1. Neonatal Lupus: 
- Ro/SSA and La/SSB are IgGs and can cross placenta and cause neonatal lupus - can manifest as cutaneous rash or as complete heart block
2. Lupus Prognosis: 
- Early deaths (<5 years - disease more active at onset) tend to be due to disease or complications of surgery.
- Late deaths (>8 years) due to premature cardiovascular disease or thrombotic events - Patients age 35-44 have 50x increased risk for CAD
- Survival at 5 years - 93%
3. Lupus antibodies: 
- ANA - 95% positive
- Anti-Smith: 20-40%, higher in african american women. Specific.
- Anti dsDNA - 60%. Specific.
- Depleted C3 and C4 - 50% ; not as specific, reflects only immune deposition disease.
 4. Lupus genetics: 
- 30-50% concordance among monozygotic twins
- 5% risk in first degree relatives (50x higher than population)
5. Lupus pathophys: 
- Immune complexes against nuclear antigens (RNP and DNA)
- Immune complexes (IC) deposit in small vessels, stimulate dendritic cells to create pro-inflammatory state
- IC cause platelet activation -> microthrombi, complement activation
- IC attract immune cells that then attack the vessels and cause small vessel vasculitis.
6. Lupus etiology:
- Increased basal IFN-a, increased apoptotic debris (decreased clearance)
- Exposed to dendritic cells, activate toll like receptors (innate immune) particularly TLR7 and TLR9, which increases IFN-a and cytokines, activates adaptive immune system (T and B cells), make antibodies against the apoptotic debris
7. Lupus treatments: 
- Hydroxychloroquine: inhibits toll-like receptor signaling via effects of endosomal pH. Bread and butter of treatment. Very good for skin lupus.
- Steroids: suppress lymphocytes, complement, reduces cytokines; effective but morbid (osteoporosis, DM, obesity, HTN)
- Steroid-sparing immunosuppressants: azothiaprine
- Cytotoxic agents for severe disease.
8. Targeted lupus treatments: 
- B-cell targets: rituximab, belimumbab (anti-BLyS, a b-cell growth factor), epratuzumab
- T-cell targets: abatacept
- Anti-cytokines blocking IFN-a and IL-6
9. Drugs/Toxins that worsen gout:
- diuretics, aspirin, high fructose corn syrup, cyclosporine, pyrazinamide, ethambutol, lead
10. Modifiable risk factors for gout:
- HTN, hyperlipidemia