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Get Into the Loop – Learn About Lupus Irene Blanco, MD, MS October 28, 2010 Cherkasky Auditorium, Montefiore Medical Center.

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Presentation on theme: "Get Into the Loop – Learn About Lupus Irene Blanco, MD, MS October 28, 2010 Cherkasky Auditorium, Montefiore Medical Center."— Presentation transcript:

1 Get Into the Loop – Learn About Lupus Irene Blanco, MD, MS October 28, 2010 Cherkasky Auditorium, Montefiore Medical Center

2 Agenda Introduction to Lupus Lupus and Your Heart – Dr. Mario Garcia Question & Answer Session

3 What is Lupus? Autoimmune disease: Excessive immune system activation Loss of tolerance of immune system to one’s body Certain genes are more likely to occur in patients with lupus Many of these genes encode components of the immune system. Abnormal estrogen metabolism In animal studies estrogen worsens disease activity and causes early mortality

4 Who Gets Lupus? Female:Male ratio of 9:1 during childbearing years Closer to 2:1 during childhood and after menopause, suggesting hormonal influence Disease in males is can be more severe 70% of SLE: females between ages % present age >60

5 Who Gets Lupus? Highest occurrence is in Afro-Caribbean females 1:250 African American to Caucasian ratio 3:1 Child of SLE mother - risk of SLE 1:15 (7%) 10-15% of SLE patients have 1 st degree relative with SLE

6 Mortality 90% survive 5 years, 80% 10 years Renal disease causes worse prognosis African Americans have more aggressive and treatment resistant disease Two different causes of death: – Early: disease activity and infections – Late: cardiovascular disease, disease activity, end stage renal disease, and thromboembolic

7 Criteria for the Diagnosis of SLE Malar (Butterfly) Rash Discoid Rash Sensitivity rash to the sun (Photosensitivity) Ulcers in the nose and mouth Arthritis Fluid around the heart, lungs and in the abdomen Lupus kidney disease Neurologic Disorders: – Stroke, inflammation, depression, memory dysfunction, etc… Anemia, low platelets and low white blood cell count Abnormal blood antibody levels ANA blood test

8 Malar (Butterfly) Rash Fixed red, flat or raised, over the bridge of the nose and cheeks Tends to spare the nasolabial folds

9 Discoid Rash Red raised patches with scaling, skin follicle plugging Can be very scarring Singer Seal afflicted with discoid lupus at age 23

10 Photosensitivity Skin rash as a result of unusual reaction to sunlight, by patient history or physician observation

11 Oral and Nasal Ulcers Oral or nasopharyngeal ulcers, usually painless

12 Hair Thinning

13 Arthritis Non-erosive arthritis involving two or more joints, characterized by pain, swelling, or fluid collections 80% of patients have it Can move deformed fingers back into position Pain may be out of proportion with appearance

14 Severe or Life Threatening Complications

15 Treatment of SLE Active Treatment Topical Steroids NSAIDs Advil, Mobic, Naproxen Antimalarials Plaquenil Steroids Prednisone, Medrol Cytotoxics/Biologics Cellcept, Cytoxan, Imuran, Benlysta Preventative Treatment Sunscreen At least SPF 30 Calcium, Vitamin D, Folate supplements To help prevent SE from other medications Influenza Vaccine Pneumococcal Vaccine

16 Side Effects to Lupus Medications Weight gain Hair loss, or new hair growth in unwanted places Damage to the bones Osteoporosis and Osteonecrosis High blood pressure High cholesterol Low immune system and infections

17 Follow Up Visits How often depends on: – Lupus activity, severity, response to treatment, type of treatment, need for monitoring of medication side effects At routine visits, blood and urine tests and should be checked Even in patients with previously normal values Patients with known kidney disease should also have urine checked every 8 weeks or so


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