1. LUPUS IN MEN

2. SLE: IMMUNOLOGIC FACTORS HALLMARK: POLYCLONAL IMMUNE HYPERACTIVITY WITH INCREASED PRODUCTION OF ANTIBODIES AGAINST “SELF” CONSTITUENTS. INFLUENCES: GENETIC HORMONAL ENVIRONMENTAL

3. SLE CLASSIFICATION CRITERIA MALAR RASH: FIXED ERYTHEMA, FLAT OR RAISED,SPARING THE NASOLABIAL FOLDS DISCOID RASH: RAISED PATCHES, ADHERENT KERATOTIC SCALING, FOLLICULAR PLUGGING, OLDER LESIONS MAY CAUSE SCARRING PHOTOSENSITIVITY: RASH FROM SUNLIGHT

4. SLE CLASSIFICATION CRITERIA ORAL/NASOPHARYNGEAL ULCERS: USUALLY PAINLESS ARTHRITIS: NONEROSIVE, INFLAMMATORY, IN TWO OR MORE PERIPHERAL JOINTS SEROSITIS: PLEURITIS OR PERICARDITIS

5. SLE CLASSIFICATION CRITERIA RENAL DISORDER: PERSISTANT PROTEINURIA OR CELLULAR CASTS NEUROLOGIC DISORDER: SEIZURES OR PSYCHOSIS HEMATOLOGIC DISORDER: HEMOLYTIC ANEMIA, LEUKOPENIA, LYMPHOPENIA, OR THROMBOCYTOPENIA

6. SLE CLASSIFICATION CRITERIA IMMUNOLOGIC DISORDER: ANTI-DsDNA ANTIBODIES OR ANTI-Sm ANTIBODIES OR ANTI-PHOSPHOLIPID ANTIBODIES ANTINUCLEAR ANTIBODIES

7. DIAGNOSIS CLINICAL!!!!!!!!!!! (CONFIRMED BY LABS) FEATURES: I. EPISODIC DISEASE II. MULTISYSTEM DISEASE III. ANA PRESENT IV. AGE OF ONSET: ≥ 5 YEARS OLD

8. LUPUS IN MEN ETIOLOGY: SEX HORMONE DIFFERENCES ESTROGENS V.S. ANDROGENS INCIDENCE: FOR EVERY MALE WITH LUPUS, THERE ARE NINE FEMALES MAKING THE DIAGNOSIS…………DELAYED! WHY?

9. LUPUS IN MEN SYMPTOMS: DO THEY DIFFER? ARE THEY MORE SEVERE? SKIN: DISCOID PLEURISY HEMOLYTIC ANEMIA VASCULAR: RAYNAUDS, VASCULITIS OLDER ONSET?

10. LUPUS IN MEN TESTING: SIMILAR IN MALES, FEMALES WHAT IS THE ROLE OF AN ANA? RISKS FOR OTHER FAMILY MEMBERS IS THE DISEASE MONITORED DIFFERENTLY? ARE DIFFERENT DRUGS USED FOR MEN?

11. LUPUS IN MEN IS SEXUAL FUNCTION EFFECTED IN LUPUS MEN? ARE TESTOSTERONE LEVELS ALTERED? DO THE DRUGS ALTER THESE? WHAT IS THE PSYCHOLOGICAL IMPACT?

16. TREATMENT

17. FATIGUE COMMON!!!!!!!!!!!!! WIDE DIFFERENTIAL DIAGNOSIS: DISEASE ITSELF DEPRESSION, FIBROMYALGIA SLEEP DIFFICULTIES MEDICATIONS: STEROIDS, ALCOHOL, ANTI-HYPERTENSIVES WEAKNESS DECONDITIONING

18. RASHES CLASSIFY THE RASH! PHOTOSENSITIVITY: COVER UP! CLOTHES BLOCKERS LIFESTYLE STEROID CREAM INTRALESIONAL INJECTIONS PLAQUENIL DAPSONE, IMMUNOSUPPRESSIVES

19. TREATMENT OF MILD SLE ARTHRITIS: NSAIDS, PLAQUENIL CONSTITUTIONAL: LIFESTYLE MODIFICATION, PLAQUENIL ALOPECIA: PLAQUENIL, INTRALESIONAL STEROIDS RAYNAUDS: CONTROL OF ENVIRONMENT, VASODILATORS,

20. TREATMENT OF MODERATE-SEVERE SLE CORTICOSTEROIDS IMMUNOSUPPRESSIVES CYCLOPHOSPHAMIDE AZATHIOPRINE MYCOPHENOLATE MOFITIL

21. TREATMENT HYDROXYCHLOROQUINE SAFE SLOW ONSET OF ACTION GOOD FOR “MILD”DISEASE: SKIN, JOINTS, ALOPECIA, CONSTITUTIONAL SX. TOXICITIES: OCULAR, ALLERGIC RASHES, NAUSEA

22. STEROIDS VERY EFFECTIVE: ANTI-INFLAMMATORY IMMUNOSUPPRESSIVE FAST ONSET OF ACTION LASTING EFFECT MULTIPLE PREPARATIONS

23. IMMUNOSUPPRESSIVES CYCLOPHOSHAMIDE: CNS, RENAL DISEASE TOXICITIES: MALIGNANCIES, INFECTIONS, HEMATOLOGIC, CONSTITUTIONAL, GI, STERILITY MYCOPHENOLATE MOFITIL: CNS, RENAL, SEVERE SKIN TOXICITIES: GI, HEMATOLOGIC, INFECTIONS AZATHIOPRINE: CNS, RENAL, SEVERE SKIN TOXICITIES: GI, HEMATOLOGIC, INFECTIONS

24. BELIMUMAB FIRST DRUG APPROVED IN 50 YEARS TO TREAT SLE MECHANISM OF ACTION: MONOCLONAL ANTIBODY INHIBITS BIOLOGICAL ACTIVITY OF B LYMPHOCYTE STIMULATOR (BLyS) 2 STUDIES (BLISS 52,76): DECREASED DISEASE ACTIVITY, NOT “ORGAN-SPECIFIC”

25. IMPROVED PROGNOSIS EARLIER DIAGNOSIS BETTER KNOWLEDGE OF THE DISEASE IMROVED LABORATORY IMPROVED/MORE RATIONAL APPROACH TO RX: STEROIDS IMMUNOSUPPRESSIVES ANTI-HYPERTENSIVES

26. LUPUS IN MEN QUESTIONS?