SLE Sketchy

1.
1 - Autoimmune Disease: Overview & Systemic Lupus anti-Smith antibodies (Smith antigen: the core protein of
Erythematosus (SLE) small nuclear ribonucleoproteins [snRNPs]) (specific for SLE)
(an ANA)
1) Familiar hallway: 17) Terminals A & B (on duRO LAst battery):
autoimmunity (immune system inappropriately reacting to anti-Ro (SSA) and anti-La (SSB) antibodies (more common
self-antigens) in Sjogren’s Syndrome) (an ANA)
18) "U" car logo & "Runs on Natural Petroleum" sticker:
Triggers SLE mayƒ present with anti-U1 RNP antibodies (more
2) High School of Los Angeles: common in mixed connective tissue disease) (an ANA)
some Human Leukocyte Antigen (HLA) alleles confer 19) "Don’t do DRUGS, you’ll be HISTORY":
genetic susceptibility for autoimmune diseases (includes DRUG-induced lupus may present with anti-HISTONE
HLA-B27 [a MHC Class I allele] and HLA-DR & HLA-DQ antibodies (highly specific) (an ANA)
[MHC Class II alleles]) 20) Tired & wrapped joints:
3) Locker TRIGGERing mockery: DRUG-induced lupus presents with arthralgias [painful joints]
environmental triggers for autoimmune diseases and fatigue (no involvement of skin, kidneys, or CNS)
4) Bacterial & viral ribbons: 21) Eating red circular meat with antibody fork:
infections (viral or bacterial) can trigger autoimmunity antibodies against RBCs
(foreign antigens incite immune system to react against self- 22) Pale kid:
antigens) autoimmune hemolytic anemia (due to antibodies directed
5) Mimicking mirror: against RBCs)
infections may trigger autoimmunity via MOLECULAR 23) Plate with antibody fork:
MIMICRY (viruses or bacteria present antigens that are antibodies against platele
similar to self-antigens → immune system targets self [in 24) Broken plates:
addition to virus/bacteria]) (M protein in Strep pyogenes → immune thrombocytopenia (due to antibodies directed against
rheumatic heart disease) platelets)
6) Mortar & pestle decal: 25) Antibody fork on "white squire" school logo:
drugs can trigger autoimmunity (procainamide, hydralazine, antibodies against lymphocytes
isoniazid [drug-induced lupus]) 26) Torn squire mascot:
7) Toxin decal: decreased lymphocyte count (specifically decreased
toxins can trigger autoimmunity (cigarette smoke → regulatory T cells) (due to antibodies against lymphocytes)
rheumatoid arthritis) 27) Antibody earrings paired with phospholipid necklace:
8) Exposing secret diary: antiphospholipid antibodies → causes antiphospholipid
autoimmunity can be triggered by release of normally syndrome
SEQUESTERED antigens → immune system views “new” 28) Overflowing thrombotic trash:
antigen as foreign → immune response (example: intracellular antiphospholipid syndrome is characterized by a
antigens exposed as result of cell damage) hypercoagulable state (increased risk of blood clots &
9) Teen wolf girl: pregnancy loss)
multisystem autoimmune disease (most commonly presents in 29) Sports COMPLEX with inflammatory torch & 3 pillars:
young women [age 20s-30s]) in SLE, ANAs bind their antigens to form antigen-antibody
10) "DR Q": immune COMPLEXES → deposit throughout body →
HLA-DR and HLA-DQ alleles (encode for MHC Class II inflammatory response in the affected tissue (type 3
molecules) increase susceptibility to SLE hypersensitivity reaction)
11) Female bathroom: 30) "High five":
estrogens may contribute to the development (by stimulating in SLE, antigen-antibody immune complexes activate the
the cell-mediated immunity) (explains increased incidence in classical COMPLEMENT pathway → activate secretion of
females) inflammatory molecules → tissue injury
31) Torn "3-4 PM" poster:
Antibodies and Immune cells active SLE presents with decreased C3 and C4 (due to
12) AUTO-shop: consumption of complement proteins)
formation of auto-antibodies is crucial for pathogenesis
13) Antibody clamps on car nucleus: Symptoms
SLE presents with anti-nuclear antibodies (ANAs) (directed 32) Falling thin kid with flame bandana:
against antigens that are normally sequestered in cell nucleus) constitutional symptoms (fatigue, fever, weight loss)
14) Double-stranded cables on antibody clamps: 33) Glomerular bendy straw:
SLE frequently presents with anti-double stranded DNA glomerulonephritis (deposition of immune complexes within
antibodies (specific for SLE) (an ANA) glomeruli → inflammation → proliferation of endothelial,
15) "Always be SPECIFIC": mesangial, or epithelial cells) (presents with oliguria,
anti-double stranded DNA antibodies are highly specific for hematuria, hypertension, RBC casts in urine)
SLE
16) Mr Smith:
34) Butterfly-patterned rouge:
SLE can present with a malar rash (“butterfly” distribution)
(acute cutaneous lupus erythematosus) (may present months or
years before systemic symptoms)
35) Discoid red sunglasses:
a discoid rash (round scaly erythematous plaques and
follicular plugging) (chronic cutaneous lupus erythematosus)
36) Standing near UV window:
SLE-associated skin rashes are exacerbated by UV light
(“photosensitivity”)
37) Drippy skull pattern between upper and lower shirt:
in SLE, affected skin displays liquefactive degeneration and
edema at the dermoepidermal junction
38) Glowing green skulls:
in SLE, immunofluorescence of affected skin reveals
deposition of Ig and complement at dermoepidermal junction
39) Migrating athlete with wrapped hands and knees:
SLE commonly presents with arthritis (migratory symmetrical
polyarthritis) affecting hands and knees
40) Small torn fibers:
SLE can present with vasculitis (due to immune complex
deposition in blood vessels) most commonly involving
cutaneous small vessels
41) Palpating small purple bite marks:
cutaneous small vessel vasculitis presents with palpable
purpura
42) Fingerless gloves with black nail polish:
SLE can present with Raynaud phenomenon (cold temperature
→ vasospasm → pale cyanotic digits)
43) Inflamed pack lining:
SLE can present with pericarditis (due to immune complex
deposition within the pericardium)
44) Shark-tooth necklace:
pericarditis presents with sharp precordial chest pain
(worsened with inspiration, relieved by leaning forward)
45) Lunch Sack:
SLE can present with Libman-Sacks endocarditis (sterile
verrucous endocarditis) (aggregations of immune complexes,
leukocytes, and thrombi)
46) 2-cusped plastic bag:
Libman-Sacks endocarditis most commonly affects the
MITRAL valve

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