Lupus

Question 1

What is lupus?

Answer 1

A relapsing and remitting multisystem autoimmune disease

Question 2

Outline the immunopathology of lupus.

Answer 2

Deposition of immune complex within small vessels activates complement, attracts inflammatory cells and causes tissue damage

Question 3

In what groups of patient is lupus most common?

Answer 3

Women, Afro-Carribean, Asian, Hispanic

Question 4

Name three possible triggers for lupus.

Answer 4

Hormonal changes e.g. menarche
EBV
Drug-induced
Silica dust

Question 5

What non-specific symptoms are seen in lupus?

Answer 5

Myalgia, malaise, fatigue, fever, weight loss

Question 6

For each system give possible manifestations of lupus:

a) skin
b) MSK
c) respiratory
d) cardiac
e) renal
f) neuro

Answer 6

a) discoid lupus, malar rash, photosensitivity, alopecia, oral ulcers
b) arthritis/arthralgia, muscle pain/weakness, Raynaud’s, deforming arthropathy
c) pleurisy, fibrosis, PHT, effusion, infection
d) Libman-Sacks endocarditis, pericarditis, cardiomyopathy
e) glomerulonephritis, hypertension
f) TIA/stroke, depression, headaches, cranial or peripheral neuropathy

Question 7

What are the a) ESR and b) FBC likely to show in lupus?

Answer 7

a) elevated b) thrombocytopenia, leukopenia, anaemia

Question 8

What is the most specific lupus antibody?

Answer 8

Anti-Sm (only 30-40% sensitive)

Question 9

What is the most sensitive lupus antibody?

Answer 9

ANA (but not specific)

Question 10

Why is anti-dsDNA useful?

Answer 10

Highly specific and levels correlate with flare. Around 60% sensitive

Question 11

How is SLE monitored?

Answer 11

C3/C4
anti-dsDNA
ESR

Question 12

How is low-level (i.e. no major organ involvement) SLE managed?

Answer 12

General- analgesia, lifestyle advice
Hydroxychloroquine
Low-dose prednisolone

Question 13

What treatment options are there for more advanced disease?

Answer 13

Methotrexate
Azathioprine
Cyclophosphamide
Mycophenolate
Biologics