Lupus

Question 1

What is Ankylosing spondylitis?
How does it present?
How is it managed?

Answer 1

Spinal inflammation resulting in spinal fusion and deformity
Tendinitis- enthesitis
Aortic regurgitation
Anterior uveitis- occular inflammation
Apical lung fibrosis
Management: physio, NSAIDS, anti-TNF alpha, anti-IL17

Question 2

What is SLE?
How does it present?

Answer 2

Autoimmune disease involving both innate and adaptive immune systems
Non erosive arthritis- bones dont degenerate
Achy joints
Raynaud’s phenomenon- WHITE: BLUE: RED
Malar rash
Photosensitive rash
RENAL DISEASE
Haemolytic anaemia
Lymphopenia

Question 3

What antibodies are involved in SLE?
What does one of them increase the risk of?

Answer 3

Anti-nuclear antibodies (ANA)- found in all patients of SLE but not specific
Antiphospholipid antibodies (APL)- some SLE patients will have. Associated with increased risk of thrombosis and miscarriage
Anti-dsDNA- specific for SLE
Anti-Sm antibodies

Question 4

How are the innate and adaptive immune systems disturbed in SLE?

Answer 4

Overactivity of type 1 interferon activity
Complement pathway abnormality
Auto reactive B and T cells

Question 5

What is the waste disposal hypothesis?

Answer 5

Apoptosis leads to translocation of nuclear antigens to membrane surface
Impaired clearance of apoptosis cells results in enhanced presentation of nuclear antigens to immune cells
B cell autoimmunity
Tissue damage via antibodies

Question 6

What are the investigations for SLE?
What can be seen in the investigations?

Answer 6

ESR and CRP- ESR will be high but CRP will be low
FBC
Urine protein- for renal failure
Anti-nuclear antibodies- anti-dsDNA, APL, ANA
Complement consumption- low C3 and C4

Question 7

What molecules will be low and high during an active phase of SLE?

Answer 7

Low C3
High dsDNA

Question 8

How is SLE managed?
What needs to be balanced?
What are steroid side effects?
What do you do if they have renal disease or apl +?

Answer 8

Balance of treating disease vs avoiding steroid harm
Steroid side effects: avascular necrosis, infection, osteoporosis
Hydroxychloroquine
Methotrexate
Renal disease: Rituximab
B cell therapies- Rituximab and Belimumab
If APL positive, give warfarin for anticoagulation

Question 9

How does SLE affect pregnancy and how should it be managed?

Answer 9

APL associated with miscarriage
Ro antibodies can cause fetal heartblock
Methotrexate can’t be given when conceiving or pregnant
Renal dysfunction will worsen