4.3 SLE clinical pathology Flashcards
what is the gene thought to be involved in SLE?
HLADR3
What are the clinical criteria for SLE?
Acute cutaneous lupus Chronic cutaneous lupus Oral or nasal ulcers Non scarring alopecia Arthritis Serositis Renal Neurologic Haemolytic anaemia Leukopenia Thrombocytopenia
What are the immunologic criteria for SLE?
ANA Anti-DNA Anti-Sm Antiphospholipid Ab Low complement Direct coombs test
What do you need for a diagnosis of SLE?
4 or more criteria with at least one each of clinical and immunological
What is the charateristic rash for acute cutaneous lupus?
Malar butterfly rash - erythema and malar distribution over cheeks and bridge of nose sparing nasolabial folds - occurs after UV exposure
What would you see on skin biopsy in acute cutaneous lupus?
basal layer vacuolation, follicular plugging, mucin-dermal deposition
Immunofluroscence may detect immunoglobulin and complement at the dermo-epidermal junction
What is the presentation of chronic discoid lupus
discrete, erythematous plaques covered by a scale that extends into hair follicles - will have scarring alopecia
What is the typical pattern of SLE arthritis?
Migratory, usually gone after 24h
Usually finger PIPs, wrists and knees
Degree of pain exceeds objective physical findings
Rarely erosive on x-ray
Where do patients experience avascular necrosis?
Bilateral head of femur
What are SLE patients at higher risk for?
Osteonecrosis Osteoporosis Muscle disease Alopecia Arthritis/arthrialgia
What are the treatments for MSK aspects of SLE?
Analgesics - paracetamol NSAIDs Anti-malarials Tricyclic antidepressants Calcium and Vitamin D
What is the treatment for SLE?
hydrochloroquin
Methotrexate in moderately active disease with arthritis, pleural or pericardial serositis
Cyclophosphamide in severe disease with renal involvement
Azathioprine for steroid sparing effect
Mycophenolate for some renal disease
