CTD- SLE

Question 1

What is SLE (2)

Answer 1

chronic autoimmune disease

It mainly involves the skin, joints, kidneys, blood cells, and nervous system but can affect almost any organ system.

Question 2

Pathogenesis (4)

Answer 2

Immune system attacks cells and tissues resulting in inflammation and tissue damage, also involves the formation of immune complexes

(type III hypersensitivity)

disregulation of normal immune process - increased cell death

immune complex formation

Question 3

Risk factors (6)

Answer 3

Women age 20-40- Higher prev (9:1)

Afro-Caribbean

Hispanic American

Asian

Chinese ethnicity

Smokers

Question 4

constitutional symptoms (3)

Answer 4

fever

fatigue

weight loss

Question 5

Musculoskeletal symptoms (5)

Answer 5

arthralgia

myalgia

inflammatory arthritis

Arthropathy is rarely erosive or deforming

increased prevalence of avascular necrosis which may relate to steroid use

Question 6

Muco-cutaneous (6)

Answer 6

malar rash

photosensitivity

discoid lupus

subacute cutaneous lupus

oral/nasal ulceration

Raynauds phenomenon.

Question 7

Renal symptoms

Answer 7

lupus nephritis

Question 8

Respiratory symptoms (6)

Answer 8

pleurisy

pleural effusion

pneumonitis

pulmonary embolism

pulmonary hypertension

interstitial lung disease.

Question 9

Haematological symptoms (4)

Answer 9

leukopenia

lymphopenia

anaemia (may be haemolytic)

thrombocytopenia

Question 10

Neuropsychiatric symptoms (4)

Answer 10

seizures

psychosis

headache

aseptic meningitis

Question 11

Cardiac symptoms (5)

Answer 11

pericarditis

pericardial effusion

pulmonary hypertension

sterile endocarditis

accelerated iscahemic heart disease.

Question 12

Gastrointestinal symptoms (3)

Answer 12

autoimmune hepatitis

pancreatitis

mesenteric vasculitis

Question 13

antibodies (6)

Answer 13

There is no one diagnostic - The following may be useful:

Anti-nuclear antibody - not specific

Anti-dsDNA antibody - specific and varies with disease activity

Anti-Sm - specific but low sensitivity

Anti Ro, anti-La and anti-RNP

Question 14

Imaging + bloods (6)

Answer 14

FBC may show anaemia, leucopenia and thrombocytopenia

C3/4 levels - low when disease active, especially renal disease

Urinalysis to look for evidence of glomerulonephritis

Imaging studies eg CT chest for interstitial lung disease

MRI brain for cerebral vasculitis

echo for pericardial effusion.

Question 15

Monitoring (4)

Answer 15

check
-anti-dsDNA antibodies

-complement levels regularly

-urinalysis for blood or protein- may indicate glomerulonephritis.

-BP and cholesterol