Salma with facial rash

Description

Mind Map on Salma with facial rash, created by Alya Almualla on 18/03/2019.
Alya Almualla
Mind Map by Alya Almualla, updated more than 1 year ago
Alya Almualla
Created by Alya Almualla over 5 years ago
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Resource summary

Salma with facial rash
  1. Due to
    1. Systemic Lupus Erythematosus
      1. Epidemiology
        1. Prevalence and incidence
          1. More in black than white
            1. More in women than men
              1. More in Hispanics
                1. More in Indians/Alaska Natives
                2. US
                  1. Prevalence is 20-150/100,000 people
                    1. White women "Prevalence is 164/100,000 people"
                      1. African American women "Prevalence is 406/100,000 people"
                      2. In Europe & North America "Prevalence is 24/100,000 people"
                        1. In North America, South America, Europe, & Asia "Incidence is 1-25/100,000 people"
                          1. UAE "2012"
                            1. Incidence was 2.1/100,000 people
                              1. Prevalence was 103/100,000 people
                              2. Death rates
                                  1. Connective Tissue Disorder
                                    1. Rheumatoid arthritis
                                      1. Symmetric joint involvement
                                        1. Joints of the hands, feet, wrists, elbows, knees and ankles
                                        2. Morning stiffness lasting > 1 hour
                                          1. Women (30 - 60 years)
                                          2. Sjögren's syndrome
                                            1. Destruction of the salivary and lacrimal glands
                                              1. Women (40 to 60 years)
                                                1. Type 4 hypersensitivity
                                                2. Scleroderma \ Systemic sclerosis
                                                  1. Fibroblast activation and excess collagen deposition
                                                  2. Polymyositis
                                                    1. Progressive symmetric proximal muscle weakness
                                                    2. Dermatomyositis
                                                      1. Gottron’s sign
                                                        1. Symmetric erythematous eruption over knuckles
                                                        2. Heliotrope rash
                                                          1. Reddish eruption on upper eyelids
                                                          2. Shawl sign
                                                            1. Erythematous rash over neck, upper chest and shoulders
                                                          3. Mixed connective tissue disease
                                                            1. Autoimmune mediated tissue damage with mixed features of SLE, scleroderma, polymyositis
                                                            2. Psoriatic arthritis
                                                              1. Joint inflammation in patients with psoriasis
                                                                1. HLA-B27 & environmental factors
                                                              2. Risk factors
                                                                1. Gender "Women"
                                                                  1. Age "15 - 44"
                                                                    1. Race or ethnicity
                                                                      1. Family history "5% - 13% chance"
                                                                        1. Genetic factors
                                                                        2. Pathogenesis
                                                                          1. Failure to maintain self-tolerance
                                                                            1. Tissue injury due to immune complex deposition
                                                                              1. Autoantibodies "Type II hypersensitivity"
                                                                                1. Immunofluorescence "IgG"
                                                                                  1. Deposits of immunoglobulin
                                                                                    1. Granular pattern "Kidney"
                                                                                    2. Differential Diagnosis
                                                                                      1. Adult-onset Still disease
                                                                                        1. Behcet syndrome
                                                                                          1. Chronic fatigue syndrome
                                                                                            1. Endocarditis
                                                                                              1. Fibromyalgia
                                                                                                1. HIV infection
                                                                                                  1. Inflammatory bowel disease
                                                                                                    1. Lyme disease
                                                                                                          1. Reactive arthritis
                                                                                                              1. Sarcoidosis
                                                                                                                  1. Thyroid disease
                                                                                                                  2. Clinical manifestation
                                                                                                                    1. Tachypnea
                                                                                                                      1. Cough
                                                                                                                        1. Photosensitivity
                                                                                                                          1. Pleuritis/ Pleural effusion
                                                                                                                            1. Weight loss
                                                                                                                              1. Fatigue
                                                                                                                                1. Fever & Increase infection
                                                                                                                                  1. Arthritis
                                                                                                                                    1. Emotional lability
                                                                                                                                      1. Hematological disorder
                                                                                                                                        1. Neurologic disorder
                                                                                                                                          1. Raynaud’s phenomenon
                                                                                                                                            1. Pericarditis
                                                                                                                                              1. Vasculitis
                                                                                                                                                1. Rash
                                                                                                                                                  1. Erythematous
                                                                                                                                                    1. Butterfly
                                                                                                                                                    2. Lupus nephritis
                                                                                                                                                      1. Proteinuria
                                                                                                                                                        1. Hematuria
                                                                                                                                                      2. Types
                                                                                                                                                        1. Drug induced
                                                                                                                                                          1. Anti-histone antibodies
                                                                                                                                                            1. No involvement of kidney or brain
                                                                                                                                                              1. Sulfasalazine, Hydralazine, Isoniazid, Procainamide / Phenytoin, Statins
                                                                                                                                                                1. Symptoms: Arthralgia - myalgia - Fatigue - Serositis
                                                                                                                                                                2. Neonatal lupus
                                                                                                                                                                  1. In fetus with mothers that have
                                                                                                                                                                    1. Anti Ro\SSA - anti La\SSB - anti U1RNP
                                                                                                                                                                    2. Placental transmission of maternal IgG abs
                                                                                                                                                                      1. Rash resembling Subcutaneous cutaneous lupus erythematosus
