Systemic Lupus Erythematous and Scleroderma Crest Syndrome Arodis

Systemic Lupus Erythematous and Scleroderma (Crest Syndrome) Arodis Arias Michelle Enriquez Kimberly Goris

Systemic Lupus Erythematous

Systemic Lupus autoimmune disease. Causes immune system to make antibodies that attack the body’s healthy cells and tissues. Inflames: Symptoms include: ◦ ◦ ◦ ◦ ◦ Joints and muscle pain Tendons Skin Other connective tissues and organs like the heart Fatigue Malaise Hair loss Oral sores Butterfly rash

Lupus Symptom: Butterfly rash

Etiology Systemic Lupus Erythematous is unknown. Studies suggest it may be a combination of: ◦ Genetic factors ◦ Environmental factors, which may include: sunlight, (UV rays) ◦ Stress ◦ Viral ◦ Drug induced (methyldopa, procainamide, isoniazid, chlorpromazine, TNF-blocking drugs).

Types of Lupus Systemic Lupus - most common Cutaneous Lupus – “Discoid Lupus” Drug Induced: ◦ ◦ Apresoline Quinidine Isoniazid Dilantin occur in 5% of people with Lupus

Lupus Symptom: Hair Loss

Risk Factors Sex: female to male 10: 1 Age: 20 -45 Race: African American, Native America, Asian and Hispanic.

Treatment of Cutaneous SLE No cure. Goal of treatment is to control symptoms. Photo protection: avoid direct sun exposure. ◦ Sunscreens containing dioxide or zinc oxide.

Topical Corticosteroids Triamcinolone acetonide 0. 1% Clobetasol propionate 0. 05% Brand Name: Kenalog®, Oralone®, Pediaderm® MOA : decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increase capillary permeability, suppress the immune system by reducing activity and volume of the lymphatic system. Adverse effects: Frequency not defined. Drug Interaction: Avoid concomitant use with Aldesleukin. Contraindication: Hypersensitivity to triamcinolone or any component of the formulation; fungal, viral or bacterial infections of the mouth or throat. Effects on Dental Treatment: ulcerative esophagitis, perioral dermatitis, atrophy of the oral mucosa, burning and irritation.

Prednisone Oral Corticosteroids Brand name: Predni. SONE Intensol™ MOA : decrease inflammation. Inmunosuppresion, adrenal function suppresion at high doses. Adverse effects: Temporary effects and likely dose related adverse effects like osteoporosis and adrenal suppression. Drug Interaction: ◦ Avoid ethanol ◦ Prednisone interferes with calcium absorption. Limit caffeine ◦ St. John’s wart may decrease prednisone levels. Contraindications: Hypersensitivity to any component of the formulation; systemic fungal infections; administration of live attenuated vaccines with immunosuppressive doses of prednisone. Effects on Dental treatment: No significant effects or complications reported.

Topical Calciuneurin Inhibitors Tacrolimus (Protopic® 0. 1%) Pimercrolimus MOA: suppress cellular immunity. (Inhibits T-lymphocyte activation) Adverse effects: CNS: headache; Dermatologic: skin burning; Respiratory: increased cough; Cardiovascular: peripheral edema; Gastrointesntinal: diarrhea; Ocular: conjuctivitis. Drug Interaction: avoid use of Immunosuppresants and alcohol. Localized flushing (redness, warm sensation) may occur at applicationsite of topical following ethanol consumption. Contraindications: hypersensitivity Effects on Dental Treatment: No significant effects or complications reported.

Antimalarials Hydroxychloroquine (Plaquenil®) Aminoquinolone MOA: Interferes with digestive vacuole function within sensitive Adverse effects: Frequency not defined. Cardiovascular: Effects on Dental Treatment: no significant effects or malarial parasite. cardiomyopathy; CNS: ataxia, dizziness, emotional changes; Dermatologic: alopecia; Gastrointestinal: abdominal cramping, anorexia, diarrhea, nausea. complications reported.

