-dose methylprednisone and cyclophosphamide

11. Vasculitis Typified by Pulmonary-Renal
Manifestations
Microscopic Polyangitis
•Clinical presentation: Necrotizing glomerulonephritis
•Management: ABC, IV steroids, dialysis. High-dose glucocorticoid
and cyclophosphamide

Churg-Strauss Syndrome
•Clinical presentation: Pulmonary, lower urinary tract, cardiac
•Management: High-dose methylprednisone and cyclophosphamide

12. Vasculitis With Characteristic Cutaneous
Manifestations
Erythema Nodosum
•Erythematous, well-circumscribed, and
exquisitely tender
•Management: supportive and symptom
control

13. Vasculitis With Characteristic Cutaneous
Manifestations
Henoch-Schönlein Purpura
•Palpable purpura, arthralgia, abdominal
pain
•Management: Supportive and
symptomatic

14. Vasculitis With Characteristic Cutaneous
Manifestations
Polyarteritis Nodosa
•Palpable purpura, digital cyanosis, splinter hemorrhage, peripheral
neuropathy, mesenteric vasculitis
•Management: Corticosteroid and immunosuppressive agents

15. Vasculitis With Characteristic Cutaneous
Manifestations
Behçet’s Disease
•Triad: recurrent aphthous
ulcers, genital ulcers, uveitis
•Management: Steroids with
cyclophosphamide or
azathioprine

16. END
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