                                                                                                                                                                      2. Cutaneous lupus
                                                                                                                                                                        1. Acute
                                                                                                                                                                          1. Butterfly rash
                                                                                                                                                                          2. Subacute
                                                                                                                                                                            1. Annular or psoriasiform plaques
                                                                                                                                                                            2. Chronic
                                                                                                                                                                              1. Related to photosensitivity
                                                                                                                                                                              2. Chronic Discoid Lupus Erythematosus
                                                                                                                                                                                1. Red inflamed, coin-shaped patches of skin with a scaling and crusty appearance
                                                                                                                                                                                  1. ANA
                                                                                                                                                                                2. Investigations
                                                                                                                                                                                  1. CBC & differential
                                                                                                                                                                                    1. Activated PTT
                                                                                                                                                                                      1. BUN & electrolytes
                                                                                                                                                                                        1. ESR & CRP
                                                                                                                                                                                          1. Antinuclear antibodies, (ds) DNA, smith antigen
                                                                                                                                                                                            1. Urinalysis
                                                                                                                                                                                              1. Chest x-ray
                                                                                                                                                                                                1. ECG
                                                                                                                                                                                                  1. C3, C4, CH50
                                                                                                                                                                                                    1. Anti-ro & anti-La abs
                                                                                                                                                                                                      1. Thyroglobulin abs & Thyroid peroxidase abs
                                                                                                                                                                                                        1. IgG
                                                                                                                                                                                                          1. Management
                                                                                                                                                                                                            1. Immunosuppressants
                                                                                                                                                                                                              1. General Mechanisms of Action
                                                                                                                                                                                                                1. Mono- and polyclonal antibodies that block T-cell surface molecules
                                                                                                                                                                                                                    1. Antilymphocyte and antithymocyte Globulins
                                                                                                                                                                                                                      1. Basiliximab
                                                                                                                                                                                                                        1. Daclizumab
                                                                                                                                                                                                                          1. Belimumab (B-cells)
                                                                                                                                                                                                                            1. Rituximab (B-cells)
                                                                                                                                                                                                                          2. Interference with cytokine production or action
                                                                                                                                                                                                                            1. Disruption of cell metabolism, preventing lymphocyte proliferation
                                                                                                                                                                                                                            2. Corticosteroids
                                                                                                                                                                                                                              1. Mechanisms of action
                                                                                                                                                                                                                              2. Hydroxychloroquine
                                                                                                                                                                                                                                1. Decreases T-cell activation
                                                                                                                                                                                                                                2. Antibodies
                                                                                                                                                                                                                              3. Complications
                                                                                                                                                                                                                                1. Blood clots / Vasculitis
                                                                                                                                                                                                                                  1. Pericarditis / Heart attack
                                                                                                                                                                                                                                    1. Stroke / Memory changes / Behavioral changes / Seizures
                                                                                                                                                                                                                                      1. Pleuritis
                                                                                                                                                                                                                                        1. Kidney inflammation / Decreased kidney function / Kidney failure
                                                                                                                                                                                                                                          1. Pregnancy complications & miscarriage
                                                                                                                                                                                                                                          2. Prognosis
                                                                                                                                                                                                                                            1. Clinically unpredictable
                                                                                                                                                                                                                                              1. 5-year survival rate (90%)
                                                                                                                                                                                                                                                1. 10-year survival rate (80%)
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