Immunosuppressants Aza. THIOprine (Azasan®; Imuran®) Methotrexate (Rheumatrex®; Trexall®) Cyclophosphamide (Cytoxa) MOA: antagonizes purine metabolism and may inhibit synthesis of DNA, RNA and proteins; may also interfere with cellular metabolism and inhibit mitosis. Adverse effects: frequency not always defined; dependant upon dose, duration, indication, and concomitant therapy. Drug interactions: avoid conccomitant use with BCG; Febuxostat; Mercaptopurine. Contraindication: hypersensitivity to azathioprine or any component of the formulation. Effects on Dental Treatment: No significant effects or complications reported.

B-cell Suppresor Ri. TUXimab (Rituxan®) Belimumab (Benylsta®) MOA: Its an Ig. G 1 -lamba monoclonal antibody that prevents survival Adverse effects: Gastrointestinal: nausea; CNS: fever, insomnia, Effects on Dental Treatment: No significant effects or of B lymphocytes. Reduces the activity of B-cell mediatoted immunity and the autoimmune response. migrane, depression; Respiratory: bronchitis. complications reported.

NASAIDs MOA: Management of pain and swelling. Adverse effects: Cardiovascular: edema; CNS: dizziness; Dermatologic: rash; Endocrine: fluid retention. Drug interaction: May increase levels of Anticoagulants; Antiplatelet Agent; Bisphonate derivatives; Collagenase. Contraindication: associated with an increased risk of adverse cardiovascular thrombotic events, including fatal MI and stroke. Effects on Dental Treatment: Ibuprofen can interfere with the antiplatelet effect of low-dose aspirin (81 mg/day), diminishing the effectiveness of aspirin as used for cardioprotection and stroke prevention.

Scleroderma (Crest Syndrome)

A connective tissue disease that involves changes in the: ◦ ◦ Skin Blood vessels Muscles Internal organs An autoimmune disorder when the autoimmune system attacks and destroys healthy body tissues

Reynaud’s phenomenon

Sclerodactyly

Telangiectasia

Treatment

Medications Calcium channel blockers used for Reynaud’s phenomenon. Corticosteroids – Antiinflammatory NSAIDs ACE Inhibitors Methotrexate Immune suppressing medication Antineoplastic agaent MOA: Ultrasoft acting IV barbiturate anesthetic. Adverse effects: Frequency not defined. Drug Interaction: None known. Contraindication: Hypersensitivity to barbiturates (porphyria). Effects on Dental Treatment: No significant effects or complications reported.

Medications Cyclophosphamide continuation Antineoplastic agent MOA: Prevents cell division, and potent immunosuppressive. Adverse effects: Dermatologic: alopecia; may cause sterility; nausea, vomiting, anemia, headache, nasal congestion. Drug Interaction: Increased effect on Vitamin K antagonist. Contraindication: severely depressed bone marrow function. Effects on Dental Treatment: mucositis and stomatitis.

Dental Hygienist Role Obtain thorough medical history which include all the medications and side effects. Maintain patient on strict oral hygiene regimen and recalls. Recommend powered toothbrush to patient due to lack of dexterity on their hands. Advise patient to use Water. Pick to clean interproximally since the patient may not be able to maneuver the dental floss. Recommend patient to eat a healthy diet.

Questions 1. What does Lupus affect? 2. What type of medications are used? 3. What is the most significant symptom of Scleroderma? 4. What does Raynaud’s phenomenon affect?

Resources You have full text access to this Online. Open article. Arthritis & Rheumatism. Volume 62, Issue 12, Article first published online: 30 NOV 2010 http: //www. nlm. nih. gov/medlineplus/ency/article/000435. htm http: //www. medicinenet. com/systemic_lupus/page 5. htm#what_is_t he_treatment_for_systemic_lupus_erythematosus http: //emedicine. medscape. com/article/1064663 -treatment